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Chest X-ray showing multiple bilateral lungs patches with the differential diagnosis of secondaries, miliary tuberculosis, or mycetoma infiltrations.
Citations
... For mycetoma, however, prolonged administration of antifungal therapy (more than one year) and surgery is often necessary (Suleiman et al., 2016). Sometimes limb amputation is reported to avoid potential, but rare, fatal dissemination (Mohamed et al., 2016). Indeed, in our patient, despite optimally dosed antifungal treatment, surgery was needed and allowed remission. ...
We report a case of black-grain eumycetoma co-localized with Mycobacterium tuberculosis infection, presenting as a painless leg abscess and associated with vertebral tuberculosis. The rare association of these two pathogens raises several challenges regarding foreseeable drug interactions, side effects, the most appropriate management and the potential link between these two diseases.
... usually a localised subcutaneous mycosis which spreads locally along the fascial planes, thus affecting the skin, local deep structures, and bones. The spreading of the mycetoma agents via the local lymph nodes is rarely reported because few cases of blood-spread mycetoma have been reported (Box 1) [2,3]. Almost all of these rare cases of this form have been reported from Sudan, which can be considered as the most endemic country in the mycetoma belt [4]. ...
... However, since the first report by Fahal and colleagues [6] in Sudan in 1996, disseminated eumycetoma from a subcutaneous mycetoma has continued to be reported by the Mycetoma Research Centre (MRC) at the University of Khartoum in Sudan. In 2016, multiple mycetoma lung secondaries to a knee eumycetoma, such as our present case, and mycetoma pulmonary secondaries to a gluteal eumycetoma were reported by teams from the MRC [2,3]. Similarly, in 2017, they reported broncho-pleuro-cutaneous fistula and pneumothorax as rare challenging complications of chest wall eumycetoma [7]. ...
Mycetoma is a neglected tropical disease which is endemic in Senegal. Although this subcutaneous mycosis is most commonly found on the foot, extrapodal localisations have also been found, including on the leg, knee, thigh, hand, and arm. To our knowledge, no case of blood-spread eumycetoma has been reported in Senegal. Here, we report a case of pulmonary mycetoma secondary to a Madurella mycetomatis knee eumycetoma. The patient was a 41-year-old farmer living in Louga, Senegal, where the Sudano-Sahelian climate is characterised by a short and unstable rainy season and a steppe vegetation. He suffered a trauma to the right more than 20 years previously and had received treatment for more than 10 years with traditional medicine. He consulted at Le Dantec University Hospital in Dakar for treatment of a right knee mycetoma which had been diagnosed more than 10 years ago. He had experienced a chronic cough for more than a year; tuberculosis documentation was negative. Grains collected from the knee and the sputum isolated M . mycetomatis , confirmed by the rRNA gene ITS regions nucleotide sequence analysis. An amputation above the knee was performed, and antibacterial and antifungal therapy was started with amoxicillin-clavulanic acid and terbinafine. The patient died within a month of his discharge from hospital.
... Interestingly, eumycetoma at extrapedal sites is a rarity and the explanation for these observations is unclear. [11][12][13][14] M. mycetomatis causing head and neck eumycetoma as noted in this patient is also rare. The overwhelming predominance of this causative organism in central Sudan may provide a partial explanation. ...
Mycetoma is a chronic granulomatous disease that significant affects the subcutaneous tissue and deep structures. Mycetoma is caused by certain fungi (eumycetoma) or higher bacteria (actinomycetoma). The clinical presentation is variable and depends on the causative agent. For proper treatment and patient management, an accurate diagnosis of the species is mandatory. The disease mainly involves the extremities and it is rarely seen in the head and neck or other sites. In this communication, we present an interesting case of both invasive and aggressive mastoid bone eumycetoma caused by Madurella mycetomatis. Such cases are defied by complex challenges in finding effective surgical and medical treatments when the patient does not respond to both prolonged and different antifungal therapies.
... Constitutional symptoms are very rare in mycetoma patients but can be seen in those with prolonged durations of disease with secondary bacterial infection and sepsis. 8 These symptoms were noticed in some of our reported patients. In this 40 article we present a case series of four patients with infections due to different mycetoma agents with different clinical presentations and outcomes. ...
... Infrequently it spreads through the lymphatic system to induce a 270 regional mycetoma satellite and, rarely, via the bloodstream to affect other remote organs. [6][7][8] Lymphatic spread is more frequently seen among actinomycetoma patients than in eumycetoma patients, but the explanation is unclear. 6 However, the fact that actinomycetoma is more aggressive and inflammatory and 275 lacks a fibrous capsule around the lesion may contribute to the more frequent lymphatic spread. ...
