Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Dermatologic Manifestations of Mycetoma Follow-up

  • Author: Oliverio Welsh, MD(DrSc); Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jul 26, 2013
 

Prognosis

Actinomycetomas generally respond well to trimethoprim-sulfamethoxazole/amikacin (see Medication) in 90% of cases. In those cases in which bacteria have become resistant to this treatment, antibiotic susceptibility testing should be performed to select the best antimicrobial agent or agents to be used.

Eumycetoma tends to be a more chronic disease, and success with medical therapy is observed in only about 40% of cases. If the response is partial or negative to medical treatment, surgery of the affected area should be performed, and antifungal drugs continued until complete remission of the disease.

 
Contributor Information and Disclosures
Author

Oliverio Welsh, MD(DrSc) Former Chair, Active Emeritus Professor, Department of Dermatology, Universidad Autónoma De Nuevo León, Mexico

Oliverio Welsh, MD(DrSc) is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Lucio Vera-Cabrera, PhD Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario, UANL, Mexico

Lucio Vera-Cabrera, PhD is a member of the following medical societies: American Society for Microbiology

Disclosure: Nothing to disclose.

Mario C Salinas-Carmona, MD, PhD Chair, Department of Immunology, Universidad Autónoma De Nuevo León, Mexico

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Susan M Swetter, MD Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, American Society of Clinical Oncology, Society for Melanoma Research, Eastern Cooperative Oncology Group, American Medical Association, Pacific Dermatologic Association, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

References
  1. Welsh O, Vera-Cabrera L, Salinas-Carmona MC. Mycetoma. Clin Dermatol. 2007 Mar-Apr. 25(2):195-202. [Medline].

  2. Pinoy E. Actinomycoses et mycetomas. Bull Inst Pasteur. 1913. 11:929-38.

  3. Solis-Soto JM, Quintanilla-Rodriguez LE, Meester I, et al. In situ detection and distribution of inflammatory cytokines during the course of infection with Nocardia brasiliensis. Histol Histopathol. 2008 May. 23(5):573-81. [Medline].

  4. Salinas-Carmona MC, Welsh O, Casillas SM. Enzyme-linked immunosorbent assay for serological diagnosis of Nocardia brasiliensis and clinical correlation with mycetoma infections. J Clin Microbiol. 1993 Nov. 31(11):2901-6. [Medline].

  5. Salinas-Carmona MC, Perez-Rivera I. Humoral immunity through immunoglobulin M protects mice from an experimental actinomycetoma infection by Nocardia brasiliensis. Infect Immun. 2004 Oct. 72(10):5597-604. [Medline].

  6. Salinas-Carmona MC, Rosas-Taraco AG, Welsh O. Systemic increased immune response to Nocardia brasiliensis co-exists with local immunosuppressive microenvironment. Antonie Van Leeuwenhoek. 2012 Oct. 102(3):473-80. [Medline].

  7. Lopez Martinez R, Mendez Tovar LJ, Lavalle P, Welsh O, Saul A, Macotela Ruiz E. [Epidemiology of mycetoma in Mexico: study of 2105 cases]. Gac Med Mex. 1992 Jul-Aug. 128(4):477-81. [Medline].

  8. van de Sande WW, Fahal A, Verbrugh H, van Belkum A. Polymorphisms in genes involved in innate immunity predispose toward mycetoma susceptibility. J Immunol. 2007 Sep 1. 179(5):3065-74. [Medline].

  9. Kresch-Tronik NS, Carrillo-Casas EM, Arenas R, Atoche C, Del Río-Ávila C, Ochoa-Carrera LA. First case of mycetoma associated with Nocardia takedensis. J Dermatol. 2013 Feb. 40(2):135-6. [Medline].

  10. Kresch-Tronik NS, Carrillo-Casas EM, Arenas R, Atoche C, Ochoa-Carrera LA, Xicohtencatl-Cortes J. Nocardia harenae, an uncommon causative organism of mycetoma: report on two patients. J Med Microbiol. 2012 Aug. 61(Pt 8):1153-5. [Medline].

  11. Kashima M, Kano R, Mikami Y, et al. A successfully treated case of mycetoma due to Nocardia veterana. Br J Dermatol. 2005 Jun. 152(6):1349-52. [Medline].

  12. Rodriguez-Nava V, Couble A, Molinard C, Sandoval H, Boiron P, Laurent F. Nocardia mexicana sp. nov., a new pathogen isolated from human mycetomas. J Clin Microbiol. 2004 Oct. 42(10):4530-5. [Medline].

  13. Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ Jr. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev. 2006 Apr. 19(2):259-82. [Medline].

  14. Desnos-Ollivier M, Bretagne S, Dromer F, Lortholary O, Dannaoui E. Molecular identification of black-grain mycetoma agents. J Clin Microbiol. 2006 Oct. 44(10):3517-23. [Medline].

  15. Vera-Cabrera L, Ortiz-Lopez R, Elizondo-Gonzalez R, Perez-Maya AA, Ocampo-Candiani J. Complete genome sequence of Nocardia brasiliensis HUJEG-1. J Bacteriol. 2012 May. 194(10):2761-2. [Medline]. [Full Text].

  16. Vera-Cabrera L, Campos-Rivera MP, Gonzalez-Martinez NA, Ocampo-Candiani J, Cole ST. In vitro activities of the new antitubercular agents PA-824 and BTZ043 against Nocardia brasiliensis. Antimicrob Agents Chemother. 2012 Jul. 56(7):3984-5. [Medline].

  17. Espinoza-González NA, Welsh O, Ocampo-Candiani J, Said-Fernandez S, Lozano-Garza G, Choi SH. Evaluation of the Combined Therapy of DA-7218, a New Oxazolidinone, and Trimethoprim/ Sulfamethoxazole in the Treatment of Experimental Actinomycetoma by Nocardia brasiliensis. Curr Drug Deliv. 2010 May 24. [Medline].

