Luz Calderón

Mycetoma: Experience of 482 Cases in a Single Center in Mexico

Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3∶1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.

Mucormycosis in children: a study of 22 cases in a Mexican hospital

We present a single‐centre, retrospective study (1985–2012) of 22 cases of mucormycosis in children. A total of 158 mucormycosis cases were identified, of which 22 (13.96%) were children. The mean age of the children was 10.3 years (range: 6 months–18 years), and 59% of the infections occurred in males. The rhinocerebral form was the main clinical presentation (77.27%), followed by the primary cutaneous and pulmonary patterns. The major underlying predisposing factors were diabetes mellitus in 68.18% of the patients and haematologic diseases in 27.7% of the patients. The cases were diagnosed by mycological tests, with positive cultures in 95.4% of the patients. Rhizopus arrhizus was the foremost aetiologic agent in 13/22 cases (59.1%). In 21 cultures, the aetiologic agents were identified morphologically and by molecular identification. In 10 cultures, the internal transcribed spacer region of the ribosomal DNA was sequenced. Clinical cure and mycological cure were achieved in 27.3% cases, which were managed with amphotericin B deoxycholate and by treatment of the underlying conditions.

Periungual Eccrine Poroma

Background: Eccrine poroma is a rare, benign skin appendage tumor originating from the intraepidermal portion of the eccrine sweat duct, which typically occurs on the sides and soles of the feet. Nonetheless, eccrine poroma may be found in any skin area bearing sweat glands. Objective: Herein we report a case of an eccrine poroma in an unusual location, the surgical management of the condition, and follow-up processes.

Cutaneous Mucormycosis: Mycological, Clinical, and Therapeutic Aspects

Cutaneous mucormycosis (CM) is caused by ubiquitous filamentous fungi belonging to the order Mucorales. It is a rare, emerging mycosis, with increasing incidence since the last two decades, only surpassed by rhinocerebral and pulmonary mucormycosis. CM can be further classified in primary and secondary clinical forms. Primary cases can be seen on immunocompetent patients, frequently due to traumatic injuries, while in immunocompromised patients (those with diabetes mellitus or hematologic malignancies), lesions can arise at catheter insertion sites or after the use of contaminated adhesive tapes. Clinical features of primary cutaneous mucormycosis (PCM) are necrosis, followed by ulceration, generally associated to good prognosis. Secondary cutaneous mucormycosis (SCM) is related to rhinocerebral and/or disseminated forms. SCM usually starts as a palpebral fistula, as an erythematous area that rapidly evolves to necrosis and ulceration, related to worse prognosis. Direct examination, cultures, skin biopsies, and molecular tests are performed to diagnose both clinical forms. Liposomal amphotericin B (LAmB) in combination with surgical debridement constitutes the treatment of choice; however, for SCM, the addition of posaconazole or caspofungin is recommended.

Treatment of cutaneous actinomycosis with amoxicillin/clavulanic acid

Abstract Objective: To evaluate the efficacy and tolerability of amoxicillin/clavulanic (AMX/CLV) acid as treatment for cutaneous actinomycosis. Methods: We present a long-term follow-up study of cutaneous actinomycosis patients. Cervicofacial (CFA) and abdominal (AA) were recruited during 6 years. Diagnoses were based on clinical and microbiological characteristics; presence of granules, isolation and identification of etiological agents were carried out in each case. Patients received AMX–CLV 875/125 mg BID PO at a maximum period of 12 weeks. Results: Twenty-two cases were enrolled; the mean age was 45.2 years old. Twenty patients (91%) presented CFA and two AA (9%). All patients with CFA had dental caries, seven (35%) with periodontal disease and 10 (50%) had type-2 diabetes mellitus (T2DM). One case of AA had history of intrauterine device and other appendicitis. Granules were observed in all the cases, the main etiological agent was Actinomyces israelii 16/22 (72.7%). Clinical and microbiological cure was achieved in 19/22 cases (86.4%), the remaining patients presented clinical improvement. The average duration of the treatment was 6.6 weeks. Side effects were recorded in 4/19 cases (18.2%), three of them presented nausea and one diarrhea. Conclusion: Treatment with AMX/CLV acid showed efficacy in the management of actinomycosis with cutaneous involvement.