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Background Few central nervous systems (CNS) cases of actinomycetoma have been recorded in the literature, and most were reported in tropical and subtropical regions. The management of this invasive infection is difficult, especially when it affects the spine and the cranio-cervical regions. Case We report an unusual case of a cranio-cervical junction actinomycetoma, in a patient presenting a cerebellar syndrome from brainstem compression. The CT scan showed a compressive solid osteolytic lesion in the cranio-cervical junction. The patient underwent cranio-cervical decompression and lesion resection. The diagnosis of actinomycetoma was confirmed on immune-histochemistry and molecular analysis. At 4 months' follow-up, the patient presented a fatal recurrence disseminating within the cerebellum and the spine. Conclusion The surgical treatment of CNS actinomycetoma presented poor prognosis and a disseminating recurrence. We believe that clinicians and surgeons must be informed about these "new" infectious pathologies that are so difficult to treat, especially with the arrival of migrant patients from endemic countries in conflict.

Endoscopic prelacrimal recess approach is a promising technique for treating various maxillary sinus diseases because it allows for adequate visualization and wide access to the entire maxillary sinus. However, the incidence of absent prelacrimal recess (PLR) has ranged from 7% to 17.5%, implying that there is a limitation for the application of EPLA in this population. Here, a male patient with concomitant Krouse T2 maxillary inverted papilloma and mycetoma presenting with unilateral nasal obstruction and blood-tinged secretion is described. The presurgical computed tomography showed no recess. By dislocating the nasolacrimal duct from the bony canal and removing the medial maxillary wall sufficiently to extend the surgical corridor; and by preserving the inferior turbinate, nasal mucosa, and nasolacrimal duct, the patient did not experience any postoperative complications. In conclusion, our modified technique may be an effective and safe strategy for treating maxillary sinus disease without prelacrimal recess.

Cunninghamella is a member of the class Zygomycetes. Cunninghamella species include ubiquitous filamentous fungi; infections caused by Cunninghamella species are less frequent but have higher mortality rates than infections caused by Mucorales group members such as Rhizopus and Mucor. Herein, we reported a rare fatal case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae tracheobronchial mycetoma. A 73-year-old female with a history of right-sided breast cancer who had undergone mastectomy 11 years previously and had no recurrence presented to our emergency department with a 1-week history of left-sided back pain. Chest X-ray revealed left lung atelectasis; bronchoscopy revealed an endobronchial mass lesion in the left main bronchus. Pathological examination revealed fungal mycetoma but malignant lesions were not detected. Endobronchial and lung mycetoma caused by Cunninghamella bertholletiae were initially diagnosed; liposomal amphotericin B was administered, but her condition deteriorated. Rigid endoscopy showed growth of hemorrhagic tissue occupying the left main bronchus just under the carina. Pathological examination of the shaved lesion revealed metastasis from breast cancer covered with abundant necrotic tissue. No mold was observed in the necrotic tissue; this was probably due to liposomal amphotericin B treatment. To our knowledge, this is the first case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae mycetoma. Distinguishing endobronchial metastases from breast cancer and atypical presentations of Cunninghamella endobronchial mycetomas can be very difficult. Repeated bronchoscopies maybe helpful in establishing an accurate diagnosis when clinical prognosis does not match the initial diagnosis.

Eumycetomas are chronic subcutaneous pseudo-tumoral infections, endemic in arid tropical areas, which are caused by exogenous fungi that produce grains in vivo. The objective of our work is to establish their epidemiological, clinical and mycological profile in our Moroccan context. Therefore, we conducted a retrospective study, extending from 1975 to 2019, compiling all cases of eumycetomas that were diagnosed in the parasitology-mycology laboratory of the Ibn Sina University Hospital of Rabat. The diagnosis, based on the swabbing of exudates and eventual grains or the study of biopsies, included the direct examination of 30% KOH mounts, the realization of appositions colored by May-Grunwald-Giemsa and the incubation on 3 Sabouraud media at 27° and 37 °C. In 44 years, 12 cases of eumycetoma have been diagnosed, with a male to female ratio of 5:1 and a mean age of 44.8 years. The lesions, evolving from 1 to 30 years, were podal in 10 cases, popliteal and gluteal in one case each, with osteolysis in 3 patients. The collected grains were black in 9 cases, white in 2 others. Direct examination was unanimously positive, revealing entangled hyphae, whilst culture isolated Madurella sp. in 9 cases, Trichophyton rubrum, Acremonium sp. in one case each and remained sterile in the last case. The treatment was medical in 8 cases, medico-surgical in 3 others, with loss of sight of most patients.

Simultaneous double mycetoma is a rare presentation. Worldwide only three to four cases are found in literature. Here we report such an unusual case, to the best of our knowledge first documented case from India, where a 60 years old male farmer presented with double eumycetoma in different sites of same limb with discharge of black and white grains, which conventionally diagnosed as Madurella grisea from foot and Acremonium falciformi from buttock respectively.

