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BACKGROUND: Mycetoma is considered a neglected disease. It mainly affects the poor population working in the agriculture field. The majority of the cases are diagnosed in the medical unities of primary care. Only a few goes to the specialty's hospitals. OBJECTIVE: To investigate the frequency, type of mycetoma and other epidemiological characteristics of this disease in patients attending a high specialty hospital. MATERIALS AND METHODS: A retrospective, observational and analytic study of the mycology reports from Medical Mycology Laboratory of Specialties Hospital, National Medical Center Siglo XXI, Mexico City, was conducted from 1993 to 2016. RESULTS: Thirty-six cases of mycetoma were recorded: 25 actinomycetomas (22 Nocardia spp and 3 Actinomadura madurae) and 11 eumycetomas (9 dematiaceous fungi and 2 hyaline fungi). Thirty-four of the cases were men between 20 and 50 years old (94.4%). The majority of them were working in the agriculture field. Alcoholism of different level was detected in 100% of the patient as well as smoking in 50% of them. Generally, the patients with actinomycetoma had good therapeutical responses compared to the patients with eumycetoma whose response could only permit the slowdown of the disease spread. CONCLUSIONS: In Mexico, even in an advanced specialty hospital, the eumycetoma prognostic is poor due to the lack of antifungic sensitivity studies and of the special studies for rapid diagnostic like PCR and to the weak therapeutic answer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mycetoma is a chronic inflammatory syndrome acquired after exogenous traumatic inoculation of fungi or actinomycetes. Lactosylceramide (CD17) is a cellular receptor found in macrophages, granulocytes, T cells, and dendritic cells, once activated, it induces cell adhesion to bacteria and fungi with a function in phagocytosis, entrapment, motility, and cell proliferation. OBJECTIVE: To demonstrate the in situ presence of the lactosylceramide receptor in the inflammatory cells that surround the grain in human mycetomas, produced by Madurella mycetomatis, Nocardia brasiliensis and Actinomadura madurae. MATERIALS AND METHODS: Prospective study carried out from October 2019 to February 2020. Nine histopathological studies of patients diagnosed with mycetoma by M. mycetomatis, N. brasiliensis and A. madurae at the Dr. Manuel Gea González General Hospital (Mexico City). We performed two sections per sample: one for staining with hematoxylin and eosin, another for labeling lactosylceramide with anti-human CD17 IgM, and as secondary antibody IgG anti-IgM mouse FITC made in rabbit. RESULTS: A high number of CD17+ cells were observed in the mycetoma sections caused by A. madurae, followed with lower number in those caused by N. brasiliensis and M. mycetomatis, which showed the same frequency. CONCLUSIONS: CD17+ cells were found in all mycetomas studied, which can actively participate in the inflammatory response present in this syndrome. [ABSTRACT FROM AUTHOR]

A 40-year-old male patient of the black race came to the Doctor’s office due to an increase in volume in the right lower limb. Surgical treatment was performed and eumycetoma was diagnosed. The causative agents of mycetomas are of exogenous origin, and can be fungi (eumycetoma) or actinomycetals (actinomycetoma). They are more frequent in men, although they occur with a very low frequency. Several stages of the disease are observed in endemic areas: plaques in early lesions, advanced lesions, nodules with drainage to the bony sinuses and, very rarely, the formation of a cyst of varying size. Histology consists of a mixture of granulomatous and suppurative reaction, in the dermis and the subcutis. [ABSTRACT FROM AUTHOR]