... In this series, both eumycetoma and actinomycetoma were equally implicated, but the number of reported patients is small and hence it is difficult to draw conclusions about the mode of and reasons for spread. 280 Although superficial secondary inguinal mycetoma satellites are reported in the medical literature, 8 secondary inguinal lesions with deep abdominal invasion, as reported in this case series, are infrequent and their pathogenesis is unclear. Further immunological and genetic studies are needed to investigate this. ...
Mycetoma is a chronic subcutaneous granulomatous disease of the soft tissue and extremities. Herein we report four cases of mycetoma caused by different agents, two caused by Madurella mycetomatis, with Actinomadura madurae and Streptomyces somaliensis affecting the others. These lesions originated at different sites but eventually spread to the inguinal region. The exact mechanism for such spread is still unknown and the clinical presentation of our case series was distinctive and required intensive follow-up for appropriate management.
... Les localisations secondaires pulmonaires des mycétomes fongiques pulmonaires sont rarement décrites. Nous avons retrouvé trois cas dans la littérature [2,6,7]. Il s'agit de mycétomes secondaires à des localisations périphériques aux membres inférieurs (genou et cuisse) [6,7] et au flanc droit [2]. ...
... Nous avons retrouvé trois cas dans la littérature [2,6,7]. Il s'agit de mycétomes secondaires à des localisations périphériques aux membres inférieurs (genou et cuisse) [6,7] et au flanc droit [2]. Elles posent le problème du mode de dissémination des grains. ...
... Le décès de notre patient nous a été rapporté par sa famille, comme c'est le cas dans les observations isolées de mycétomes pulmonaires [6,7]. Ces décès sont souvent liés à l'altération de l'état général, au déficit immunitaire, aux difficultés respiratoires, mais également à la surinfection bactérienne chronique aboutissant à un tableau de septicémie. ...
Mycetoma is transmitted by thorns infected. The commonest site for mycetoma is the foot. The primary pulmonary are rare and usually secondary to other primary site. We report a case of pulmonary fungal mycetoma secondary to primary site in the knee. We do a review of the literature and we discuss the way of dissemination.
... Les localisations secondaires pulmonaires des mycétomes fongiques pulmonaires sont rarement décrites. Nous avons retrouvé trois cas dans la littérature [2,6,7]. Il s'agit de mycétomes secondaires à des localisations périphériques aux membres inférieurs (genou et cuisse) [6,7] et au flanc droit [2]. ...
... Nous avons retrouvé trois cas dans la littérature [2,6,7]. Il s'agit de mycétomes secondaires à des localisations périphériques aux membres inférieurs (genou et cuisse) [6,7] et au flanc droit [2]. Elles posent le problème du mode de dissémination des grains. ...
... Le décès de notre patient nous a été rapporté par sa famille, comme c'est le cas dans les observations isolées de mycétomes pulmonaires [6,7]. Ces décès sont souvent liés à l'altération de l'état général, au déficit immunitaire, aux difficultés respiratoires, mais également à la surinfection bactérienne chronique aboutissant à un tableau de septicémie. ...
... Although mycetoma is primarily a localised disease of gradual onset and slow progress, some patients present with massive, aggressive, uncontrolled disease and most of these are fatal. In these patients, the disease progressed wildly and aggressively from the subcutaneous tissue to involve the deep organs such as the urinary bladder, pelvic organs, spinal cord, lung and other structures and resulted in fatal outcome [53][54][55][56]. ...
... In these patients, Madurella mycetomatis had progressed widely without response to the different medical and surgical treatment modalities. Vascular spread, which is a rare phenomenon in mycetoma, may explain the secondary lung lesions encountered in these patients [52,[54][55][56]. ...
... In these cases, the urinary bladder, rectum, hip bones and other local structures were involved. The disease was complicated by multiple urinary and rectal fistulae, pathological fractures and all patients died from massive sepsis ( Figure 13) [52][53][54][55][56]. encountered in these patients [52,[54][55][56]. ...