Mycetoma is a chronic granulomatous inflammatory disease that is caused either by bacteria or fungi. Bacterial mycetoma (actinomycetoma) can be caused by various causative agents of the genera Nocardia, Streptomyces and Actinomadura. On the other hand, fungal mycetoma (eumycetoma) is most commonly caused by causative agents belonging to the genera Madurella, Scedosporium and Falciformispora. Early and accurate diagnosis of the causative organisms can guide proper patient management and treatment. To allow rapid and accurate species identification, different molecular techniques were developed over the past decades. These techniques can be protein based (MALDI-TOF MS) as well as DNA based (Sequencing, PCR and isothermal amplification methods). In this review, we provide an overview of the different molecular techniques currently in use and identify knowledge gaps, which need to be addressed before we can implement molecular diagnostics for mycetoma in different clinical settings.

Resume Introduction Les mycetomes sont des affections cutanees infectieuses rares causees par des agents de nature fongique ou bacterienne. Elles siegent preferentiellement sur les extremites. Nous rapportons ici un cas original de mycetome polyfistulise chez un commercant camerounais. Observation Une masse cutanee polyfistulisee etait recue au laboratoire d’anatomopathologie. Elle provenait d’un commercant de 30 ans, sans antecedents particuliers, vivant a Yaounde qui avait ete vu en consultation pour une lesion de la plante du pied apparue plusieurs mois auparavant. Cette lesion, au depart se serait presentee sous la forme d’un nodule dur et indolore qui aurait par la suite fistulise a la peau. Ces faits cliniques ne permettant d’evoquer un diagnostic certain, on avait procede a une exerese chirurgicale de cette masse et une analyse anatomopathologique avait ete requise. L’examen histopathologique usuel couple a des colorations speciales avait revele le diagnostic de mycetome d’etiologie fongique. Discussion Cette observation decrit un cas original de mycetome d’origine fongique non suspecte cliniquement, survenu chez un commercant camerounais, vivant en milieu urbain et en dehors de toute zone d’endemicite de mycetome. Ce cas pour lequel le diagnostic etait pose en histologie confirme l’apport indeniable de l’anatomopathologie au diagnostic de certitude. A notre connaissance, et selon les donnees disponibles, c’est la premiere fois qu’un mycetome soit decrit en milieu urbain au Cameroun.

The deep mycoses are uncommon in our setting. These fungal infections occur mainly in immunosuppressed patients or in tropical climates, and include subcutaneous infections and systemic infections. The skin is always involved in the former. In the first part of this review, we describe the main subcutaneous mycoses: sporotrichosis, chromoblastomycosis, mycetoma, phaeohyphomycosis, hyalohyphomycosis, and lacaziosis. Early recognition and treatment is important, as these infections are frequently associated with high morbidity.

Botryomycosis is a chronic bacterial infection that manifests clinically as tumours or plaques that are often ulcerated and have discharging sinuses draining small white-coloured granules. Therefore, they closely mimic mycetoma or other fungal infections. It is most commonly caused by Staphylococcus aureus. It can present as cutaneous or visceral disease. The cutaneous form can invade deep tissue leading to extensive destruction and disfigurement. A 31-year-old female presented with progressive swelling of her right foot over a period of 8 years. She had a disfigured right foot with multiple sinuses discharging pus. X-ray and magnetic resonance imaging of the foot showed invasion and destruction of the deep layers of the foot including the bone. Deep biopsy from the foot showed an abscess cavity with Gram-positive cocci within and bacterial culture grew S. aureus establishing the diagnosis of botryomycosis. Botryomycosis is a rare presentation of a common pathogen and needs to be considered while evaluating a chronic invasive subcutaneous infection.

Recently, the prevalence of invasive fungal infections (IFIs) is rising. The global mortality rate of IFIs is 10-49%. This study aimed to determine the prevalence, the causative agents, and the risk factors associated with the invasive fungal infections in a tertiary health center to provide valid decision-grounds for healthcare professionals to effectively prevent, control, and treat fungal infections. The current study was conducted on 1477 patients suspected to have systemic fungal infections from different units of the hospital. After screening using routine mycological examination, the patients were confirmed with complementary mycological and molecular methods. Patients were included based on the confirmed diagnosis of IFI and excluded based on lack of a microbiologically and histologically proven diagnosis of IFI. Of the 1477 patients recruited in this study, confirmed cases of fungal infection were 490 (169 proven; 321 cases probable). Among the fungi recovered, Candida species had the highest frequency 337 (68.8%) followed by Aspergillus species 108 (22.1%), Zygomycetes species 21 (4.3%), non-Candida yeast 9 (1.8%). Others were black fungi 5 (1%), mycetoma agents 5 (1%), Fusarium 4 (0.8%), and Trichoderma (0.2%). Hematologic malignancies and diabetes mellitus were the most common underlying diseases among IFI-confirmed patients. This study observed an increased frequency of invasive candidiasis with non-albicans Candida and other invasive saprophytic fungal infections. The increased rate of invasive candidiasis with non-albicans agents highlights a new perspective in the epidemiology and treatment of invasive fungal infections.

Maduromycosis, commonly called Madura foot, is an infectious pathology caused by fungi or bacteria, and it is native of the tropical, subtropical and equatorial areas. This paper presents a well preserved male skeleton, between 23 and 57 years old from a medieval necropolis (13th-15th centuries) in Estremoz, Portugal.The left foot of this individual showed marked alterations on the morphology of the calcaneus and cuboid that are ankylosed, which led to arthrosis of the calcaneous and talus. The five metatarsals have bone destruction and irregular subperiosteal new bone formation with multiple lytic foci and progressive osteoporosis with very little reactive bone formation. After a careful differential diagnosis, taking into consideration various pathological conditions,it was concluded that this is a possible case of maduromycosis.This study suggests that in the past this pathology could have been present in Europe, particularly in the Mediterranean region, and especially when the climatic conditions were conducive. This could be one of the first cases of maduromycosis infection published in an archaeological context.

The Aspergillus species is a ubiquitous fungus, which can cause pathogenic and opportunistic fungal infections in the immunocompromised. This is an atypical occurrence in the host with an otherwise normal immune status. We report a case of an immunocompetent 45-year-old patient who developed cutaneous aspergillosis with a very benign course presenting simply with a gradually enlarging mass and none of the classical signs and symptoms. All prior laboratory examinations failed to detect or reproduce the organism or establish a diagnosis. Surgery was both diagnostic and therapeutic, to remove the mass which causes the patient pain and limitation of activity. This was to our advantage because the fungal elements were very well encapsulated and the mass was a well-organized conglomeration of cystic abscesses that even prolonged chemotherapy alone might not succeed in eradicating the infection.

Mycetoma is a bacteriological or fungal infectious disease affecting the skin and/or soft tissues, which can be complicated by bone involvement. The most common feature is a tumor of the foot, but extrapodal localizations have been described. We report one case of a 47-year-old man who presented with tumefaction of a leg with multiple skin fistulae. Histopathological examination permitted to confirm the diagnosis of actinomycetoma and TDM showed the degree of bone and soft tissues involvement. Our case was characterized by the very inflammatory aspect of the tumor, its localization to the leg without foot involvement, the modest functional signs compared to the importance of radiological bone involvements, the deep destruction of the fibula while the tibia was apparently intact and the good response to treatment. In spite of its characteristic features, diagnosis of mycetoma is still late in our country, often with bone and/or articular spread. Priority may be given to measures for reduction of mycetoma diagnosis lateness.

Bacteria of the genus Gordonia are rarely involved in human infections. We report here the case of a 30-year-old man from Guinea Buissau with mycetoma of the foot. 16S DNA sequencing after surgical biopsy identified Gordonia westfalica. To our knowledge, this is the first report of human infection caused by G. westfalica. Keywords: Actinomyces, Gordonia, Mycetoma, Neglected tropical disease, Spectrum analysis

Resume Le mycetome actino-mycosique est une pathologie cutanee et sous-cutanee inflammatoire chronique, d’evolution progressive due a une infection fongique ou bacterienne entrainant un aspect de pseudo-tumeur poly-fistulisee. Sa localisation au niveau du pied est aussi appelee « pied de Madura ». Cette affection est endemique dans les regions tropicales et subtropicales et est rarement rencontree dans les pays occidentaux. Les auteurs exposent ici un cas historique sur le territoire d’un patient presentant un mycetome actino-mycosique du pied non traite evoluant depuis 20 ans. Le diagnostic de mycetome actino-mycosique avait ete pose sur un examen histologique en 1987. Le patient presentait un tableau d’osteite chronique evoluee a Staphylocoque aureus qui a conduit a la realisation d’une amputation trans-tibiale. Le cas de ce patient, permet de presenter cette pathologie qui, meme si elle est rare en France peut toutefois etre rencontree notamment parmi une population de migrants.

Resume Nous presentons le cas d’un mycetome actinomycosique du pied, du a Actinomycetes viscosus , evoluant depuis 9 ans chez un jeune patient de 26 ans, issu d’un milieu rural : Douar a Inezgane (ville au sud du Maroc). L’etude bacteriologique de la peau et des grains a confirme le diagnostic en montrant des bacilles Gram positif a l’examen direct et a la culture. L’etude anatomopathologique a montre une inflammation granulomateuse polymorphe sans signe de malignite, avec un aspect des grains compatible avec une actinomycose. En absence d’autres localisations viscerales, on a retenu le diagnostic d’une actinomycose cutanee primitive. Le traitement a repose sur une antibiotherapie a base de penicilline G, en perfusion intraveineuse pendant cinq semaines puis relais par l’amoxicilline per os, associee a trimethoprime-sulfamethoxazole per os au long cours. A partir du sixieme mois de traitement, l’evolution etait favorable avec une diminution de la tumefaction du pied et du nombre des fistules, des nodules, des adenopathies et un allongement du delai d’emission des grains. Le recul actuel est de 15 mois. L’actinomycose cutanee primitive est toujours d’actualite au Maroc.