A case of podial mycetoma in a 54-year-old male with rural residence in two endemic areas is described, one long-term in Naguanagua (Carabobo State, Venezuela) and the second of middle-term in Puebla (Mexico). The inflammatory lesion, located on the back of the right foot, was initially treated as erysipela and deserved hospitalization for more than 20 days. The evolution was progressive and insidious with a duration of approximately 10 years until the diagnosis was established; which was performed by clinical evaluation and by anatomopathological study with demonstration of granuloma by living agent, of mycetoma type. The patient referred, as an anecdotal and binding fact, to visit frequently a lagoon in the mountainous sector; denying the presence of intra-domiciliary animals, snails or others. It is recommended to wear reasoned occlusive footwear, when going to areas like this. Epidemiological data and diagnostic guidance are of high value, in individuals from or moving into endemic areas. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mycetoma is an infectious, granulomatous, chronic disease that affects the skin, subcutaneous cellular tissue and bone. It is caused by filamentous bacteria (actinomycetoma) and fungi (eumycetoma). In Mexico, the most frequent causative agent of actinomycetoma is Nocardia brasiliensis, followed by Actinomadura madurae. OBJECTIVE: To evaluate the expression of mannose (MRC1) and complement (CR3) receptors in human neutrophils infected with N. brasiliensis and A. madurae. MATERIAL AND METHOD: An experimental study performed from June to December 2017 was done in which human neutrophils from peripheral blood were infected with N. brasiliensis and A. madurae, the kinetics were followed post infection of 1, 2, 3, 4 and 5 hours. The total RNA was obtained for its subsequent retro-transcription, the quantification of the genes of the receptors was carried out by qPCR and the expression at the protein level was corroborated by confocal microscopy. RESULTS: In human neutrophils infected with N. brasiliensis and A. madurae, a high expression of the MRC1 receptor was detected which was increased from the first hours of infection with both strains, with respect to the CR3 receptor, we found that the neutrophils expressed a discreet way in early times of infection. CONCLUSION: Neutrophils infected with N. brasiliensis and A. madurae on express the mannose receptor MRC1; however, the levels of expression of complement receptor CR3 are low. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Mycetoma is a common inflammatory syndrome in Mexico that mainly affects the skin, subcutaneous tissue and to a lesser extent, fascia, muscles and even bones and internal organs. It is caused by actinomycetes (actinomycetoma) or true fungi (eumycetoma). Intense inflammation penetrates grains actinomycetoma by releasing enzymes such as b-glucuronidase. OBJECTIVE: To evaluate neutral polysaccharide degradation in the grains with Nocardia brasiliensis β-glucuronidase treated of neutrophils. MATERIAL AND METHOD: Three studies were conducted in grains of patients with actinomycetoma by N. brasiliensis assisted at the Dermatological Center Ladislao de la Pascua, Mexico City: a) Quantification of the difference in weight of grains treated with b-glucuronidase from neutrophils. b) Quantification of total sugars released by polysaccharide degradation of N. brasiliensis grains, by the phenol-sulfuric method. c) In histological sections provided by the same hospital, the determination of the enzymatic activity of b-glucuronidase present in the grains, with the use of the kit of lymphocyte enzymes Sigma Aldrich No. 181-C was performed. RESULTS: Difference in weight in grains of N. brasiliensis treated with b-glucuronidase from neutrophils after 96 hours of treatment was 58% on average, when using an enzyme concentration of 200 and 100 units/ mL. Concentration of total sugars by the method of phenol-sulfuric, supernatants from degradation grains N. brasiliensis using 195 units/ mL of enzyme was 27.2 mg/mL and 97 units/mL of enzyme was 21 mg/ mL. Enzymatic activity of b-glucuronidase was observed in red color, which is result of the reaction of Naphthol AS-BI-b-D glucuronic acid. CONCLUSION: b-glucuronidase enzyme from neutrophils has good enzymatic activity on the cement binding (neutral polysaccharide) of grains of actinomycetoma caused by N. brasiliensis. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is the most common subcutaneous mycosis in Mexico; however, until now, there is no clear evidence on why this infection is infrequent in children. To our knowledge, there are only few published studies regarding mycetomas in pediatric patients. Objectives: To describe epidemiologic and clinical findings in cases of mycetoma in children. Material and method: A retrospective study was done throughout a 14-year-period in search of mycetomas in pediatric patients at the Dermatologic Institute of Jalisco Dr. José Barba Rubio. Results: In total 189 cases of mycetoma were identified, 19 cases corresponded to patients under 18 years old (10%), incidence of 1.3 cases per year. The oldest was 17 years and the youngest was 6 years, with a mean age of 13 years old. It hardly predominated in men (11/19) with an average duration of the disease of 23.15 months. The most common area affected was lower limbs in 10/19 cases. Direct microscopy examination was positive in 17/19 cases and isolation by culture was achieved in 13/19 cases, identifying Nocardia spp in all cases. Patients were treated under a trimethoprim-sulfamethoxazole regimen in 15/19 cases, as monotherapy or combined medical treatment. Conclusion: Mycetomas in children are rare and it could be explained by the absence of sexual hormones at this age; however, the clinical findings are similar as in adults. [ABSTRACT FROM AUTHOR]

Background: The mycetoma is a clinical inlammatory syndrome with sinus tracts draining a seropurulent exudates and affecting skin and subcutaneous tissue and bones. In Mexico, actinomycetomas are the most common in 97.9% and eumycetomas only in 2.1%. Nocardia has a high incidence with 86.5% of these etiological agents N. brasiliensis is the most important one, followed by Actinomadura madurae with 10%. Grains in actinomycetoma are composed of bacteria amalgamated by a polysaccharide and surrounded by polymorphonuclear which are producing enzymes in their pellets specific such as collagenase, alkaline phosphatase, lysozyme, and lactoferrin, the latter is important for its bacteriostatic, bactericide and immunomodulatory action. Objective: To demonstrate the presence of the enzyme lactoferrin in grains of patients with actinomycetomas in humans. Material and method: Eight biopsies of patients with diagnosis of actinomycetoma from Dermatological Center Dr. Ladislao de la Pascua and General Hospital Dr. Manuel Gea González were done. Two cuts were made by biopsy, one for H-E and the other for the marking of the lactoferrin enzyme. We used the commercial kit Cell and tissue staining kit goat kit HRP-AEC system (catalog no. CTS009) R&D systems, and the primary antibody that was used was the IgG polyclonal anti-human lactoferrin made in goat by Santa Cruz Biotechnology laboratories. Results: In general the actinomycetomas showed the presence of lactoferrin from activated neutrophil polymorphonuclear. In actinomycetomas by A. madurae, we found a 66.6% of high concentration of lactoferrin in the grain, and 33.3% of low concentration. To analyze the actinomicetomas produced by N. brasiliensis 60% of high concentration of lactoferrin in the grains, 20% of moderate concentration and 20% of low concentration. Lactoferrin is released within the actinomycetoma grain, on the way the cell inside them during the inlammatory process, releasing the contents of their granules side (or specific) directly to the environment, to try to eliminate and control the infection. Conclusion: Lactoferrin is present and attached in the grains of the actinomycetomas, with a high or signiicant concentration according to our assessment, suggesting that it exerts its bactericidal or bacterio-static action participating as one of the mechanisms of innate immune resistance in this pathology. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic infection of skin and subcutaneous cell tissue characterized by enhanced volume and sinnuses, which drain serum-purulent material caused by Nocardia sp. (actinomycetoma) as well as fungi (eumycetoma). Foot is affected in 80% and abdominal mycetoma is an atypical form of presentation. In abdominal mycetoma exists risk of visceral affection. Patients with abdominal mycetoma and sepsis could present general attack, anemia, weight loss, which are mainly due to bacterial infection and sepsis. In those cases it would be useful a double therapeutic scheme with amikacine and imipenem. This patient reports the case of a patient with abdominal mycetoma and therapeutic response to imipenem in combination with amikacine. [ABSTRACT FROM AUTHOR]

We communicate the case of a scholar child with a minimycetoma on the right shoulder of six months evolution. Minimycetomas affect children, adolescents or young adults. Their etiological agent is Nocardia brasiliensis, and affect mainly the face, trunk and upper extremities. They are of small size, with a few fistulas; they do not increase volume nor deform the region involved, neither reach deep structures. They can be single or multiple and have a good prognosis, since they respond adequately to sulfones or sulfonamides. They are not incipient mycetoma since they do not evolve to the classical type despite of time. [ABSTRACT FROM AUTHOR]

