title: Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil.
abstract: Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria that form grains in the tissue. The purpose of this study is to describe the epidemiologic, clinic, laboratory, and therapeutic characteristics of patients with mycetoma at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil, between 1991 and 2014. Twenty-one cases of mycetoma were included in the study. There was a predominance of male patients (1.3:1) and the average patient age was 46 years. The majority of the cases were from the Southeast region of Brazil and the feet were the most affected anatomical region (80.95%). Eumycetoma prevailed over actinomycetoma (61.9% and 38.1% respectively). Eumycetoma patients had positive cultures in 8 of 13 cases, with isolation of Scedosporium apiospermum species complex (n = 3), Madurella mycetomatis (n = 2) and Acremonium spp. (n = 1). Two cases presented sterile mycelium and five were negative. Six of 8 actinomycetoma cases had cultures that were identified as Nocardia spp. (n = 3), Nocardia brasiliensis (n = 2), and Nocardia asteroides (n = 1). Imaging tests were performed on all but one patients, and bone destruction was identified in 9 cases (42.68%). All eumycetoma cases were treated with itraconazole monotherapy or combined with fluconazole, terbinafine, or amphotericin B. Actinomycetoma cases were treated with sulfamethoxazole plus trimethoprim or combined with cycles of amikacin sulphate. Surgical procedures were performed in 9 (69.2%) eumycetoma and in 3 (37.5%) actinomycetoma cases, with one amputation case in each group. Clinical cure occurred in 11 cases (7 for eumycetoma and 4 for actinomycetoma), and recurrence was documented in 4 of 21 cases. No deaths were recorded during the study. Despite of the scarcity of mycetoma in our institution the cases presented reflect the wide clinical spectrum and difficulties to take care of this neglected disease.
authors.affiliation: National Institute of Infectious Diseases, Oswaldo Cruz Foundation - Rio de Janeiro - Brazil.
authors.forename: Felipe Maurício Soeiro
authors.identifier: 0000-0002-2235-5473
authors.initials: FM
authors.lastname: Sampaio
authors.affiliation: National Institute of Infectious Diseases, Oswaldo Cruz Foundation - Rio de Janeiro - Brazil.
authors.forename: Bodo
authors.initials: B
authors.lastname: Wanke
authors.affiliation: National Institute of Infectious Diseases, Oswaldo Cruz Foundation - Rio de Janeiro - Brazil.
authors.forename: Dayvison Francis Saraiva
authors.initials: DF
authors.lastname: Freitas
authors.affiliation: National Institute of Infectious Diseases, Oswaldo Cruz Foundation - Rio de Janeiro - Brazil.
authors.forename: Janice Mery Chicarino de Oliveira
authors.initials: JM
authors.lastname: Coelho
authors.affiliation: National Institute of Infectious Diseases, Oswaldo Cruz Foundation - Rio de Janeiro - Brazil.
authors.forename: Maria Clara Gutierrez
authors.initials: MC
authors.lastname: Galhardo
authors.affiliation: National Institute of Infectious Diseases, Oswaldo Cruz Foundation - Rio de Janeiro - Brazil.
authors.forename: Marcelo Rosandiski
authors.initials: MR
authors.lastname: Lyra
authors.affiliation: National Institute of Infectious Diseases, Oswaldo Cruz Foundation - Rio de Janeiro - Brazil.
authors.forename: Maria Cristina da Silva
authors.initials: MC
authors.lastname: Lourenço
authors.affiliation: National Institute of Infectious Diseases, Oswaldo Cruz Foundation - Rio de Janeiro - Brazil.
authors.forename: Rodrigo de Almeida
authors.initials: RA
authors.lastname: Paes
authors.affiliation: National Institute of Infectious Diseases, Oswaldo Cruz Foundation - Rio de Janeiro - Brazil.
authors.forename: Antonio Carlos Francesconi
authors.initials: AC
authors.lastname: do Valle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D009615:Nocardia / Q000302:isolation & purification*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents