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[Mycetoma of the foot].

A forty-year-old woman suffering from maduromycosis of the right sole is described with a disease history of 17 years. After a contusion and surgery for fibroma she developed an edema on the skin of the right sole, then ulcers with purulent discharge. She was repeatedly treated on an outpatient basis and in hospital by surgeons, phthisiologist, and dermatologist for osteomyelitis, tuberculosis of the bones, and Kaposi's sarcoma without effect. The diagnosis of maduromycosis of the sole was confirmed by laboratory examinations and histologically by detecting Actinomyces elements. Since conservative therapy has proved ineffective, surgical treatment was recommended.

Actinomycetales Infections↗

The effect of temperature on the fatty acid and phospholipid composition of Cephalosporium falciforme and Cephalosporium kiliense.

The effect of temperature on the lipid composition of Cephalosporium falciforme and Cephalosporium kiliense, causative agents of maduromycosis, was investigated. The fungi were grown at 28.5 C and 37 C in a chemically defined medium. The lipids were solvent extracted, purified on Sephadex, and separated into their component classes by silicic acid column chromatography. Five lipid classes were found: (a) sterol esters, (b) triacylglycerides, (c) free fatty acids, (d) sterols, and (e) phospholipids. Fatty acids were analyzed by gas liquid chromatography. Temperature induced changes of varying degrees occurred in both the fatty acid and phospholipid fractions of each organism.

Acremonium↗

Allescheria boydii infections in the immunosuppressed host.

Allescheria boydii, a true fungus frequently isolated from soil, is best known as a causative agent of maduromycosis of the foot. In our report we describe two patients under treatment for acute leukemia who died from rapidly progressive A. boydii infections. One patient had signs of central nervous system infection and was found at autopsy to have had a large brain abscess. The second patient had a cavitary necrotizing pneumonia with thoracic inlet obstruction (Pancoast's syndrome) and failed to show improvement despite treatment with amphotericin B. The clinical spectrum of allescheriasis is reviewed with particular emphasis on its role as a pathogen in the compromised host. Since A. boydii may resemble other fungi morphologically in tissue sections and may produce infections clinically similar to other mycoses, culture of the organism is required for definitive diagnosis. Based on recently reported in vitro susceptibility studies, miconazole may have a future role in the therapy of A. boydii infections which are resistant to presently available antifungal agents.

Adult↗

Improvement of eumycetoma with itraconazole.

Treatment of eumycetoma, both medical and surgical, is difficult and often unsuccessful. We describe a case of maduromycosis, 18 years in duration, with significant improvement after 6 months of itraconazole therapy.

Aged↗

Mycetoma of the hand.

Mycetoma or maduromycosis is a rare chronic granulomatous disease caused by a fungus infection. We report a rare case of mycetoma in the hand; to our knowledge this is the first report in the United States of mycetoma caused by Nocardia asteroides. The patient had had 2 years of chronic drainage and edema of the left hand after a penetrating injury sustained in the shipyards. After surgical debridement he was treated with co-triamazole, 1 tablet orally four times a day for 6 months. The chronic drainage has ceased but most of his wrist and hand joint movements are restricted.

Hand↗

Atypical presentation of Madurella mycetomatis mycetoma in a renal transplant patient.

A renal transplant patient presented with a swelling on his foot. Fungal hyphae were found in the abscess, and culture demonstrated Madurella mycetomatis, an agent of mycetoma. There were no black grains in the pus and no overlying sinuses. This was an atypical presentation of maduromycosis in a renal transplant patient.

Drug Therapy, Combination↗

Pulmonary infection with Allescheria boydii.

Allescheria boydii, the most common fungus isolated from North American maduromycosis, is a well-described pathogen. Reports of its isolation from sites other than the extremities are rare. Only ten cases of pulmonary infection are recorded in the literature. Of these, two are primary infections, and eight are secondary. An eleventh case is reported. Although there are some elements in the patient's history that indicate that this infection is secondary, the authors regard the infection a primary one. A pathologic and microbiologic compendium of all 11 cases is presented.

Aged↗

Fungal arthritis simulating juvenile rheumatoid arthritis.