This paper reviews the case of a 45-year-old male, farmer, who presented with a localized lesion on the left foot (back and both sides) with increased volume, and fistulae of a 5-year evolution. Clinically, micetoma was suspected and micribiological studies identified the causative agent to be Actinomadura madurae. The radiography showed involvement (geodes) at the metatarsal bones. Treatment was initiated with trimethoprim sulfamethoxazole, diaminodiphenylsulphone and proteolytic enzymes, showing improvement after three months of treatment. [ABSTRACT FROM AUTHOR]

Background: The mycetoma is a chronic syndrome, granulomatous, subcutaneous and inflammatory disease caused by several species of true filamentous fungi (eumycetoma) or filamentous bacteria (actinomycetoma). The syndrome is characterized by a volume increase, deformation of the area and multiples nodules, that suppurate and drain serous or purulent exudates, in which the parasite is forming grains. These causative agents are usually present in the soil and they enter in to the subcutaneous tissue trough traumatic inoculation. In the actinomycetoma has been observed there is not a performance of the antigen presentation and there is not lymphocytes TCD4 H1 activation either, therefore there is not presence of the secretion of INF-γ. And the presence of pro-inflammatory cytokines is being carried out through the activation of keratinocytes. Objetives: Demonstrate the participation of the acquired immune response with the presence of Lymphocytes TCD4 H1 producers of the INF-γ (activation), in a histological section of patients diagnosed with eumycetoma. Methods: Seven biopsies of patients with diagnosis of eumycetoma were analyzed (three slides from each patient), and stained with Hematoxylin- Eosin, anti-CD4+ human (FITC), anti-CD8+ human (RE) and anti-INF-γ human (Avidin-Biotin). Results: The presence of TCD4+ H1 lymphocytes and INFγ was found in all studied eumicetomas. Conclusions: Unlike of actinomycetoma, in the eumycetoma was found the presence of Lymphocytes TCD4+ H1 INF-γ producers. Thus through this cytokine is carried out the macrophages activation for the secretion of TNFα and IL-1β (pro-inflammatory cytokines), in the inflammatory reaction of this syndrome. [ABSTRACT FROM AUTHOR]

Mycetoma is divided in two groups due to its etiology: eumycetoma, that is caused by white and black true fungi, and actinomycetoma caused by actinomycetes (aerobic and filamentous bacteria). In Mexico, these diseases are frequent due to the fact that our country belongs to the ecological strip of mycetoma, being the actinomycetomas the most common ones. We describe the case of a 81-year-old male with a located dermatosis, affecting the right foot, characterized by increased volume of the affected area, nodular lesions, multiple sinus tracts with pus. There were performed direct examination of the seropurulent material, cultures and biopsy of the lesion. The diagnosis was compatible with actinomycetoma caused by Actinomadura pelletieri. The therapy consisted of trimethoprim-sulfamethoxazole and diamino-diphenyl sulfone during one year and two months, obtaining clinical and microbiological cure. [ABSTRACT FROM AUTHOR]

Background: Actinomycetoma due to Actinomadura madurae is a chronic infection of skin and adjacent tissues. It is characterized by increased volume and fistulas draining a phyllant exudate, containing the grains. Objetive: To determine the in vitro susceptibility of Actinomadura madurae to kanamycin sulphate, as well as toxicity in infected and non infected murine peritoneal macrophages. Material and method: It was investigated the susceptibility of Actinomadura madurae to several antibiotics —amikacin, erythromycin, ethambutol, kanamycin, penicillin-streptomycin, rifampicin and trimethoprim-sulfamethoxazole—, by antibiogram assay in bacterial cultured in agar and inside phagocytic cells, as well as the toxicity of murine peritoneal macrophages infected and non infected by actinomycetes. The used strains were isolated from five patients of the Mycological Service, of the Dermatological Center Dr. Ladislao de la Pascua, who had mycetoma dye to A. madurae with bone affectation and bad response to conventional treatment. Antibiotic levels in assays were similar to those used in clinical practice, by kg of weight and by day. Results: The most effective antibiotic against these strains was kanamycin. Conclusions: Kanamycicin represents an advisable antibiotic for the treatment of patients with actinomycetomas due to Actinomadura madurae with bone affection, bad prognosis topography and resistance to conventional treatment. