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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]

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]

Presents a letter to the editor about small eumycetic mycetoma due to black grain.

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]