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Background Mycetoma is a neglected tropical disease that attracts little attention in regard to research and publications and hence this study was undertaken to determine the trends and global scientific research output in mycetoma-related fields. Methods Mycetoma data were retrieved from the Web of Science (WoS) and Scopus databases. The MeSH Browser was used to extract relevant keywords. Biblioshiny software (R-studio cloud), VOSviewer v. 1.6.6 and SPSS software were used for data management. Results Research trends on mycetoma increased globally from 1999 to 2020. The results were 404 documents (4444 citations) in WoS and 513 documents (5709 citations) in Scopus, and the average number of citations per article was 11 in WoS and 11.13 in Scopus. There was a significant association between the total number of citations and the total citations per year in both WoS (r=0.833, p<0.0001) and Scopus (r=0.926, p<0.0001). Sudan, India, the Netherlands and Mexico were the top-ranking productive countries for mycetoma publications in WoS, while India, the USA and Mexico were the top-ranking countries in Scopus. Articles on mycetoma were mainly published in PLoS Neglected Tropical Diseases , the International Journal of Dermatology and the Journal of Clinical Microbiology. A. H. Fahal from the Mycetoma Research Centre, University of Khartoum, Sudan, had the highest number of citations in mycetoma research during 1999–2020, followed by W. W. J. van de Sande from the Erasmus Medical Centre, University of Rotterdam, the Netherlands, during 2003–2020. Conclusion The analysis provides insight into a global overview of Mycetoma research. In addition, the analysis holds a better understanding of the development trends that have emerged in Mycetoma over the past 21 years, which can also offer a scientific reference for future research. [ABSTRACT FROM AUTHOR]

The Community Dermatology Program established in the state of Guerrero, Mexico for almost 30 y provides an adaptable method of detecting and monitoring skin neglected tropical diseases such as mycetoma, which is endemic in the state. The program utilises general and thematic teaching elements combined with distance learning through teledermatology, direct patient consultations and close collaboration with community teams. Using this approach, a picture of mycetoma in Guerrero has emerged, with a focal hot spot located in the southern part of the state in the Costa Chica region. Although in much of Mexico Nocardia infections dominate, in this area there are also substantial numbers of cases of eumycetoma. This combined approach provides a means of early case detection and long-term surveillance through targeted use of a small specialist team. [ABSTRACT FROM AUTHOR]

Context: Mycetoma is a chronic, granulomatous disease caused by fungi (eumycetoma) or aerobic filamentous actinomycetes (actinomycetoma). Actinomadura madurae is one of the most frequent actinomycetes. Aim: The study aims to provide an update on clinical, diagnostic, therapeutic, and outcome data for patients with actinomycetoma in a single center in Mexico. Settings and Design: This was a retrospective study of 47 cases diagnosed with actinomycetoma. Subjects and Methods: The cases were selected from a total of 536 mycetoma obtained during 35 years (from 1985 to 2019). Clinical data were retrieved from the clinical records of our department. Microbiological data were obtained from our Mycology laboratory. Statistical Analysis: Frequencies and percentages were used for categorical variables. Normality was determined with the Kolmogorov–Smirnov test. We used means and medians to describe the variables. Results: Forty-seven patients with actinomycetoma were included; female:male ratio 1.9:1; median age 38 years. The foot was the most affected region in 76.5% of cases. The bone invasion was observed in 89%. The time between symptoms onset and diagnosis was 5.5 years. Grain detection by direct examination was positive in 95% of cases. The most commonly used, as well as the most effective treatment scheme was streptomycin + sulfamethoxazole-trimethoprim with dapsone. Sixty-three percent (30 patients) achieved clinical and mycological cure, and 10.6% (5 patients) had treatment failure. Conclusions: We highlight the importance of designing therapeutic strategies to standardize treatments and gain more experience to improve the care of these patients. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is a neglected, chronic, and deforming infectious disease caused by fungi and actinomycetes. In Mexico, N. brasiliensis is the predominant etiologic agent. Therapeutic alternatives are necessary because the current drug regimens have several disadvantages. Benzothiazinones (BTZ) are a new class of candidate drugs that inhibit decaprenyl-phosphoribose-epimerase (DprE1), an essential enzyme involved in the cell wall biosynthesis of Corynebacterineae. Methodology/Principal findings: In this study, the in vitro activity of the next generation BTZ, PBTZ169, was tested against thirty Nocardia brasiliensis isolates. The MIC50 and MIC90 values for PBTZ169 were 0.0075 and 0.03 μg/mL, respectively. Because Nocardia is a potential intracellular bacterium, a THP-1 macrophage monolayer was infected with N. brasiliensis HUJEG-1 and then treated with PBTZ169, resulting in a decrease in the number of colony-forming units (CFUs) at a concentration of 0.25X the in vitro value. The in vivo activity was evaluated after infecting female BALB/c mice in the right hind food-pad. After 6 weeks, treatment was initiated with PBTZ169 and its activity was compared with the first generation compound, BTZ043. Both BTZ compounds were administered at 100 mg/kg twice daily by gavage, and sulfamethoxazole/trimethoprim (SXT), at 100 mg/kg sulfamethoxazole, was used as a positive control. After 22 weeks of therapy, only PBTZ169 and SXT displayed statistically significant activity. Conclusion: These results indicate that DprE1 inhibitors may be useful for treating infections of Nocardia and may therefore be active against other actinomycetoma agents. We must test combinations of these compounds with other antimicrobial agents, such as linezolid, tedizolid or SXT, that have good to excellent in vivo activity, as well as new DprE1 inhibitors that can achieve higher plasma levels. [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]

