title: Actinomycetoma in SE Asia: the first case from Laos and a review of the literature.
abstract: BACKGROUND
  Mycetoma is a chronic, localized, slowly progressing infection of the cutaneous and subcutaneous tissues caused either by fungi (eumycetoma or implantation mycosis) or by aerobic actinomycetes (actinomycetoma). It is acquired by traumatic implantation, most commonly in the tropics and subtropics, especially in rural agricultural communities. Although well recognized elsewhere in Asia, it has not been reported from the Lao People's Democratic Republic (Laos).
  
  
  METHODS
  A 30 year-old female elementary school teacher and rice farmer from northeast Laos was admitted to Mahosot Hospital, Vientiane, with a massive growth on her left foot, without a history of trauma. The swelling had progressed slowly but painlessly over 5 years and multiple draining sinuses had developed. Ten days before admission the foot had increased considerably in size and became very painful, with multiple sinuses and discharge, preventing her from walking. Gram stain and bacterial culture of tissue biopsies revealed a branching filamentous Gram-positive bacterium that was subsequently identified as Actinomadura madurae by 16S rRNA gene amplification and sequencing. She was treated with long-term co-trimoxazole and multiple 3-week cycles of amikacin with a good therapeutic response.
  
  
  CONCLUSIONS
  We report the first patient with actinomycetoma from Laos. The disease should be considered in the differential diagnosis of chronic skin and bone infections in patients from rural SE Asia.
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Sayaphet
authors.initials: S
authors.lastname: Rattanavong
authors.forename: Sivay
authors.initials: S
authors.lastname: Vongthongchit
authors.forename: Khamhou
authors.initials: K
authors.lastname: Bounphamala
authors.forename: Phouvong
authors.initials: P
authors.lastname: Vongphakdy
authors.forename: Jacques
authors.initials: J
authors.lastname: Gubler
authors.forename: Mayfong
authors.initials: M
authors.lastname: Mayxay
authors.forename: Rattanaphone
authors.initials: R
authors.lastname: Phetsouvanh
authors.forename: Ivo
authors.initials: I
authors.lastname: Elliott
authors.forename: Julie
authors.initials: J
authors.lastname: Logan
authors.forename: Robert
authors.initials: R
authors.lastname: Hill
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
authors.forename: David
authors.initials: D
authors.lastname: Dance
mesh_terms: D000192:Actinomycetales / Q000302:isolation & purification*; D000328:Adult; D000583:Amikacin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001706:Biopsy; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D005260:Female; D005528:Foot / Q000473:pathology*; D006801:Humans; D007812:Laos; D008271:Mycetoma / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D010802:Phylogeny; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin