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Unexpected High Prevalence of Secondary Bacterial Infection in Patients with Mycetoma

1998; American Society for Microbiology; Volume: 36; Issue: 3 Linguagem: Inglês

10.1128/jcm.36.3.850-851.1998

1098-660X

Abdalla O. A. Ahmed, El Sir A. M. Abugroun, Ahmed Hassan Fahal, Ed E. Zijlstra, Alex van Belkum, Henri A. Verbrugh,

Actinomycetales infections and treatment

Mycetoma is a chronic granulomatous infection of the subcutaneous tissue caused by true fungi or higher bacteria; hence, it is classified as eumycetoma or actinomycetoma, respectively (5). Mycetoma is endemic in (sub)tropical areas, and the Sudan seems to be the mycetoma homeland, with hundreds of new patients attending specialized clinics each year. Mycetoma pathogens such as the fungusMadurella mycetomatis can be found in certain types of soil or as colonizers of plants and show widespread environmental distribution. Infection may be initiated once fungal material is inoculated into the subcutaneous tissues through minor trauma (7). M. mycetomatis is the main cause of eumycetoma, being responsible for approximately 70% of all mycetoma cases in Sudan (2, 6). Mycetoma usually presents as a slowly progressing subcutaneous nodule which increases in size. Multiple secondary nodules may evolve as well. The nodules may suppurate, and characteristic (black) grains as well as purulent material may be discharged through multiple sinus tracts (Fig. 1 and reference2). Mycetoma is usually painless (4), but in some cases, patients seek medical advice because of persisting pain. The pain may be produced by bone invasion or it may be due to secondary bacterial infection (SBI) (3). The latter is diagnosed upon bacterial cultures positive for potentially pathogenic species other than the microorganisms causing the mycetoma and obtained from deep within the sinus tracts. Little is known about the incidence of SBI in mycetoma, the organisms involved, and its potential contribution to morbidity.