Petriellidium boydii is often isolated from maduromycosis but has recently been associated with arthritis. A previously healthy 6-year-old boy developed chronic purulent arthritis of the knee after a bicycle accident. Culture of aspirate grew no pathogens and antibiotic treatment had no effect. Culture of synovial fluid grew P boydii, which responded initially to amphotericin but reappeared after six months. Subsequent treatment with miconazole was stopped after development of haematuria. The fungus was sensitive to ketoconazole, and treatment with this drug cured the infection. With the introduction of ketoconazole it is of practical importance to recognise fungal infections.

Antifungal Agents↗

Prevalence and causal conditions for amputation surgery in the third world: ten years experience at Dodoma Regional Hospital, Tanzania.

This is a partly retrospective study of 252 major limb amputations carried out in regional hospital in Tanzania over a period of ten years mostly by the authors. The paper reports on the aetiology and levels of amputation and identifies prevalence and sex of the amputees. The causes of amputation classified under tumours, vascular diseases, trauma, infections, burns, animal bites, iatrogenic causes, maduromycosis and miscellanea--are discussed with particular reference to the influence of the environment, cultural habits and local customs.

Adolescent↗

Terbinafine: broad new spectrum of indications in several subcutaneous and systemic and parasitic diseases.

Immunocompromised patients are at risk of contracting serious fungal infections. The emergence of acquired resistance to azole treatment by opportunistic fungal organisms is increasing and poses a major therapeutic challenge. Treatment of some deep cutaneous and subcutaneous mycoses remains unresolved, relapses are frequent, lack of tolerability of the antifungal drugs becomes an obstacle, and, unfortunately, surgery is, in some cases, the last option. The development of allylamine antifungals, of which terbinafine is the most effective to date, may help to resolve this situation. In vitro, terbinafine is highly active against a broad spectrum of pathogenic fungi. Clinical studies have shown that terbinafine is effective in the treatment of both cutaneous and lymphocutaneous sporotrichosis, and in several patterns of disseminated and refractory aspergillosis. Patients with chromoblastomycosis, and other mycoses (phaeohyphomycosis, maduromycosis, and mucormycosis) have also been successfully treated with terbinafine. Old World cutaneous leishmaniasis, a parasitic disease, has also been treated with terbinafine. These results suggest that the therapeutic potential of terbinafine extends well beyond its currently licensed applications to include a range of serious and life-threatening subcutaneous and systemic mycoses.

Antifungal Agents↗

Deep fungal infection in systemic lupus erythematosus - three cases reported, literature reviewed.

Three patients with systemic lupus erythematosus (SLE) and deep fungal infection are described. Two patients had disseminated cryptococcal infection and the third disseminated histoplasmosis. Allwere receiving corticosteroids at the time fungal infection developed. One patient with disseminated cryptococcosis improved after treatment with amphotericin B and 5-fluorocytosine. The other patient with disseminated cryptococcosis died before adequate therapy could be given. The patient with histoplasmosis responded satisfactorily to amphotericin B. A survey of the literature revealed 30 additional cases of deep fungal infection in patients with SLE, most of whom were on corticosteroid therapy. The majority of the patients had candidiasis (14 patients); 11 patients had severe cryptococcal infection. Other fungal infections reported were histoplasmosis, aspergillois, coccidioidomycosis, and maduromycosis caused by Allerscheria boydii. Twenty-seven patients died; in 22 death was related to the fungal infection. The fungal infection was not diagnosed until necropsy in at least 11 persons. Deep fungal infections should be considered whenever patients with SLE have fever of unknown origin, diffuse pulmonary infiltrates, or unexplained CNS symptoms.

Adult↗

Actinomycotic mycetoma. Report of a case with diagnosis by fine needle aspiration.

Mycetoma (madura foot, maduromycosis) is present worldwide but more so in the tropics. We report a case of actinomycetoma diagnosed by fine needle aspiration using cell smears. The authors believe it to be the first case so diagnosed. Definitive diagnosis of the etiologic agent is made by culture, leading to a delay in institution of treatment. The authors advocate the use of fine needle aspiration for rapid diagnosis, thus instigating further workup and treatment.

Actinomycosis↗

Fungal arthritis due to Pseudallescheria boydii (Scedosporium apiospermum).

Musculoskeletal infections by fungal agents are uncommon conditions. Pseudallescheria boydii is an ubiquitous saprophytic fungus frequently involved in maduromycosis but rarely in septic arthritis. We describe a case of Pseudallescheria boydii destructive suppurative arthritis and osteomyelitis of the knee in an adult Guadeloupean man. Osteoarticular infections due to Pseudallescheria boydii are reviewed.

Arthritis, Infectious↗