Scedosporium prolificans are opportunistic moulds that can cause mycetoma following penetrating injuries. This fungus is more virulent than other species and treatment options are limited. Here we describe the first known case in the UK of S. prolificans osteomyelitis, in a 4 year old following penetrating injury. Successful outcome with limb salvage and foot function is achieved after repeated surgical debridement, and combination chemotherapy with voriconazole/terbinafine.

Mycetoma is a chronic granulomatous infection of skin and subcutaneous tissue, which may involve bone. The disease is caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Both types of organism are important soil saprophytes, and therefore infection is normally acquired by traumatic inoculation of the skin by contaminated material. Clinically, mycetomas are characterized by tumefaction, draining sinuses and discharging grains. The grains are aggregates of fungal hyphae or bacterial filaments, and grain size, colour and consistency provide the initial clue to the causative organism. To our knowledge, this probably is the first case report of oral eumycetoma of infancy. Review of literature shows only ten cases of eumycetoma involving the head and neck, including the present case. Histological examinations of the biopsies were the cornerstone in the diagnosis of mycetoma. The distinction between eumycetoma and actinomycetoma is essential for treatment. Direct microscopic examination of the grain and histopathological examination, using histochemical staining will distinguish between the two. Treatment consists of long courses of antifungals and antibacterials agents, often combined with surgery.

Highlights • Purulent drainage, woody induration and sinus tract formation suggest mycetoma. • Phaeohyphomycosis management may require debridement and prolonged antifungal therapy. • Microbiological identification is needed for optimal medical management., A 26-year old woman presented for evaluation of extensive edema, erythema, sinus tract formation and purulent drainage from the left lower extremity after trauma from a wooden object approximately three months prior. Skin biopsies and blood cultures revealed Phaeoacremonium parasiticum consistent with a diagnosis of phaeohyphomycosis. Despite hospitalization and initial treatment with several antifungals, including voriconazole, her infection progressed. Surgical debridement with split thickness skin grafting was performed. Subsequent clinical improvement allowed a transition from intravenous to oral voriconazole and discharge home. Seven months post presentation she remained on oral voriconazole with significant improvement and no clinical evidence of recurrence. This case illustrates an approach to management where aggressive debridement with split-thickness skin grafting and a prolonged course of intravenous and oral antifungals resulted in a good long-term outcome for the patient.

Among diseases of horses caused by fungi (=mycoses), dermatophytosis, cryptococcosis and aspergillosis are of particular concern, due their worldwide diffusion and, for some of them, zoonotic potential. Conversely, other mycoses such as subcutaneous (i.e., pythiosis and mycetoma) or deep mycoses (i.e., blastomycosis and coccidioidomycosis) are rare, and/or limited to restricted geographical areas. Generally, subcutaneous and deep mycoses are chronic and progressive diseases; clinical signs include extensive, painful lesions (not pathognomonic), which resemble to other microbial infections. In all cases, early diagnosis is crucial in order to achieve a favorable prognosis. Knowledge of the epidemiology, clinical signs, and diagnosis of fungal diseases is essential for the establishment of effective therapeutic strategies. This article reviews the clinical manifestations, diagnosis and therapeutic protocols of equine fungal infections as a support to early diagnosis and application of targeted therapeutic and control strategies.

International audience; Eumycetomas are chronic infectious entities characterized by presence of mycotic grains in (sub-)cutaneous tissues, after accidental inoculation of an exogenous filamentous fungus in the skin. The lesions evolve towards painless pseudotumor of the soft parts. We report the original case of a Guinean woman exhibiting eumycetoma of the right foot. Both laboratory tests identified a dematiaceous fungus, Exophiala jeanselmei, as the responsible infectious agent. A medical treatment with voriconazole alone was sufficient to notice a substantial clinical improvement. This finding is unusual as E. jeanselmei is uncommon in Guinea-Conakry, and as optimal treatment rather associate antifungal azoles and surgical excision.; Les eumycétomes constituent des entités infectieuses chroniques caractérisées par la présence de grains fongiques au sein des tissus (sous-)cutanés, après inoculation accidentelle d’un champignon filamenteux exogène. Les lésions évoluent sur un mode indolore vers des pseudo-tumeurs des parties molles. Nous rapportons ici le cas original d’une femme guinéenne avec un eumycétome du pied droit. Les différents examens de laboratoire ont permis d’identifier le champignon dématié Exophiala jeanselmei comme agent responsable. Un traitement médicamenteux par voriconazole seul était suffisant pour visualiser une amélioration clinique sensible. Ce constat est intéressant car E. jeanselmei est une espèce peu commune en Guinée-Conakry et le traitement habituel associe plutôt un antifongique azolé à la chirurgie d’exérèse.

