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. 2014 Sep;59(5):529.
doi: 10.4103/0019-5154.139889.

Mycetoma in iran: causative agents and geographic distribution

Affiliations

Mycetoma in iran: causative agents and geographic distribution

Shahindokht Bassiri-Jahromi. Indian J Dermatol. 2014 Sep.

Abstract

Background: Mycetoma is a chronic granulomatous disease caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). It usually involves the subcutaneous tissue after a traumatic inoculation of the causative organism. We reviewed retrospectively 13 patients with mycetoma.

Materials and methods: This study reports the etiologic agents and distribution of mycetoma in 35 cases from 1994 to2009 in Iran. The diagnostic of mycetoma were confirmed by histopathology and direct preparation, culture techniques, and histopathology of granules and surgical biopsies, radiological examination of the affected site.

Results: Mycetoma was identified in 35 patients of 168 suspected patients (20.8%). They occurred in 22 male and 13 females. Their ages ranged from 14 to 80 years. The duration of the disease ranged from two months to 38 years. Sixteen patients had eumycetoma, and 19 patients had actinomycetoma, one of them had mix infections by eumycetoma and actinomycetoma. The majority of the patients were from central and states in south and north of Iran. The feet were most affected site (65.7%) of the cases, followed by hands (25.7%), face (2.8%), and trunk (2.8%), and buttock (2.8%). Most patients (68.5%) were more than 40 year-old. The male to female ratio was 5:3. The disease was abundant among housewife in urban and farmer in rural area of Iran. The most common prevalent mycetoma agents in this study were Actinomyces sp. There was a history of risk factors in 28.6% of patients in this study.

Conclusion: Mycetoma occasionally occurs particularly in the South, Central, and North of Iran, and seen most often in persons, who live in hot, humid climates. If there are risk factors for invasive fungal infections traumatic inoculation with any fungus may result in rapid local spread and systemic disease, often with fatal outcome.

Keywords: Actinomycetoma; eumycetoma; fungal infections; mycetoma; subcutaneous fungal infection.

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Conflict of interest statement

Conflict of Interest: Nil.

Figures

Figure 1
Figure 1
Advanced mycetoma of the foot. Note the swelling, deformity and sinuses
Figures 2 and 3
Figures 2 and 3
Mix mycetoma in palm and back of hand due to Nocardia asteroides and Pseudallescheria boydii in the brass worker woman, resident in North of Iran
Figure 4
Figure 4
Actinomadura madurae revealing the numerous, delicate (1μm) gram positive filaments at the periphery of the granule
Figure 5
Figure 5
Higher magnification of Actinomycetoma granule showing details of granule embedded in purulent exudates
Figure 6
Figure 6
H and E stained tissue section of mycetoma showing branched, septate hyphae of Aspergillus fumigatus
Figure 7
Figure 7
Microscopic morphology of Aspergillus fumigatus showing typical columnar, uniseriate conidial heads and conidia
Figure 8
Figure 8
Histopathology of mycetoma showing branched, septate hyphae of Aspergillus flavus (H and E, stain)
Figure 9
Figure 9
Microscopic morphology of Petriellidium boydii, in the imperfect state, ovoid or pyriform, is produced singly at the tip of conidiophores
Figure 10
Figure 10
Macroscopic characteristic of Paecilomyces lilacinus showing colony pigmentation
Figure 11
Figure 11
Microscopic morphology of Paecilomyces lilacinus showing divergent phialides and chains of ellipsoidal conidia
Figure 12
Figure 12
Histopathology of Paecilomyces lilacinus stained by hematoxylin and eosin
Figure 13
Figure 13
Colonies of C. albicans, Sabouraud glucose agar, 25C
Figure 14
Figure 14
Clinical appearance view of irregular, draining subcutaneous nodules of hand mycetoma due to Paecilomyces in the insulin induction site

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