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Eumicetoma: actualidades y perspectivas.

Roberto Arenas1, M ª Elisa Vega-Mémije2, Lucía Rangel-Gamboa2

  • 1Sección de Micología Médica. Hospital General Dr. Manuel Gea González, Ciudad de México, México.

Gaceta Medica De Mexico
|February 8, 2018
PubMed
Summary

Eumycetoma is a chronic fungal infection causing debilitating masses and sinus tracts. Genetic susceptibility and accurate etiological agent identification are crucial for effective treatment and developing new therapies.

Keywords:
EumycetomaMadura footMadurellaPseudallescheriaTrematosphaeria

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Area of Science:

  • Mycology
  • Infectious Diseases
  • Dermatology
  • Genetics

Background:

  • Eumycetoma is a severe, chronic fungal infection of the skin and subcutaneous tissue, characterized by a triad of painless mass, sinus tracts, and fungal grain discharge.
  • While prevalent in tropical and subtropical regions, its occurrence in Latin America is less frequent, suggesting potential genetic predispositions influencing susceptibility.
  • Recent research identified specific gene polymorphisms (CR1, IL-8, NOS2, chitotriosidase) associated with eumycetoma development, highlighting the role of host genetics.

Purpose of the Study:

  • To review the current understanding of eumycetoma, focusing on its clinical presentation, diagnosis, and etiological agents.
  • To emphasize the importance of accurate identification of causative fungal species for effective treatment strategies.
  • To highlight the need for further research into host genetic susceptibility and the physiology of grain formation for developing novel therapies.

Main Methods:

  • Diagnosis relies on clinical presentation, confirmed by histopathology, microbiology, and radiological evaluation.
  • Phylogenetic analyses have been employed to reclassify fungal species and identify new etiological agents within the genus Madurella.
  • Review of existing literature on genetic associations and antifungal susceptibility patterns.

Main Results:

  • Madurella mycetomatis remains the most frequently identified causative agent, although new species and reclassifications (e.g., Trematosphaeria grisea, Pseudallescheria boydii) have emerged.
  • Antibody prevalence in endemic areas exceeds the number of clinically affected individuals, supporting the hypothesis of genetic susceptibility.
  • Differences in antifungal susceptibility among etiological agents necessitate precise identification for targeted treatment.

Conclusions:

  • Accurate identification of the etiological agent is paramount due to variations in antifungal resistance and susceptibility.
  • Current treatment involves a combination of surgery and antifungal drugs.
  • Further research into grain formation physiology and drug effects is essential for developing new pharmacological strategies against eumycetoma.