title: Last generation triazoles for imported eumycetoma in eleven consecutive adults.
abstract: BACKGROUND
  Optimal management of eumycetoma, a severely debilitating chronic progressive fungal infection of skin, disseminating to bone and viscera, remains challenging. Especially, optimal antifungal treatment and duration are ill defined.
  
  
  RESULTS
  We conducted a monocentric retrospective study of 11 imported cases of eumycetoma treated by voriconazole or posaconazole for at least 6 months. Response to treatment was assessed through evolution of clinical and magnetic resonance imaging (MRI). (1→3) ß-D-glucan (BG) and positron emission tomography using [18F] fluorodeoxyglucose (PET/CT) results were also assessed. Identified species were Fusarium solani complex (n = 3); Madurella mycetomatis, (n = 3), and Exophiala jeanselmei, (n = 1). Moreover, two coelomycetes and one phaeohyphomycetes strains without species identification were retrieved. Serum BG and PET/CT were abnormal in 7/8 and 6/6 patients tested, respectively. Patients received last generation azoles for a mean duration of 25.9±18 months. Complete response (major clinical and MRI improvement) was observed in 5/11 patients, partial response (minor MRI improvement or stable MRI findings) in 5 and failure (MRI evidence of disease progression) in one, with a 73±39 [6-132] months mean follow-up. Relapse occurred in 2 patients after treatment discontinuation. Optimal outcome was associated with fungal species, initiation of last generation triazole therapy (<65 months since first symptoms), negative serum BG and PET/CT normalization.
  
  
  CONCLUSIONS
  MRI, PET/CT and serum BG appear as promising tools to assess optimal time of antifungal treatment for eumycetoma.
authors.affiliation: Centre d'Infectiologie Necker Pasteur, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Crabol
authors.affiliation: Service d'Imagerie Médicale, Hôpital Necker-Enfants malades, Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Poiree
authors.affiliation: Laboratoire de parasito-mycologie, Hôpital Universitaire Necker-Enfants malades, CNRS URA3012, Paris, France.
authors.forename: Marie-Elisabeth
authors.initials: ME
authors.lastname: Bougnoux
authors.affiliation: Unité de Médecine Nucléaire et TEP, Université Paris Descartes, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Maunoury
authors.affiliation: Service de Dermatologie, Hôpital Tenon, APHP, Université Pierre et Marie Curie, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Barete
authors.affiliation: Service de Médecine Interne, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Zeller
authors.affiliation: Service de maladies infectieuses et réanimation médicale du Centre hospitalier universitaire de Rennes, Rennes, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Arvieux
authors.affiliation: Hôpital Universitaire de Nantes, Service des Maladies Infectieuses et Tropicales, Nantes, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Pineau
authors.affiliation: Centre d'Infectiologie Necker Pasteur, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France.
authors.forename: Karima
authors.initials: K
authors.lastname: Amazzough
authors.affiliation: Centre d'Infectiologie Necker Pasteur, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France; Unité de Biologie des Infections, Institut Pasteur, Inserm U1117, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Lecuit
authors.affiliation: Centre d'Infectiologie Necker Pasteur, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Lanternier
authors.affiliation: Centre d'Infectiologie Necker Pasteur, Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Hôpital Universitaire Necker-Enfants malades, APHP, Paris, France; Unité de Mycologie Moléculaire, Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D005093:Exophiala / Q000187:drug effects; D019788:Fluorodeoxyglucose F18; D005670:Fusarium / Q000187:drug effects; D006801:Humans; D020461:Madurella / Q000187:drug effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D049268:Positron-Emission Tomography; D011509:Proteoglycans; D012189:Retrospective Studies; D012867:Skin / Q000382:microbiology; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole / Q000627:therapeutic use*; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood
chemical_list: D000935:Antifungal Agents; D011509:Proteoglycans; D014230:Triazoles; D047071:beta-Glucans; D019788:Fluorodeoxyglucose F18; C010770:polysaccharide-K; C101425:posaconazole; D065819:Voriconazole