1 / 39

Bonifaz A, Ibarra G, Saúl A, Carrasco E.

Title. MYCETOMA IN CHILDREN. Bonifaz A, Ibarra G, Saúl A, Carrasco E. Dermatology & Micology Department General Hospital of Mexico Hospital Infantil de Mexico. Introduction. MYCETOMA IN CHILDREN. Chronic infection

enrique-rios
Download Presentation

Bonifaz A, Ibarra G, Saúl A, Carrasco E.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Title MYCETOMA IN CHILDREN Bonifaz A, Ibarra G, Saúl A, Carrasco E. Dermatology & Micology Department General Hospital of Mexico Hospital Infantil de Mexico

  2. Introduction MYCETOMA IN CHILDREN • Chronic infection • Based on its etiology: eumycetoma (true fungae) actinomycetoma (filamentous actinomycetes) • Clinically characterized by swelling, sinuses and alteration of affected region • Mycetoma are uncommon in children. Only few reports* * Aceves Ortega R. Deep mycosis in children. Mod Probl Paediatr 1975;17: 228-241. Welsh O. Mycetoma in children. Mod Probl Paediatr 1975; 17:248-253.

  3. Introduction MYCETOMA IN CHILDREN • Occurs in well-defined geographic areas. Between the tropics • Actinomycetoma is more frequent in subtropical areas (Mexico, Venezuela) • Eumycetoma: predominates in Africa and India

  4. Background MYCETOMA IN CHILDREN Frequency: • Mexican multi-center study that included 2,105 cases.* • 78 cases were under 15 years: 3.7% • 11 cases were under 10 years: 0.5% • In our study: 15/334: 4.5% *López-Martínez R, Méndez-Tovar LJ, Lavalle P, Welsh O, Saúl A, Macotela-Ruiz E. Epidemiología del micetoma en México: estudio de 2105 casos. Gac Med Mex 1992; 128: 477-481.

  5. Factors Background MYCETOMA IN CHILDREN Factors to development mycetoma: Patient’s condition Inoculum Hormonal

  6. Background MYCETOMA IN CHILDREN Mycetoma is an occupational disease… • Traumas • Farm labors • More frequent in boys, maybe help more in farm works

  7. Ecology MYCETOMA IN CHILDREN • Sub-tropical area: actinomycetoma Nocardia spp • Tropical-Senegalese climate: Eumycetoma. Madurella mycetomatis y Pseudoallescheria boydii

  8. Clinical MYCETOMA IN CHILDREN Two clinical features: • Classical form: swelling, sinuses and alteration of affected region • Milder presentation (mini-mycetoma): 1 or 2 sinuses (no-swelling). Clinical diagnosis is more difficult • Seldom involvement of bones and viscera

  9. Age MYCETOMA IN CHILDREN Mean 11.2 years Range: 6-15 years

  10. Gender MYCETOMA IN CHILDREN 12 boys 80% 3 girls 20%

  11. Clinical location MYCETOMA IN CHILDREN

  12. Predisposing factors MYCETOMA IN CHILDREN

  13. A 10 year old boy • Evolution: 2 years • Dermatosis localized to the right leg. Pruritus • Direct exam: Nocardia granules • N. brasiliensis

  14. A 12 year old girl • Evolution: 1 year • Dermatosis localized to the left shoulder. Pruritus • Direct exam: Nocardia granules • N. brasiliensis

  15. A 15 years old boy • Evolution: 3 years • Localized to the left foot. Pain • Direct exam: eumycetic black granules • M. mycetomatis

  16. A 11 years old girl • Evolution: 8 months • Dermatosis localized to the left arm. Pruritus • Direct exam: Nocardia granules • N. brasiliensis

  17. A 10 years old boy • Evolution: 4 months • Dermatosis localized to the left leg. Pruritus & pain • Direct exam: Nocardia granules • N. asteroides

  18. A 14 years old boy • Evolution: 1 year • Milking worker • Dermatosis localized to the hand right. • Biopsy: A. madurae granules • Actinomadura madurae

  19. A 15 years old boy • Evolution: 6 months • Dermatosis localized in torax. Pain • Direct exam: Nocardia granules • N. brasiliensis

  20. A 6 years old girl • Evolution: 2 years • Dermatosis localized to the left shoulder. Pruritus • Direct exam: Nocardia granules • N. brasiliensis

  21. A 17 year old boy • Evolution: 4 years • Dermatosis localized to the torax. Pruritus & pain • Direct exam: Nocardia granules • N. brasiliensis

  22. A 13 years old boy • Evolution: 4 years • Dermatosis localized to the torax. Pain • Direct exam: Nocardia granules • No culture

  23. Lab Diagnosis MYCETOMA IN CHILDREN • Direct examination (KOH, lugol & ISS) • Grains or granules • Culture (Sabouraud, PDA, etc.) • Identifying microorganisms • Biopsy

  24. Etiology MYCETOMA IN CHILDREN

  25. Treatment MYCETOMA IN CHILDREN Actinomycetoma: TMP-SMX + DDS Amikacin Amoxicilin/clavulanate Eumycetoma: Griseofulvin Ketoconazole, itraconazole

  26. Treatment response MYCETOMA IN CHILDREN Shortest: 8 months Longest: 2.5 years Mean: 1.3 years

  27. TMS-SMX + DDS

  28. TMS-SMX + DDS

  29. TMS-SMX + DDS

  30. Comment: • Successful treatment depends on 3 conditions: the etiologic agent, the extent and depth of the mycetoma, and the patient condition Good prognosis Summary I - 14 years-old - Healthy N. brasiliensis

  31. Comment: • Successful treatment depends on 3 conditions: the etiologic agent, the extent and depth of the mycetoma, and the patient condition Bad prognosis Summary II M. mycetomatis - Deficient GI absorption - Osteolysis

  32. Conclusions MYCETOMA IN CHILDREN • Mycetomas are exceptional in children • In Mexico actinomycetomas are more frequent than eumycetomas • Clinical and diagnosis is simple • Treatment response is better for actinomycetomas than eumycetomas • Bonifaz A, Saúl A, Ibarra G, Rosales A, Araiza J, Méndez-Tovar LJ. Micetoma en niños y adolescentes. Monogr Dermatol 2006; 19: 17-23 • Bonifaz A, Ibarra G, Saúl A, Paredes-Solis V, Carrasco-Gerard E, Fierro-Arias L. Mycetoma in children. Experience with 15 cases. Pediatr Infect Dis J 2007; 26: 50-52

  33. Final MYCETOMA IN CHILDREN • Thank you very much for your attention

More Related