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

Background Actinomycetoma is the most frequent type of mycetoma in Mexico. Localization on the scalp is very rare. Because of this topography and potential spread to the brain, the present case became a diagnostic and therapeutic challenge. Materials and methods We report the case of a 44-year-old woman with a 6 × 5 cm red, friable, granulomatous, vascular neoformation on the scalp and eye diagnosed as Nocardia brasiliensis actinomycetoma. Results A combination of amikacin and oral trimethoprim-sulfamethoxazole (SXT) was successfully administered with an excellent outcome and no side effects. Conclusions This is a rare presentation of mycetoma of the scalp that was cured in 12 weeks with a combination of amikacin and SXT. [ABSTRACT FROM AUTHOR]

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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 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]

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]

Mycetoma 15 the most frequent deep mycosis in Mexico and is caused by Nocardia brasiliensis in 86% of the cases. Two cases of mycetoma due to Nocardia caviae, the first in Mexico, are reported. The strains were identified by their biochemical properties according to the criteria of Gordon and Mihm (1962). Few cases of mycetoma caused by this actinomycete have been reported in the world. One of our cases was unusual: occurring on the trunk as a tumor and diagnosed by finding the "grains" on histologic examination. [ABSTRACT FROM AUTHOR]

Background: Deep mycoses and pseudomycoses (DMP) may cause significant disability and even death; however, the reports regarding these diseases, mainly affecting the foot, are scarce., Objective: To describe the epidemiological, clinical, and diagnostic characteristics of DMP of the foot in 160 patients., Methods: A retrospective and observational study of DMP affecting the foot was carried out in a tertiary-care center in Mexico for 20 years (from January 2000 to December 2019). Cases with confirmatory microbiological studies were included; the identification of the isolated fungi was based on the forms of reproduction. For actinomycetes, morphological analysis in an automated system ATB Vitek® 1574 (Biomèrieux) was used. The fungi were identified by PCR, using several primers from the ITS regions and for actinomycetes in the 16S rRNA region. Data from histopathological studies were also collected., Results: One hundred and sixty proven cases of DMP of the foot were included. The cases were categorized into nine types of infections including mycetoma (actinomycetoma and eumycetoma) in 102 cases (63.7%); sporotrichosis in 21 cases (13.1%); chromoblastomycosis, 18 cases (11.2%); phaeohyphomycosis, 3 cases (1.8%); histoplasmosis, 12 cases (7.5%); coccidioidomycosis 2 cases (1.2%) and botryomycosis and nocardiosis with one case respectively (0.6%). Most cases developed after traumatic implantation (147 cases, 91.8%). One hundred fifteen cases (71.8%) were men. The evolution was chronic in 125 cases (78.2%); bone involvement was observed in 64 cases (40%). Parasitic forms were observed In 139 cases (86.8%). The isolation and identification of the etiological agents were confirmed in all cases., Conclusion: The main DMP affecting the foot were infections due to traumatic implantation; most were endemic mycoses. The clinical characteristics and the evolution of the diseases are easily misdiagnosed, and thus, diagnostic tests are usually required., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Mycetoma, a chronic and mutilating subcutaneous infection recognized by the WHO as a neglected tropical disease, has been reported in >25 countries in Africa, Asia, and South America. In Latin America, Trematosphaeria grisea is assumed to be the prevalent fungal agent. Recent molecular studies have shown that this is an environmental saprobe in Europe, where it is rarely implicated in human diseases. The aim of the present paper is to establish the identity of Latin American cases ascribed to Trematosphaeria grisea Three cases analyzed were caused by Nigrograna mackinnonii Data on an additional 21 strains in the literature revealed that N. mackinnonii rather than T. grisea is responsible for most cases of black grain eumycetoma in Latin America., (Copyright © 2018 American Society for Microbiology.)

Mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. This disease has been reported from countries between 30°N and 15°S since 1840 but the exact burden of disease is not known. It is currently unknown what the incidence, prevalence and the number of reported cases per year per country is. In order to estimate what the global burden of mycetoma is, a meta-analysis was performed. In total 50 studies were included, which resulted in a total of 8763 mycetoma cases. Most cases were found in men between 11 and 40 years of age. The foot was most commonly affected. Most cases were reported from Mexico, Sudan and India. Madurella mycetomatis was the most prevalent causative agent world-wide, followed by Actinomadura madurae, Streptomyces somaliensis, Actinomadura pelletieri, Nocardia brasiliensis and Nocardia asteroides. Although this study represents a first indication of the global burden on mycetoma, the actual burden is probably much higher. In this study only cases reported to literature could be used and most of these cases were found by searching archives from a single hospital in a single city of that country. By erecting (inter)national surveillance programs a more accurate estimation of the global burden on mycetoma can be obtained. [ABSTRACT FROM AUTHOR]