A. Thammayya

Actinomycetoma pedis caused by Nocardia caviae in India

Two cases of actinomycetoma pedis caused by Nocardia caviae are described. Both presented with mycetoma pedis of the right foot with multiple seropurulent discharging sinuses devoid of granules. One had no definite history of trauma but the patient usually worked barefoot in fields. The other had a history of operation at the site of the disease.N. caviae isolated from these cases was considered to be the causative agent. The source of infection and the saprophytic existence of N. caviae in Indian soils are discussed. These are the first cases reported from India and only 2 other similar cases have been reported.

Exophiala jeanselmei causing mycetoma pedis in India

Exophiala jeanselmei causing mycetoma pedis in a 65-year-old Bengalee businessman was described. The right lower leg and foot were irregularly swollen, firm, painless, non-tender and had many small nodules and sinuses all over the swelling. The lower end of the tibia and bones of the foot were affected. The discharge from the sinuses and nodules contained black brown, soft, vermicular, crescent-shaped to irregular granules, measuring 0.5--2.00 mm and composed mostly of swollen spherical cells, 4-8 micrometer diameter, and a few hyphae, 2.5--3.0 micrometer diameter. The isolate was polymorphic in nature and exhibited various morphological features such as yeast-like cells producing secondary conidia, toruloid hyphae, and terminal and intercalary annellophores bearing annelloconidia at one or more points.

Actinomycetoma caused by organisms of the Nocardia asteroides complex and closely related strains.

Eighteen cases of actinomycetoma caused by Nocardia asteroides are described. The cases presented with mycetoma of neck, chest, back, elbow, palm, inguinal region, vulva, thigh, popliteal fossa, leg, ankle, foot and toes, having swelling with nodules and discharging sinuses. In 2 cases, the infection had spread extensively on the chest wall, but the underlying viscera ware not affected. The disease followed previous injury in 8 cases. There was higher predilection of males to the disease, but age and occupation appeared to have no relation to susceptibility to this infection. Radiology showed involvement of bony tissues in 6 cases. The discharge from the nodules and sinuses contained macroscopic granules in 4 cases; small, delicate, microscopic granules composed of branched filaments of less than 1 |x diameter in 6 cases, and GRAM positive, branched filaments in all the cases. Direct microscopy of the discharge with KOH was found to be superior to examination of stained smears in finding microscopic granules. Histopathology revealed presence of granules in microabscesses in 3 cases. The cultural, physiological and biochemical properties of the organisms isolated from all these cases were in conformity with N. asteroides. The local soil was considered to be the source of infection.

Primary oral histoplasmosis in India

The histopathology and mycology of histoplasmosis restricted to the oral mucous membrane in an Indian patient, who had never gone outside the country, are described. The yeast form of Histoplasma capsulatum was transferable experimentally to mice by successive intraperitoneal inoculations. The infectivity of the disease, the extrapulmonary symptoms in most of the Indian histoplasmosis cases and the source of infection in India are discussed.