title: Management of mycetomas in France.
abstract: OBJECTIVE
  Mycetomas are chronic sub-cutaneous tropical infections in which exogenous causative agents, fungal (eumycetes) or bacterial (actinomycetes), generate grains. The typical presentation is multi-fistulized pseudotumors. This disease, particularly eumycetoma, is difficult to treat. It is a major health problem in tropical and subtropical countries. In France, the disease is rare, but patients have access to a broader range of treatments. The authors had for objective to present the cases of mycetomas diagnosed in developed country and their management.
  
  
  METHODS
  A retrospective study was made on the clinical presentation and management of mycetomas from 1995 to 2011, in the Bobigny Avicenne teaching hospital.
  
  
  RESULTS
  Six patient files were studied. The patients were men with a median age of 31 years (16-70). Five patients were from Sub Saharan Africa, one from Sri Lanka. The etiologies were one actinomycetoma and five eumycetomas. There was bone involvement in five cases. There was one atypical presentation: a primary intra-osseous mycetoma. Three patients were cured including two by surgical management and one by medical treatment (actinomycetoma). Antifungal therapy failed (four patients) in every case (voriconazole, itraconazole, ketoconazole, terbinafine, caspofungin).
  
  
  CONCLUSIONS
  The results of this study made in a non-epidemic zone revealed that despite a typical clinical presentation, the diagnosis and management were delayed because this imported disease is rare in France. The patients received new broad-spectrum triazole and caspofungin, but none were cured with antifungal therapy alone.
authors.affiliation: Service de maladies infectieuses et tropicales, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93000 Bobigny, France. sarah.mattioni@tnn.aphp.fr
authors.forename: S
authors.initials: S
authors.lastname: Mattioni
authors.forename: M
authors.initials: M
authors.lastname: Develoux
authors.forename: S
authors.initials: S
authors.lastname: Brun
authors.forename: A
authors.initials: A
authors.lastname: Martin
authors.forename: F
authors.initials: F
authors.lastname: Jaureguy
authors.forename: N
authors.initials: N
authors.lastname: Naggara
authors.forename: O
authors.initials: O
authors.lastname: Bouchaud
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D019049:Developed Countries; D019468:Disease Management; D054242:Emigrants and Immigrants; D005533:Foot Dermatoses / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000601:surgery; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000601:surgery; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D013188:Sri Lanka / Q000208:ethnology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
keywords: Actinomycetoma; Actinomycétome; Eumycetoma; Eumycétome; France; Mycetoma; Mycétome