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is a chronic, infectious and granulomatous process that affects skin, subcutaneous tissue and bone. It is produced by bacteria (actinomycetoma) or fungus (eumycetoma). In Mexico, the most common agent causing actinomycetoma is Nocardia brasiliensis followed by Actinomadura madurae. For diagnosis it is necessary to identify the etiologic agent (grain) by direct exam, culture, and histopathological study. The gold standard treatment is diaminodifenilsulfona (DDS) plus trimethoprim/sulfamethoxazol (TMP/SMX); in patients with bad-prognosis topography and bone and/or visceral affection, amikacin in added to this treatment; thus, the use of kanamycin in the treatment of actinomycetomas arises from the need of an efficacious and low-cost drug. Objective: To show the efficacy of kanamycin, added to trimethoprim-sulfamethoxazole and DDS, in patients with diagnosis of actinomycetomas due to Nocardia brasiliensis and Actinomadura madurae with topography of bad prognosis and bone and/or visceral damage. Patients and method: At the Mycology Service of the Dermatological Center Dr. Ladislao de la Pascua, 20 patients with Nocardia brasiliensis and Actinomadura madurae actinomycetomas resistant to conventional treatment were studied. To the conventional treatment of TMP-SMX (160-800 mg/12 h) and DDS (100 mg/day) kanamycin sulphate (15 mg/kg/day) was added in cycles of 14 days with interval of one month; depending on the clinical features 2-4 cycles of kanamycin sulfate were administered. Results: The clinical improvement was achieved in all patients in a mean time of three months. Cure, corroborated by a microbiological study, was obtained in 18 patiens (90%) in a mean time of seven months. Radiological improvement was observed in 50%-70% of cases. Conclusions: Considering the good clinical and radiological response in our group of study, we propose this therapeutic scheme as an efficient and safe alternative in the treatment of actinomycetomas, with topography of bad prognosis and bone and/or visceral damage. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic granulomatous disease frequent in Mexico (Morelos, Guerrero, Veracruz and Michoacan), usually limited to skin and subcutaneous tissue, but there are topographies as the thoracic and abdominal considered a bad prognosis by the visceral dissemination. We report the case of a male patient with a diagnosis of mycetoma by Nocardia brasiliensis in chest and lung involvement, with good response to treatment with trimethoprim-sulfamethoxazole and amikacin. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is a clinical syndrome that consists in deformant, inflammatory, painless lesions, and fistulae affecting cutaneous and subcutaneous tissues, aponeurosis and bone; usually in feet. Histologically, the lesion has been described in three zones: first closer to grain or zone 1 composed mainly by neutrophils and macrophages; the zone 2 by lymphocytes T, and the distant zone or zone 3 by lymphocytes B. Macrophages and neutrophils are recruited by chemoattractants derived by complement molecules possibly as consequence of IgG, IgM and complement present in surface and filaments surrounding the grain. In last decade, it has been demonstrated that keratinocytes participates actively in innate immune response, because they express Toll-like receptors (TLRs) and are an important source of cytokines, chemokines and antimicrobial peptides. Besides, these cells are able to express class II MHC antigens. In consequence, keratinocytes have an important role in epidermic immune response and now they are considered an inductor to adaptative immune response. Objective: To demonstrate keratinocyte activation as a producer of proinflammatory cytokines (IL-1β and TNF-α) in actinomycetoma by Nocardia brasiliensis and Actinomadura madurae. Material and methods: Biopsies from patients with mycetoma by N. brasiliensis and A. madurae were provided by Mycology Department from Dermatological center Dr. Ladislao de la Pascua and Dr. Manuel Gea González Hospital. The histopathological study was made by H-E stain to find and characterization of grains. For detection of interleukins (IL-1β and TNF-α) in situ, immunohistochemical analysis was done using Cell and tissue staining kit, HRP-AEC, R&D Systems. Results: IL-1β and TNF-α were observed bounded to grains and in epidermis (keratinocyte zone), where the stain was intensified due the presence of high concentration of these cytokines. Conclusion: The presence of polymorphonuclear neutrophils activated is consequence of proinflammatory mediators secretion derived from keratinocytes. As a result of this fact, the immune innate response is evident in this syndrome. [ABSTRACT FROM AUTHOR]

