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Management of mycetomas in France
S Mattioni1, M Develoux, S Brun
1Service de maladies infectieuses et tropicales, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93000 Bobigny, France. sarah.mattioni@tnn.aphp.fr
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.
Insights
Mycetoma, a chronic tropical infection, is difficult to treat, especially eumycetoma. This study highlights delayed diagnosis and poor antifungal treatment outcomes in France, emphasizing surgical intervention for eumycetoma.
Area of Science:
- Medical Mycology
- Tropical Infectious Diseases
- Dermatology
Background:
- Mycetomas are chronic subcutaneous infections caused by fungi (eumycetes) or bacteria (actinomycetes), presenting as multi-fistulized pseudotumors.
- Eumycetoma is particularly challenging to treat and represents a significant global health issue in tropical and subtropical regions.
- While rare in France, mycetoma cases in developed countries may benefit from broader treatment options.
Purpose of the Study:
- To present the clinical presentation and management of mycetoma cases diagnosed in a developed country (France).
- To analyze treatment outcomes, particularly the efficacy of antifungal therapies in a non-endemic setting.
Main Methods:
- Retrospective study of mycetoma cases from 1995 to 2011 at Bobigny Avicenne teaching hospital.
- Analysis of clinical presentation, etiology, bone involvement, and treatment management.
Main Results:
- Six male patients (median age 31) were studied, with five from Sub-Saharan Africa and one from Sri Lanka.
- Five eumycetomas and one actinomycetoma were diagnosed, with bone involvement in five cases; one atypical intra-osseous mycetoma was noted.
- Three patients were cured (two surgically, one medically for actinomycetoma); antifungal therapy failed in all four eumycetoma cases.
Conclusions:
- Mycetoma diagnosis and management are often delayed in non-endemic areas like France due to its rarity.
- Newer broad-spectrum antifungals (triazoles, caspofungin) showed no efficacy in treating eumycetoma in this cohort.
- Surgical management appears more effective for eumycetoma, while medical treatment was successful for the single actinomycetoma case.