title: Autochthonous cases of mycetoma in Europe: report of two cases and review of literature.
abstract: BACKGROUND
  Mycetoma is a chronic granulomatous infection involving cutaneous and subcutaneous tissues. It is endemic in tropical and subtropical areas, but sporadic cases have been reported also in countries of temperate climate. The purpose of this paper is to review the cases of mycetoma in European subjects (and presumably acquired in Europe), to give an insight in the main factors associated with this condition, and to describe two previously unpublished cases observed at our Centre.
  
  
  RESULTS
  PubMed was systematically searched for case reports and case series of mycetoma in Europeans reported between 1980 and 2014, using specific search strategies. Two further cases diagnosed by the authors are described. Forty-two cases were collected. Eleven cases were caused by Scedosporium apiospermium, mainly in immunosuppressed patients from Bulgaria, Germany, the Netherlands, Portugal, Slovenia, Spain and the United Kingdom. Excluding all patients with immunosuppression, 29 cases remain. Most of them were reported from Bulgaria and in Albanian patients (all diagnosed outside Albania). In the Bulgarian case series many different micro-organisms, both bacteria and fungi, were isolated, while all the 5 cases from Albania were caused by Actinomadura spp. Other countries reporting cases were Greece, Italy and Turkey. In general, Actinomadura spp is the most frequent causative agent isolated, followed by Nocardia spp and Madurella mycetomatis. The foot was the most reported site involved. Most patients were medically treated, but unfortunately a long-term follow up (at least one year) was available only in a few cases.
  
  
  CONCLUSIONS
  Our review and our own cases suggest that Europeans without travel history can be affected by Madura foot. The lack of a surveillance system is likely to cause an underreporting of cases. Moreover, the unfamiliarity of Western doctors with this peculiar infection may cause a mismanagement, including unnecessary amputations.
authors: Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy.
authors: Dora
authors: D
authors: Buonfrate
authors: Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy.
authors: Federico
authors: F
authors: Gobbi
authors: Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy.
authors: Andrea
authors: A
authors: Angheben
authors: Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy.
authors: Stefania
authors: S
authors: Marocco
authors: Microbiology Institute, AO Papa Giovanni XXIII, Bergamo, Italy.
authors: Claudio
authors: C
authors: Farina
authors: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Jef
authors: J
authors: Van Den Ende
authors: Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy.
authors: Zeno
authors: Z
authors: Bisoffi
mesh_terms: D000328:Adult; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology