Mycetoma / Chromoblastomycosis / Paracoccidioidomycosis

J. Afeltra

Author address: 

Mycology Section Hospital J.M. Ramos Mejí­a, Buenos Aires, Argentina

Abstract: 

Mycetoma is local, chronic, slowly progressive, often painless destructive infection that begins in the subcutaneous tissue and spreads to contiguous structures. The defining characteristic is the presence of tiny "œgrains" which form in the tissue and can be seen in the serosanguineous drainage from sinus tracts. The grains are colonies of the organism. The infection is caused by fungi (dematiaceous or non-dematiaceous) and aerobic and/or microaerophilic bacteria. Different colors of grains can be helpful in the identification of the causal agent. This disease is typically chronic and may result in amputation of the infected body part. Mycetoma is found worldwide in tropical zones and less commonly in temperate zones. The disease appears to be most common in India, Mexico, Saudi Arabia, Venezuela and Sub-Saharan Africa. Mycetoma is seen most frequently in men between the ages of 20 and 40 years. It occurs most often in farmers and other laborers in rural areas, edouins, and nomads. Exposed to penetrating wounds by thorns and splinters often see. The most common site of infection is the foot, particularly on the dorsum of the forepart. Appropriate and early microbiological diagnosis is essential to implement an appropriate therapy. Chromoblastomycosis is a mycotic infection of the cutaneous and subcutaneous tissues characterized by the development in tissue of dimorphic dematiaceous fungi (usually Fonsecaea pedrosoi, Cladophialophora carrionii and Phialophora verrucosa). Infections are caused by the traumatic implantation of fungal elements into the skin. The infection is usually chronic, slowly progressive and localized, most frequent in the foot and usually occurs around the area of inoculation producing nodule, crusted or verrucose lesions. This disease is world-wide distributed but more common in populations living in tropical regions. Diagnosis is confirmed by the presence of muriform cells in tissue and the isolation and the identification of the etiological agent in culture. Treatment should be guided according to clinical, mycological and histopathological criteria with itraconazole, terbinafine or a combination of both. Paracoccidioidomycosis is a fungal disease caused by a dimorphic fungus, Paracoccidioides brasiliensis, which is endemic in South America. It is relatively common in Brazil, Venezuela, Colombia, Ecuador, and Argentina. Depending on the adaptative immunity of the host, the infection can assume many forms and affect single or multiple organs (like skin, lymph nodes, lungs, and oral, nasal, and gastrointestinal mucous membranes) eventually becoming a severe and even fatal. The diagnosis can be carried out by direct examination of samples revealing the presence of budding yeasts, as well as culture at 25 and 37 degrees. Antibiotics like the sulfamethoxazole-trimethoprime combination or antifungal azole are use in the therapeutic management of patients.
2009

abstract No: 

W07.2

Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)