Objective of the study Mycetomas are chronic sub-cutaneous tropical infections in which exogenous causative agents, fungal ( eumycetes ) or bacterial ( actinomycetes ), generate grains. The typical presentation is multi-fistulized pseudotumors. This disease, particularly eumycetoma, is difficult to treat. It is a major health problem in tropical and subtropical countries. In France, the disease is rare, but patients have access to a broader range of treatments. The authors had for objective to present the cases of mycetomas diagnosed in developed country and their management. Patients and methods A retrospective study was made on the clinical presentation and management of mycetomas from 1995 to 2011, in the Bobigny Avicenne teaching hospital. Results Six patient files were studied. The patients were men with a median age of 31 years (16–70). Five patients were from Sub Saharan Africa, one from Sri Lanka. The etiologies were one actinomycetoma and five eumycetomas. There was bone involvement in five cases. There was one atypical presentation: a primary intra-osseous mycetoma. Three patients were cured including two by surgical management and one by medical treatment (actinomycetoma). Antifungal therapy failed (four patients) in every case (voriconazole, itraconazole, ketoconazole, terbinafine, caspofungin). Conclusion The results of this study made in a non-epidemic zone revealed that despite a typical clinical presentation, the diagnosis and management were delayed because this imported disease is rare in France. The patients received new broad-spectrum triazole and caspofungin, but none were cured with antifungal therapy alone.

Resume Introduction Les mycetomes sont des processus pathologiques au cours desquels des agents etiologiques fongiques ou actinomycosiques d’origine exogene produisent des grains. Ces agents etiologiques resident dans les sols et vegetaux des zones endemiques. Ils sont introduits lors de traumatismes et la principale localisation est podale. La localisation orbitaire est exceptionnelle. Observation Nous rapportons le cas d’un eleve de 17 ans recu pour une exophtalmie gauche evoluant depuis deux ans, apres un traumatisme penetrant, par une fourche en milieu rural. L’examen montre une tumefaction orbitaire heterogene polyfistulisee produisant du pus et des grains noirs et fait evoquer le diagnostic de mycetome fongique devant la couleur des grains. L’IRM montre le processus effondrant la lame papyracee de l’ethmoide et le plancher de l’orbite. L’examen anatomopathologique confirme la nature fongique de l’affection meme si la culture sur milieu de Sabouraud n’est pas contributive. L’evolution est favorable apres exenteration et evidemment du sinus maxillaire ipsilateral et des fosses nasales, associes a un traitement a base de ketoconazole pendant quatre mois. On constate une absence de recidive 14 mois apres la chirurgie. Discussion Les mycetomes sevissent a l’etat endemique au Nord de l’Afrique de l’Ouest. Leur localisation, frequente au niveau du pied est exceptionnelle au niveau de l’orbite. La couleur des grains donne une orientation etiologique. Les mycetomes a grains noirs sont toujours fongiques et leur traitement est chirurgical, chirurgie quasi carcinologique, la persistance d’un seul grain conduisant a une recidive certaine. Conclusion La localisation orbitaire d’un mycetome est exceptionnelle. Dans ce cas clinique, la notion de porte d’entree, l’aspect clinique et la couleur des grains ont oriente le diagnostic. L’examen histologique de la piece operatoire l’a confirme.

Objective Isolated sphenoid sinus aspergilloma (ISSA) is a rare disorder that is difficult to diagnose in a timely manner. These lesions can also extend to adjacent structures and thereby cause severe complications. ISSA patients with orbital complications typically have a poor prognosis even when surgical interventions have been successful. We here reviewed 30 ISSA cases with respect to clinical characteristics and treatment outcomes. Methods A group of 30 patients diagnosed with ISSA between January 1990 and October 2010 were retrospectively reviewed in terms of clinical manifestations, endoscopic findings, radiologic imaging data, and treatment results. We also compared the clinical manifestations and treatment results between patients with and without orbital complications. Results Old age (median, 55 years) and a female predominance (23 women in the study) were noted. The most commonly reported symptom was headache (80%) and the average duration of the symptoms before diagnosis was 8.1 months. On radiologic examination, including CT and MRI scans, 13 patients showed bony wall erosions and five patients demonstrated orbital complications including diplopia and visual loss. The appearance of a bony wall erosion on a CT scan and the acute onset of ISSA symptoms were found to be significant factors in the onset of orbital complications ( P = 0.003 in each case). Endoscopic sphenoidotomy was performed in all 30 cases. Most of the preoperative symptoms among the patients, including headache, facial pain, and postnasal drip, were improved after surgery. Among the five patients in the study group with orbital complications, diplopia was completely resolved after surgery in each case but there was no improvement in visual loss. Conclusions An early diagnosis of ISSA, although not easy, is important to prevent complications arising from extensions of these lesions beyond the sphenoid sinus. Our present study demonstrates that ISSA could be effectively treated with an endoscopic sphenoidotomy, and that timely intervention is needed in patients with a sinus bony wall to prevent irreversible complications such as visual loss.