The mycetoma is a chronic infectious, granulomatous process, caused by actinomycetes and eumycetes, in Mexico Nocardia brasiliensis is the most common causative agent actinomycetoma, followed by Actinomadura madurae. It is more common in adult women, usually located in the foot, with uncommon extrapodal locations. We report the case of a male patient with clinical and microbiological characteristics, who also had pulmonary tuberculosis and evolved satisfactorily with antifìmic treatment, in addition to trimethoprim-sulfamethoxazole. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is an inflammatory syndrome frequently in Mexico. Affects skin and subcutaneous tissue, muscle, bone and internal organs. It is caused by actinomycetes or true fungus. In histopathological studies of this pathology, the epidermic alteration has been shown as irregular acanthosis and pseudoepitheliomatose hyperplasia near the fistulose tract. Objective: To determine the presence of leukocytoclastic vasculitis in mycetoma lesions induced by Nocardia brasiliensis and the presence of inflammatory subpopulation cells that participate in the establishment and development of this syndrome by histological techniques and the detection of tumor necrosis factor alpha (TNF-α) by immunohistochemical methods. Material and methods: Nocardia brasiliensis was isolated from a mycetoma patient diagnosed in General Hospital Dr. Manuel Gea González in Dermatology and Mycology Service. A suspension was prepared to reach 100 mg/mL. Sixty two Balb/c female mice with 45-60 days old and 20-25 g weight were used. 0.02 mL of the suspension was administrated by subcutaneous route in right foothpad and 0.02 mL of sterile physiologic saline solution in left foothpad (control). The animals were sacrificed by cervical dislocation according the calendar: 24 hours, 15 days, 1 month (m), 2m, 2.5m, 3m, 3.5m, 4m, 5m, 5.5m, 6m and 6.5m). The feet were removed and fixed in formol at 10% and histologically processed to hematoxylin-eosin and Ziehl-Neelsen stain. To immunohistochemical stain R&D system HRP-AEC was used (catalog CTS009) avidine-antibodies: anti-mouse TNF-α (R-19) (goat polyclonal IgG, Santa Cruz Biotechnology). Results: The presence of leukocytoclastic vasculitis in mycetoma by Nocardia brasiliensis in mice was 23%. Conclusions: Acute process was established with neutrophils present at 24h and 15d post-inoculation, after a month the infiltrate changed and the epithelioid as vacuolated histiocytes, lymphocytes and some plasmatic cells were mainly observed. Finally after the third month the presence of neutrophils around the grain and abundant histiocytes were evident. The presence of TNF-α adhered to the grain after two months post inoculation right up until the end of the study was observed. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is a clincal syndrome that consists of inflammatory, painless, and deformant lesions and fistulaes that affect cutaneous and subcutaneous tissues, aponeurosis and bone. It is produced by bacteria (actinomycetoma) or fungus (eumycetoma); it is more frequent in men and is considered an occupational illness. For diagnosis should be necessary to identify the etiologic agent (grain) by direct exam, culture, and histopathological study where mixed inflammatory infiltrate is observed surrounding the grain. Three inflammatory zones has been described according the cell arrangement. Zone 1 is characterized by neutrophils surrounding the grain; zone 2 or medium has macrophages and giant cells, and peripheral zone (3) has lymphocytes and plasmatic cells. Immunohistochemical tests show that cells that surround the grain (neutrophils) are positive reaction to CD15, in the middle zone the cells are positive to CD68 (macrophages) and CD3 (T lymphocytes) and