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Bonifaz A, Ibarra G, Saúl A, Bonifaz A, Ibarra G, Saúl A, Carrasco E.Carrasco E.
Dermatology & Micology Dermatology & Micology Department Department
General Hospital of General Hospital of MexicoMexico
Hospital Infantil de Hospital Infantil de MexicoMexico
MYCETOMA IN CHILDREN
Title
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MYCETOMA IN CHILDRENMYCETOMA IN CHILDRENIntroduction
Chronic infection Based on its etiology: eumycetoma
(true fungae) actinomycetoma (filamentous actinomycetes)
Clinically characterized by swelling, sinuses and alteration of affected region
Mycetoma are uncommon in children. Only few reports*
* Aceves Ortega R. Deep mycosis in children. Mod Probl Paediatr 1975;17: 228-241.
Welsh O. Mycetoma in children. Mod Probl Paediatr 1975; 17:248-253.
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Introduction
Occurs in well-defined geographic areas. Between the tropics
Actinomycetoma is more frequent in subtropical areas (Mexico, Venezuela)
Eumycetoma: predominates in Africa and India
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Background
Frequency: Mexican multi-center study that included
2,105 cases.* 78 cases were under 15 years: 3.7% 11 cases were under 10 years: 0.5% In our study: 15/334: 4.5%
*López-Martínez R, Méndez-Tovar LJ, Lavalle P, Welsh O, Saúl A, Macotela-Ruiz E. Epidemiología del
micetoma en México: estudio de 2105 casos. Gac Med Mex 1992; 128: 477-481.
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Background
Factors to development mycetoma:
MYCETOMA IN CHILDRENMYCETOMA IN CHILDREN
Factors Patient’s condition
Hormonal
Inoculum
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Background
Mycetoma is an occupational disease…
Traumas Farm labors More frequent in
boys, maybe help more in farm works
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Ecology
Sub-tropical area: actinomycetoma
Nocardia spp Tropical-Senegalese
climate: Eumycetoma.
Madurella mycetomatis y Pseudoallescheria boydii
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Clinical
Two clinical features:Classical form: swelling, sinuses and
alteration of affected region Milder presentation (mini-
mycetoma): 1 or 2 sinuses (no-swelling). Clinical diagnosis is more difficult
Seldom involvement of bones and viscera
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Six (1)
Eigth (1)
Nine (2)
Ten (2)
Eleven (1)
Twelve (3)
Thirteen (2)
Fourtheen (1)
Fiftheen (2)
Mean 11.2 years
Range: 6-15 years
AgeMYCETOMA IN CHILDRENMYCETOMA IN CHILDREN
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Boys Girls
12 boys 80%
3 girls 20%
Gender MYCETOMA IN CHILDRENMYCETOMA IN CHILDREN
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Foot-leg
Shoulder
Foot
Back
Hand
Clinical
locationMYCETOMA IN CHILDRENMYCETOMA IN CHILDREN
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Farm work 12
Downsyndrome 1
House work 1
None 1
Predisposing factors MYCETOMA IN CHILDRENMYCETOMA IN CHILDREN
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A 10 year old boy Evolution: 2 years Dermatosis
localized to the right leg. Pruritus
Direct exam: Nocardia granules
N. brasiliensis
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A 12 year old girl Evolution: 1 year Dermatosis
localized to the left shoulder. Pruritus
Direct exam: Nocardia granules
N. brasiliensis
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A 15 years old boy Evolution: 3 years Localized to the left
foot. Pain Direct exam:
eumycetic black granules
M. mycetomatis
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A 11 years old girl Evolution: 8 months Dermatosis
localized to the left arm. Pruritus
Direct exam: Nocardia granules
N. brasiliensis
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A 10 years old boy Evolution: 4 months Dermatosis
localized to the left leg. Pruritus & pain
Direct exam: Nocardia granules
N. asteroides
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A 14 years old boy Evolution: 1 year Milking worker Dermatosis
localized to the hand right.
Biopsy: A. madurae granules
Actinomadura madurae
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A 15 years old boy Evolution: 6 months Dermatosis
localized in torax. Pain
Direct exam: Nocardia granules
N. brasiliensis
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A 6 years old girl Evolution: 2 years Dermatosis
localized to the left shoulder. Pruritus
Direct exam: Nocardia granules
N. brasiliensis
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A 17 year old boy Evolution: 4 years Dermatosis localized
to the torax. Pruritus & pain
Direct exam: Nocardia granules
N. brasiliensis
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A 13 years old boy Evolution: 4 years Dermatosis
localized to the torax. Pain
Direct exam: Nocardia granules
No culture
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Lab
Diagnosis
Direct examination (KOH, lugol & ISS) Grains or granules Culture (Sabouraud, PDA, etc.) Identifying microorganisms Biopsy
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N. brasiliensis80%
N. asteroides7%
M.mycetomatis13%
MYCETOMA IN CHILDRENMYCETOMA IN CHILDRENEtiology
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Actinomycetoma: TMP-SMX + DDS Amikacin Amoxicilin/clavulanateEumycetoma: Griseofulvin Ketoconazole, itraconazole
MYCETOMA IN CHILDRENMYCETOMA IN CHILDRENTreatment
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Cure
Improvement
Shortest: 8 months
Longest: 2.5 years
Mean: 1.3 years
MYCETOMA IN CHILDRENMYCETOMA IN CHILDRENTreatmentresponse
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TMS-SMX + DDS
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TMS-SMX + DDS
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TMS-SMX + DDS
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Summary IComment: Successful treatment depends on 3
conditions: the etiologic agent, the extent and depth of the mycetoma, and the patient condition
Good prognosis
- 14 years-old
- Healthy
N. brasiliensis
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Summary IIComment: Successful treatment depends on 3
conditions: the etiologic agent, the extent and depth of the mycetoma, and the patient condition
Bad prognosis
- Deficient GI absorption
- Osteolysis
M. mycetomatis
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Conclusions
Mycetomas are exceptional in children In Mexico actinomycetomas are more
frequent than eumycetomas Clinical and diagnosis is simple Treatment response is better for
actinomycetomas than eumycetomas
• Bonifaz A, Saúl A, Ibarra G, Rosales A, Araiza J, Méndez-Tovar LJ. Micetoma en niños y adolescentes. Monogr Dermatol 2006; 19: 17-23
• Bonifaz A, Ibarra G, Saúl A, Paredes-Solis V, Carrasco-Gerard E, Fierro-Arias L. Mycetoma in children. Experience with 15 cases. Pediatr Infect Dis J 2007; 26: 50-52
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Final
Thank you very much for your attention
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