Eumycetoma is a chronic subcutaneous mycosis mainly caused by Madurella spp. Fusarium opportunistic infections in humans are often caused by Fusarium solani and Fusarium oxysporum. We report a case of eumycetoma by F. subglutinans, diagnosed by clinical aspect and culture, and confirmed by PCR sequencing. The patient was successfully treated with oral itraconazole. To our knowledge, this is the second report of human infection and the first case of mycetoma by Fusarium subglutinans.

Exophiala oligosperma is an uncommon pathogen associated with human infections, predominantly in immunocompromised hosts. Case reports of clinical infections related to E. oligosperma have been limited to 6 prior publications, all of which have shown limited susceptibility to conventional antifungal therapies, including amphotericin B, itraconazole, and fluconazole. We describe the first case of an E. oligosperma induced soft-tissue infection successfully treated with a 3-month course of voriconazole without persisting lesions.

Actinomycetoma is a chronic subcutaneous infection caused by aerobic branching actinomycetes. Its clinical features are firm tumefaction of the affected site and the presence of abscesses, nodules, and sinuses that drain a seropurulent exudate containing filamenting granules. The disease is caused by inoculation of the infectious agent through minor trauma in susceptible individuals. Nocardia brasiliensis, Actinomadura madurae, and Streptomyces somaliensis are among the most frequent agents in the Americas. Cellular and humoral immunity have been studied in animal models. Standard therapy for uncomplicated cases is sulfamethoxazole-trimethoprim given for many months. Bone involvement, disseminated cases, and special locations require combined treatment with amikacin and sulfamethoxazole-trimethoprim. Isolated reports include the addition of other antibiotics such as rifampicin, imipenem, or meropenem. When needed, other aminoglycosides can be used. Amoxicillin-clavulanic acid is indicated in specific cases as alternative treatment. Oxazolidinone antibiotics, such as linezolid and other similar compounds (DA-7218 and DA-7157), have been studied in experimental infections in animal models as well as in vitro and ex vivo, with encouraging results.

Summary Mycetomas are chronic, subcutaneous infections characterized by a clinical triad of chronic induration, draining sinuses, and discharge of granules. It can be caused either by aerobic, branched actinomycetes or by eumycetes. This pathology is quite rare in Morocco. Two Moroccan cases of mycetoma of the foot caused by Madurella mycetomatis are reported in which identification of the etiologic agents was confirmed by mycologic analysis of the grains and culture isolation of the etiologic agent.

Mycetoma, also commonly referred to as Madura foot, is statistically rare in the United States. However, it is endemic to other parts of the world. It is a pseudotumor characterized by a triad of tumefaction, draining sinuses, and grains. Two types exist, with each caused by different groups of organisms that require different treatment approaches. Therefore, the exact diagnosis and culture of the organism is vital to successful treatment outcomes. Synovial sarcoma, in contrast, is a malignancy much more commonly seen in the United States. It is characterized by a well-circumscribed, often palpable, mass that is usually well delineated on magnetic resonance imaging. It has characteristic histologic and genetic features that help distinguish it from other soft tissue masses. We present a case of a soft tissue mass diagnosed in the United States. The patient had several clinical and radiographic features of synovial sarcoma but the histologic outcome was mycetoma. The case is followed by a review of the published data.

SummaryObjectives: The aim of this study is to highlight the importance of infections caused by members of the genera Pseudallescheria/Scedosporium in HIV-positive patients.MethodsWe describe a case of a fatal scedosporiosis in a treatment-naïve HIV patient and review all previously reported cases of pseudallescheriosis/scedosporiosis from a search of the PubMed and Deutsches Institut für Medizinische Dokumentation und Information (DIMDI) databases, applying the terms ‘Pseudallescheria’, ‘Scedosporium’, ‘Allescheria’, ‘Monosporium’, ‘Petriellidium’, ‘boydii’, ‘prolificans’, ‘inflatum’, cross-referenced with ‘HIV’ and ‘AIDS’.ResultsDetection of Scedosporium and Pseudallescheria species has been reported in 22 HIV-positive patients. Fourteen isolates belonged to the Pseudallescheria boydii complex and eight to Scedosporium prolificans. Invasive scedosporiosis (IS) was proven in 54.5% of the patients. Among them dissemination was observed in 66.7%. Pseudallescheria/Scedosporium species were mainly isolated from male individuals. Patients with proven IS showed CD4+ cell counts

Summary A case of white grain eumycetoma in a 21-year-old male immunocompetent New Delhi resident was diagnosed as Acremonium kiliense. The patient recovered after treatment with amphotericin B and itraconazole.