in the peripheral zone the CD20+ (B lymphocytes) are present.Objectives: To study the intervention of T lymphocyte by the INF-γ, IL-4 and IL-10 expression in human mycetoma and to observe how the regulation of inflammatory response that involve T lymphocytes is carried out, whether stimulating by INF-γ production or inhibiting IL-4 and IL-10 (Th2) in human mycetoma.Material and methods: Biopsies of mycetoma were obtained from patients of dermatology service at Hospital General Dr. Manuel Gea Gonzalez. Nine samples were studied: five with mycetoma by Nocardia brasiliensis, one with mycetoma by Actinomadura madurae and three eumycetomas (Acremonium, Madurella mycetomatis and M. grisea). Biopsies were fixed in paraffin, and immunohistochemical test was carry out with Cell and tissue staining mouse kit R&D Systems HRP-AEC SYSTEM (catalog CTS003) (Avidin-biotin y 3,3'diaminobenzidine), anti-hINF-γ purified mouse monoclonal IgG1 (MAB304 R&D), anti-hIL-4 purified mouse monoclonal IgG2A (MAB285 R&D) y anti-hIL-10 purified mouse monoclonal IgG2B (MAB217 R&D). Results: In eumycetomas, 50% of cytokines present are IFN-γ, 33% are IL-10, and 17% are IL-4. However in actinomycetoma T cell cytokines profile was 35% for IFN-γ, 38% corresponds to IL-14 and 27% to IL-10.Conclusion: Lymphocytes populations that participate in immunological response in mycetoma are mainly CD4+ Th1 and CD8+ T (both secreting IFN-γ), lately the control depends on CD4+ Th2 lymphocytes (secreting IL-4 and IL-10). This fact could explain the regulation between stimulating and inhibitory cytokines from cellular response in this syndrome. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is a clinic syndrome consisting of inflammatory deforming, painless lesions and fistulaes that affects cutaneous and subcutaneous tissues, aponeurosis and bone. It is a consequence of traumatic microorganisms' implantation from soil to the tissues. En 1962, Gonzalez-Ochoa observed that patients with actinomycetoma by Nocardia brasiliensis who experienced a positive skin reaction to nocardin or tuberculin had a good prognosis; meanwhile high antibody titles were associated to severe illness. Production of IL-1 and TNF by macrophages was inhibited by IL-10; this cytokine has anti-inflammatory action related to its ability to regulate the synergic proinflammatory activity of IL-1 and TNF, because these molecules amplify this response by the secondary induction of mediators as chemokines, prostaglandins and platelet activator factor (PAF).Objective: To study the IL-10 and IL-1β expression on human peripheral mononuclear blood cells (PBMC) stimulated in vitro with Actinomadura madurae, Nocardia asteroides, Nocardia brasiliensis, Candida albicans and Madurella mycetomatis as mycetoma agents and correlate these findings to the IL-10 secreted.Material and methods: PBMC were activated with Actinomadura madurae, Nocardia asteroides, Nocardia brasiliensis, Candida albicans and Madurella mycetomatis. Supernatant IL-10 was measured by ELISA technique (R&D commercial kit, Inc. Minneapolis, MN, USA Cat D1000). Total RNA from cells was obtained, and amplification by only step RT-PCR was done (Access Quick™ RT-PCR System Cat A1720) using a primer for IL-10 (human IL-10 primer pair, Biosource) and another for IL-1β (human IL-1β primer pair, Biosource).Results: production of IL-10 by PBMC stimulated in decreasing order was: Actinomadura madurae, 43.7 pg/mL; Candida albicans, 38.3 pg/mL; Nocardia brasiliensis, 22.9 pg/mL; Nocardia asteroids, 20.4 pg/mL and Madurella mycetomatis, 19.4 pg/mL. Conclusion: In advanced stages on Actinomadura madurae, Candida albicans, Nocardia brasiliensis, Nocardia asteroides and Madurella mycetomatis infections, IL-10 produces anti-inflammatory and immunomodulator effects, because can avoid the destruction of these microorganisms in phagocytic cells, allows their survival inside these cells and favours the chronicity of the infection. [ABSTRACT FROM AUTHOR]