  18. Vera-Cabrera L, Salinas-Carmona MC, Welsh O, Rodriguez MA. Isolation and purification of two immunodominant antigens from Nocardia brasiliensis. J Clin Microbiol. 1992 May. 30(5):1183-8. [Medline].

  19. Lacroix C, de Kerviler E, Morel P, Derouin F, Feuilhade de Chavin M. Madurella mycetomatis mycetoma treated successfully with oral voriconazole. Br J Dermatol. 2005 May. 152(5):1067-8. [Medline].

  20. Negroni R, Tobon A, Bustamante B, Shikanai-Yasuda MA, Patino H, Restrepo A. Posaconazole treatment of refractory eumycetoma and chromoblastomycosis. Rev Inst Med Trop Sao Paulo. 2005 Nov-Dec. 47(6):339-46. [Medline].

  21. N'diaye B, Dieng MT, Perez A, Stockmeyer M, Bakshi R. Clinical efficacy and safety of oral terbinafine in fungal mycetoma. Int J Dermatol. 2006 Feb. 45(2):154-7. [Medline].

  22. Welsh O, Sauceda E, Gonzalez J, Ocampo J. Amikacin alone and in combination with trimethoprim-sulfamethoxazole in the treatment of actinomycotic mycetoma. J Am Acad Dermatol. 1987 Sep. 17(3):443-8. [Medline].

  23. Fuentes A, Arenas R, Reyes M, Fernandez RF, Zacarias R. [Actinomycetoma and Nocardia sp. Report of five cases treated with imipenem or imipenem plus amikacin]. Gac Med Mex. 2006 May-Jun. 142(3):247-52. [Medline].

  24. Welsh O, Vera-Cabrera L, Welsh E, Salinas MC. Actinomycetoma and advances in its treatment. Clin Dermatol. 2012 Jul. 30(4):372-81. [Medline].

  25. Vera-Cabrera L, Daw-Garza A, Said-Fernandez S, et al. Therapeutic Effect of a Novel Oxazolidinone, DA-7867, in BALB/c Mice Infected with Nocardia brasiliensis. PLoS Negl Trop Dis. 2008 Sep 10. 2(9):e289. [Medline].

  26. Chacon-Moreno BE, Welsh O, Cavazos-Rocha N, et al. Efficacy of ciprofloxacin and moxifloxacin against Nocardia brasiliensis in vitro and in an experimental model of actinomycetoma in BALB/c mice. Antimicrob Agents Chemother. 2009 Jan. 53(1):295-7. [Medline].

  27. Welsh O. Mycetoma. Current concepts in treatment. Int J Dermatol. 1991 Jun. 30(6):387-98. [Medline].

  28. Fahal AH. Management of mycetoma. Exp Rev Dermatol. 2010. 5:87-93.

  29. Hay RJ, Mahgoub ES, Leon G, al-Sogair S, Welsh O. Mycetoma. J Med Vet Mycol. 1992. 30 Suppl 1:41-9. [Medline].

  30. Mahgoub ES, Murray IG. Mycetoma. London, England: William Heinemann; 1973. 76-115.

  31. van de Sande WW, Janse DJ, Hira V, et al. Translationally controlled tumor protein from Madurella mycetomatis, a marker for tumorous mycetoma progression. J Immunol. 2006 Aug 1. 177(3):1997-2005. [Medline].

  32. Vera-Cabrera L, Gonzalez E, Rendon A, et al. In vitro activities of DA-7157 and DA-7218 against Mycobacterium tuberculosis and Nocardia brasiliensis. Antimicrob Agents Chemother. 2006 Sep. 50(9):3170-2. [Medline].

Previous
Next
 
Actinomycetoma of the foot (left) and arm (center) caused by Nocardia brasiliensis. Multiple nodules and fistulae are present. Microscopic examination of the pus (right). Granules are observed, which are multilobulated and surrounded by abundant clubs.
Eumycetoma. Mycetoma of the hand (left). Microscopic features of a Madurella mycetomatis grain are observed (center). Notice the presence of brownish hyphae and intercellular cement (hematoxylin and eosin stain). Macrocolony of another eumycotic agent, Scedosporium apiospermum (Pseudallescheria boydii) (right).
Table 1. Fungi Causing Mycetoma
White grainBlack grain
Acremonium falciformeExophiala jeanselmei
Acremonium kilienseMadurella grisea
Acremonium recifeiM mycetomatis
Cylindrocarpon destructansM pseudomycetomatis
Fusarium moniliformeLeptosphaeria tomkinsii
Fusarium solaniLeptosphaeria senegalensis
Neotestudina rosatiiPyrenochaeta mackinnonii
Pseudallescheria boydiiPyrenochaeta romeroi
----------------Phlenodomus avramii
Table 2. Microorganisms Causing Actinomycetomas in Humans
Etiologic agentGrain
A maduraeWhite, large, 1-5 mm in diameter
A pelletieriRed, hard, 1 mm in diameter
N brasiliensisWhite to yellow, multilobed, soft, < 0.5 mm in diameter
N asteroidesUncommon, white, soft, < 0.5 mm in diameter
Nocardia otitidiscaviarumWhite to yellow, lobed, < 0.5 mm in diameter
Nocardia transvalensisWhite to yellow, < 0.5 mm in diameter
Nocardia veterana[11] --
Nocardia mexicana[12] --
N harenae--
N takedensis--
Nocardiopsis dassonvilleiWhite to yellow, < 0.5 mm in diameter
S somaliensisYellow, hard, 2 mm in diameter
Streptomyces sudanensisYellow, hard, 2 mm in diameter
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.