Background The indications and the outcome of surgery for pulmonary aspergilloma remain highly controversial. This retrospective observational study was conducted to study the clinical profile, indications, post-operative complications and long term outcome of patients having pulmonary aspergilloma. Methods From January 2000 to October 2008, 52 patients underwent surgery for pulmonary aspergilloma at our tertiary care institute. Results The group consisted of 32 males and 20 females with a mean age of 39.3 ± 11.2 years. The most common indication for surgery was hemoptysis (96.15%). The underlying lung diseases were tuberculosis (75%), bronchiectasis (5.76%), and lung abscess (5.76%). In one patient (2%), concomitant ruptured lung hydatid cyst and an aspergilloma was present. The procedures performed were lobectomy ( n = 43), bilobectomy ( n = 3). pneumonectomy ( n = 3), segmental resection ( n = 3). The post-operative mortality was 1.92% (one patient). Overall complications occurred in 12 (23.07%) patients. The complications included prolonged air leak ( n = 6), bleeding ( n = 3), empyema ( n = 1), repeated pneumothorax ( n = 1), and wound dehiscence ( n = 1). The mean follow-up period was 38 ± 18.6 months. There was no recurrence of disease or hemoptysis. Conclusion Pulmonary aspergilloma is common in developing countries like India in which there is high prevalence of pulmonary tuberculosis. Surgical resection of pulmonary aspergilloma is effective in preventing recurrence of symptoms including hemoptysis. We recommend early surgical resection of symptomatic aspergilloma with reasonable complications. Pre-operative preparation of the patients, meticulous surgical technique and post-operative chest physiotherapy reduces the rate of complications. Complications may still occur and are largely related to the underlying lung pathology; however, the long term outcome is good.

Fungi belonging to the Scedosporium/Pseudallescheria complex (SPCF) have been known to cause human infections for nearly a century and are important human pathogens, with an increasing frequency of infection in patients with underlying conditions. There appears to be a lower incidence of infections with SPCF in veterinary species, although this may be related to a lack of awareness of these diseases. Important recent taxonomic changes in this group of fungi include the classification of Pseudallescheria boydii and Scedosporium apiospermum as two distinct species and the identification of new pathogenic species of SPCF. In this article, the literature on natural and experimental infections caused by SPCF in veterinary species is reviewed. The importance of an accurate identification of veterinary isolates by molecular methods is stressed, especially since virulence and susceptibility to antimycotic drugs of different species may vary.

Nocardia brasiliensis, is a bacteria that lives as saprophyte in soil and causes a disease called actinomycetoma in both human and animals. Nocardia brasiliensis is an intracellular, facultative bacterium that replicates and survives within host macrophages. The mechanisms involved in the evasion of the microbicidal actions of macrophages remain unclear. The filamentous growth of N. brasiliensis is resistant to unicellular preparations, leading to inaccurate quantification of bacterial numbers by means of colony forming units (CFU). As successful survival studies with green fluorescent protein (GFP)-expressing bacterial strains have been reported, we constructed a recombinant GFP-expressing strain of N. brasiliensis. The virulence of the modified strain is maintained because it induces mycetoma in BALB/c mice. This new strain can be used for bacterial survival assays using cytometry and to elucidate the pathogenicity mechanisms in Actinomycetoma infection.

Introduction Mycetoma is a chronic disease, which is endemic in tropical and subtropical countries. We report a rare case of mycetoma located on the foot of a patient living in a temperate-climate country followed by a short discussion. Observation A 50-year-old woman with painless swelling in her left foot. The swelling started after a banal penetrating injury on the sole of her left foot 23 years ago. X-rays images showed multiple osteolytic lesions of the tarsus. The histological analyses identified the fungus madurella mycetomatis. The treatment was radical surgery (amputation). The patient had a tibial prosthesis and recovered an autonomous gait. Discussion Mycetoma is a chronic granulomatous inflammatory response often with sinus tract formations due to fungal or bacterial organisms. The infection of the forefoot is quite typical. It is a slowly progressing disease affecting the deep dermis and subcutaneous tissues that can extent to the underlying bones. Conclusion If it is not diagnosed early on, mycetoma can cause functional and esthetical impairments.

Hemoptysis and thoracic fungal infections are infrequent but challenging problems, especially when encountered in the emergency setting. The evaluation and management of massive and nonmassive hemoptysis is described with special attention to radiologic, bronchcoscopic, and surgical interventions. The important principles of airway control, stabilization, and definitive management are emphasized. Endemic and opportunistic fungal infections are more common than they seem. The role of the surgeon is to assist in diagnosis, evaluate and treat pulmonary nodules, and consider resectional therapy for mycetoma and invasive fungal infections in selected candidates.

