Actinomycetoma and advances in its treatment.
Actinomycetoma is a chronic subcutaneous infection caused by aerobic branching actinomycetes. Its clinical features are firm tumefaction of the affected site and the presence of abscesses, nodules, and sinuses that drain a seropurulent exudate containing filamenting granules. The disease is caused by inoculation of the infectious agent through minor trauma in susceptible individuals. Nocardia brasiliensis, Actinomadura madurae, and Streptomyces somaliensis are among the most frequent agents in the Americas. Cellular and humoral immunity have been studied in animal models. Standard therapy for uncomplicated cases is sulfamethoxazole-trimethoprim given for many months. Bone involvement, disseminated cases, and special locations require combined treatment with amikacin and sulfamethoxazole-trimethoprim. Isolated reports include the addition of other antibiotics such as rifampicin, imipenem, or meropenem. When needed, other aminoglycosides can be used. Amoxicillin-clavulanic acid is indicated in specific cases as alternative treatment. Oxazolidinone antibiotics, such as linezolid and other similar compounds (DA-7218 and DA-7157), have been studied in experimental infections in animal models as well as in vitro and ex vivo, with encouraging results.
Department of Dermatology, Dr. Jose E. Gonzalez University Hospital, Universidad Autonoma de Nuevo Leon, Ave Madero y Ave Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon, Mexico. owelsh@yahoo.com
Oliverio
O
Welsh
Lucio
L
Vera-Cabrera
Esperanza
E
Welsh
Mario Cesar
MC
Salinas
D000192:Actinomycetales / Q000187:drug effects*; D000583:Amikacin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006801:Humans; D023421:Models, Animal; D008271:Mycetoma / Q000188:drug therapy* / Q000473:pathology; D009615:Nocardia / Q000187:drug effects*; D023303:Oxazolidinones / Q000627:therapeutic use; D013302:Streptomyces / Q000187:drug effects*; D013997:Time Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D019980:Amoxicillin-Potassium Clavulanate Combination; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin