title: Madura foot in Europe: diagnosis of an autochthonous case by molecular approach and review of the literature.
abstract: Madura foot is a chronic granulomatous infection of the soft-tissue of the foot and it is endemic in tropical and subtropical countries. Some cases have also been reported in local people or migrants in temperate countries. The microbiological diagnosis requires prolonged bacterial cultures in aerobic and anaerobic conditions, but the use of the molecular approach could be helpful for an early and rapid diagnosis. We describe an autochthonous case of Actinomadura madurae foot infection in an Italian woman. The diagnosis was achieved 36 months after symptoms onset by PCR detection and sequencing of 16S rDNA directly on biopsy. She started therapy with rifampin, trimethoprim-sulfamethoxazole, and amikacin. After 3 months the pain had disappeared and the swelling subsided. We reviewed the literature on Madura foot due to bacterial causative agents in Europe and observed that the median time from onset to diagnosis is high, possibly due to several factors like the difficulties of the microbiological and radiological diagnosis. Our case report and the review of literature point out that the implementation of a surveillance system, the involvement of an infectious diseases specialist, with experience in tropical diseases, and the availability of a microbiology unit to perform feasible and rapid molecular diagnostic tests could result in an earlier diagnosis and an optimal antibiotic therapy of this rare but difficult-to-treat and, above all, difficult-to-diagnose infection.
authors.affiliation: Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mencarini
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Italy.|Department of Experimental and Clinical Medicine, University of Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Orthopaedic Oncology Unit, Careggi Hospital, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Scoccianti
authors.affiliation: Microbiology and Virology Unit, Careggi Hospital, Florence, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bartolini
authors.affiliation: Department of Diagnostic Imaging, Careggi Hospital, Florence, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Roselli
authors.affiliation: Orthopaedic Oncology Unit, Careggi Hospital, Florence, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Capanna
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Italy.|Department of Experimental and Clinical Medicine, University of Florence, Italy.|Microbiology and Virology Unit, Careggi Hospital, Flor.
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
authors.affiliation: Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy.|Infectious and Tropical Diseases Unit, Careggi Hospital, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bartoloni
authors.affiliation: Infectious and Tropical Diseases Unit, Careggi Hospital, Florence, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Bartalesi
mesh_terms: D039903:Actinobacteria / Q000302:isolation & purification; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D008271:Mycetoma / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology; D016133:Polymerase Chain Reaction; D012329:RNA, Bacterial / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics
chemical_list: D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S
keywords: Actinomadura madurae; Madura foot; Ribosomal RNA; Sequencing 16S r-DNA