Resume Les mycetomes actinomycosiques ou fongiques sont des infections fongiques necrosantes qui affectent les membres inferieurs, en particulier le pied. Nous rapportons le premier cas tunisien de mycetome fongique de la main du a Pseudallescheria boydii . Observation Un ouvrier agricole âge de 48 ans consulte pour des nodules tumefies indolores fistulises a la peau de la main et du poignet droits. A l’examen, la main est bosselee, tumefiee, siege de multiples fistules couvertes de croutes noirâtres au niveau des faces dorsale et palmaire. Il n’y a pas d’adenopathie satellite, ni de fievre. La radiographie du poignet montre une carpite fusionnante et destructrice. Le diagnostic de mycetome a ete confirme par la mise en evidence de grains et de filaments myceliens a l’examen histologique. Les criteres morphologiques de la culture permettent l’identification probable de P. boydii . Le patient a recu du ketoconazole 400 mg/j durant 14 mois sans amelioration. Il est traite ensuite par itraconazole 400 mg/j pendant 18 mois entrainant la cicatrisation complete des lesions. Apres un recul de six ans les fistules ne sont pas productrices ; cependant, il persiste une deformation osseuse de la main avec une ankylose du poignet.

A 31-year-old African American woman with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (recent CD4 count of 66/mm) presented to the emergency room with a tension pneumothorax that required an emergent chest tube placement. Computed tomography scan showed fungus balls in multiple lung cavities and surrounding infiltrates. The patient showed remarkable improvement with voriconazole suggesting aspergillosis. However, the patient was serologically negative for Aspergillus and other common fungal infections. Because of a persistent air leak, surgical intervention was needed. The histological finding was consistent with invasive mycosis, and cultures were positive for Scedosporium apiospermum. Literature review showed that, among patients with HIV/AIDS, Scedosporium can present from focal localized to systemic disease, is resistant to traditional antifungal agents, and may respond to prompt management with voriconazole.

We describe the case of a sixteen-year-old male who presented with multiple subcutaneous mycetomas proven on culture to be secondary to Pseudallescheria boydi., The lesions responded completely to oral potassium iodide solution. To our knowledge this has never been reported in humans.

Aspergilloma is a saprophytic infection that consists of masses of fungal mycelium that occurs in pre-existing cavities usually due to tuberculosis, bronchestasis or pulmonary infraction. However, few cases of aspergilloma within hydatid cyst have been reported in literature. We describe two patients with aspergilloma formed within cyst hydatid. Both patients consulted because of recurrent hemoptysis. In a 52-year-old woman, diagnosis was established by a transthoracic CT biopsy. Treatment consisted of postero-lateral thracotomy with wedge resection of tow aspergilloma in the left upper lobe. In a 56-year-old man, thoracotomy with lower right lobectomy was performed at emergency because of massive hemoptysis. In both cases, patients progressed favourably without antifungal therapy. Aspergilloma is an unusual complication of hydatid cyst. It results from the deterioration of local defence against opportunistic infections. Prognosis appears to be better than aspergilloma within tuberculosis cavities.

Resume Objectif Les mycetomes sont des processus pathologiques au cours desquels des agents etiologiques fongiques ou actinomycosiques d’origine exogene produisent des grains. Des cas rares et sporadiques sont signales de part et d’autre de la zone d’endemie. La presente etude a pour objectif de presenter les aspects epidemiologiques et etiologiques des cas diagnostiques en milieu hospitalier a Abidjan. Materiels et methodes Il s’agit d’une etude retrospective et analytique, sur une periode de 20 ans, qui a porte sur les demandes de recherches de mycetomes effectuees exclusivement chez des ivoiriens dans les laboratoires d’anatomie pathologique des CHU d’Abidjan et dans le laboratoire de parasitologie-mycologie de la faculte de medecine. Resultats Au cours de cette periode, 149 demandes ont ete enregistrees avec 58,4 % de confirmation diagnostique. Les sujets etaient âges de sept a 69 ans avec un sex-ratio de 1,6. Ils provenaient de toutes les regions du pays et la majorite (90,8 %) etait des agriculteurs. Les principales localisations etaient le membre inferieur (49,4 %) dont 33 aux pieds, tandis que pour 27,8 % des patients, le siege de la lesion n’a pas ete precise. Les agents etiologiques diagnostiques etaient fongiques (52,9 %) et actinomycosiques (47,1 %). Les principales especes etaient Madurella mycetomatis, Nocardia brasiliensis, Scedosporium apiospermum/Pseudallescheria boydii et Actinomadura madurae. Conclusion Les mycetomes sont une pathologie presente en Cote d’Ivoire. Cette etude donne une idee partielle de la prevalence, de la repartition de l’affection dans le pays et des agents etiologiques.