Actinomycetoma leg ulcers in north India

Area of Science:

• Medical Mycology
• Infectious Diseases
• Dermatology

Background:

• Actinomycetoma is a chronic subcutaneous infection caused by aerobic branching actinomycetes.
• Characterized by tumefaction, abscesses, nodules, and draining sinuses with granules.
• Previously considered uncommon in Northern India, recent data suggests increased prevalence, necessitating clinical vigilance.

Purpose of the Study:

• To investigate socioetiological aspects, prevalence, and diagnosis of actinomycetoma.
• To evaluate treatment modalities and outcomes for chronic nonhealing ulcers suspected of mycetoma.
• To introduce a novel scoring system for assessing post-treatment results.

Main Methods:

• Prospective study of 13 cases with chronic nonhealing lower limb ulcers from June 2009 to December 2012.
• Clinical diagnosis of mycetoma based on typical features.
• Treatment with a modified Welsh regimen (amikacin + cotrimoxazole + rifampicin).
• Evaluation of treatment outcomes using a newly devised scoring system (Masoodi's score).

Main Results:

• 10 out of 13 suspected cases were diagnosed with actinomycetoma.
• Majority of diagnosed patients were middle-aged, from lower socioeconomic strata, with no sexual predilection.
• Modified Welsh regimen demonstrated acceptable results, with varying outcomes based on Masoodi's score (2 good, 5 fair, 3 poor).

Conclusions:

• Accurate identification of the etiological agent is essential for effective actinomycetoma therapy.
• Early diagnosis and prompt treatment initiation are critical for successful management.
• The modified Welsh regimen shows efficacy, leading to remission or cure, though functional and cosmetic outcomes may lag; a comprehensive scoring system is proposed.