Background: The actinomycetic mycetomas, mainly by Nocardia brasiliensis, show prematurely tendency to invade profound tissues, and so the serious prognostic in the dorsal localization that invades the vertebral channel and the spinal cord. Objective: To demonstrate the blood dissemination and the invasion to organs by Nocardia brasiliensis since footpad mycetoma in Balb/c mice. material and methods: Thirty nine Balb/c mice were inoculated with 0.15 mL of a Nocardia brasiliensis suspension (1 mg/mL) by footpad route. The control animals received the same volume with saline solution. The animals that showed systemic symptoms were dissected and their brain and kidneys were analyzed by haematoxilin-eosin and Ziehl-Neelsen stains. Besides, the cultures in Sabouraud agar to reisolate the microorganism were done. Results: All the animals developed Nocardia brasiliensis mycetoma in footpad, only three mice showed blood dissemination manifestations as granulomatous lesions and numerous fast acid resistant thin bacilli in kidney and brain associated with brain damage without inflammatory reaction in these organs or grain presence. Conclusion: Nocardia brasiliensis is able to disseminate and invade organs by blood since mycetoma in extremities in 7.6% of the cases, during murine experimental infection. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is an infection caused by fungi (eumycetoma) or by actinomycetes (actinomycetoma). In Mexico in 70% is due to Nocardia brasiliensis. The usual treatment is dapsone (DDS) plus trimethoprim/sulfamethoxazol (TMP/SMX). Objectives: To present 15 cases of actinomycetoma cured or with a good clinical amelioration with antimicrobial drugs. Material and methods: A retrospective study was made in the department of dermatology of the General Hospital Dr. Manuel Gea González between 1995 and 2005. The data of 15 patients were evaluated (11 men and 4 women). The diagnosis of mycetoma was confirmed by direct examination, obtaining a biopsy and bacteriological culture. Results: Treatment was given from 4 months to 4 years, with an average of 12.4 months. The most commonly used drugs were the association of TMP/SMX and dapsone in 14 patients (93.33%). One was treated with imipenem plus amikacin due to failure with previous drugs during 3 months. Seven healed with TMP/SMX plus dapsone (46.66%), 3 (20%) needed two additional cycles with imipenem-amikacin. Four patients (26.66%) had adverse events to dapsone and the treatment was changed to minocyclin and rifampicin. Out of the 15 cases, 9 cured (60%) while 6 presented clinical amelioration and bacteriological cure (40%). Conclusions: The cases of actinomycetoma were treated with trimethoprim-sulfamethoxazol and dapsone an average of one year, achieving cure in 54% of the cases. When additional therapy was required, imipenem-amikacin was given and when adverse events to dapsone were present, we administered minocyclin or rifampicin. [ABSTRACT FROM AUTHOR]

Rafael Medina Jiménez (1870-1925), an outstanding Venezuelan physician was the founder of medical mycology in Venezuela. He published four articles in the "Gaceta Médica de Caracas" about medical mycology; the first three of them, written between 1914 and 1916, were fundamental in this field. His great interest in clinical and epidemiological aspects of dermatomycoses was notable. He proposed, by the first time, the need for searching clinical cases of mycetoma and sporotrichosis in our country. His technical procedures at the laboratory and the properly based research he carried out, constitute cornerstones for all medical doctors. Beyond any doubt, he is the founder of medical mycology in Venezuela. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic infection disease of the skin that may be produced by bacteria or fungi. In Mexico, most mycetoma cases ate produced by Nocardia brasiliensis. Little is known about the pathogenicity mechanisms of Nocardia infections in human beings. Information in the literature was mainly obtained in vitro using experimental animals infected with the GUH-2 Nocardia asteroides strain by Beaman and his coworkers. They demonstrated that in the case of Nocardia asteroides infections in mice, the bacterial growth-phase, presence of superoxide dismutase and catalase, the cord factor (trehalose 6,6-dimycolale). the inhibition of phagosome-lysosome fusion and the blockage of phagosomal acidification are responsible for pathogenicity and virulence of Nocardia asteroides. However, about 50% of human infections with this bacterium occur in immuno-competent persons and the proposed mechanisms do not explain the tissue damage observed in all human patients. In the case of Nocardia brasiliensis infections, we have suggested that intra-and extrabacterial proteases are, in part, responsible for the osteolytic lesions that are found in actinomycetoma cases and play a role in pathogenesis. [ABSTRACT FROM AUTHOR]