Abstract: Mycetoma is a chronic infection, newly designated by the World Health Organization (WHO) as a neglected tropical disease, which is endemic in tropical and subtropical regions. It follows implantation of infectious organisms, either fungi (eumycetomas) or filamentous bacteria (actinomycetomas) into subcutaneous tissue, from where infection spreads to involve skin, bone and subcutaneous sites, leading to both health related and socioeconomic problems. In common with other NTDs, mycetoma is most often seen in rural areas amongst the poorest of people who have less access to health care. The organisms form small microcolonies that are discharged onto the skin surface via sinus tracts, or that can burrow into other adjacent tissues including bone. This paper describes the clinical features of mycetoma, as early recognition is a key to early diagnosis and the institution of appropriate treatment including surgery. Because these lesions are mostly painless and the majority of infected individuals present late and with advanced disease, simplifying early recognition is an important public health goal.
Keywords: mycetoma; clinical presentation; review
... This section consisted of 22 statements, and these were scored 1 or 0 for correct or incorrect answer respectively. Scores were summed for each respondent and levels of knowledge were categorized as Poor [0][1][2][3][4][5][6][7][8][9][10], Satisfactory [11][12][13][14][15], and Good [> 15]. Attitude refers to the degree of positive or negative agreement with statements concerning attitudes and beliefs towards interaction with mycetoma patients and appropriate treatment methods. ...
Background: Mycetoma is a badly neglected tropical disease, characterized by enormous deformities, disfigurement and disabilities if untreated early. Frequently, the majority of the mycetoma patients present late with advanced disease, and the only available treatment for them will be amputation of the affected part.
Aim: This study aimed at producing a health-promoting film to be used to improve the knowledge, attitude and practice (KAP) of a targeted population in one of the mycetoma endemic villages at Sennar State, Sudan.
Materials and Methods : A 26 - minute drama film on a mycetoma patient journey from a small painless mass to advanced disease till lower limb amputation due to missinformation and negligence was performed. Professional actors and cinema work team were employed in the film production. It was filmed in one of the mycetoma endemic areas.
A cohort of 250 individuals from two mycetoma endemic villages were included in this study. A closed ended pre-designed questionnaire was used to collect data from the targeted population. The collected data included demographic characteristics, knowledge, attitudes and practices towards mycetoma. The data was collected before and after the film was shown.
Results: In this study, 218/250 responded to the questionnaire with a response rate of 87%. Fifty-five percent of the respondents were males, 21.6% were farmers, 29.4% were students and 29.4% were unemployed. The film had improved the KAP of the targeted population hence it can be used as a health educational material in other mycetoma endemic areas in the Sudan.
... The chest wall is a rare site, accounting for 0.1% of 6,792 mycetoma patients seen at the MRC in the period 1991-2014 [4,5]. Only 2 patients with mycetoma-induced pulmonary complications were reported [6,7]. ...
... In rarely cases, mycetoma can spread along the lymphatics to the regional lymph node [6,68]. Few blood-spread mycetoma cases [7,16,69,70,71,72] and deaths related to the infection were reported [4,9,70], but they were not observed in our study. ...
Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria that form grains in the tissue. The purpose of this study is to describe the epidemiologic, clinic, laboratory, and therapeutic characteristics of patients with mycetoma at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil, between 1991 and 2014. Twenty-one cases of mycetoma were included in the study. There was a predominance of male patients (1.3:1) and the average patient age was 46 years. The majority of the cases were from the Southeast region of Brazil and the feet were the most affected anatomical region (80.95%). Eumycetoma prevailed over actinomycetoma (61.9% and 38.1% respectively). Eumycetoma patients had positive cultures in 8 of 13 cases, with isolation of Scedosporium apiospermum species complex (n = 3), Madurella mycetomatis (n = 2) and Acremonium spp. (n = 1). Two cases presented sterile mycelium and five were negative. Six of 8 actinomycetoma cases had cultures that were identified as Nocardia spp. (n = 3), Nocardia brasiliensis (n = 2), and Nocardia asteroides (n = 1). Imaging tests were performed on all but one patients, and bone destruction was identified in 9 cases (42.68%). All eumycetoma cases were treated with itraconazole monotherapy or combined with fluconazole, terbinafine, or amphotericin B. Actinomycetoma cases were treated with sulfamethoxazole plus trimethoprim or combined with cycles of amikacin sulphate. Surgical procedures were performed in 9 (69.2%) eumycetoma and in 3 (37.5%) actinomycetoma cases, with one amputation case in each group. Clinical cure occurred in 11 cases (7 for eumycetoma and 4 for actinomycetoma), and recurrence was documented in 4 of 21 cases. No deaths were recorded during the study. Despite of the scarcity of mycetoma in our institution the cases presented reflect the wide clinical spectrum and difficulties to take care of this neglected disease.
