2. MYCETOMA IN CHILDREN 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

3. 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:
Welsh O. Mycetoma in children. Mod Probl Paediatr 1975; 17:

4. 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

5. Mexican multi-center study that included 2,105 cases.*
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:

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

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

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

9. Two clinical features:
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

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

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

12. Clinical
location
MYCETOMA IN CHILDREN

13. Predisposing factors
MYCETOMA IN CHILDREN

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

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

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

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

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

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

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

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

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

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

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

29. Etiology
MYCETOMA IN CHILDREN

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

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

32. TMS-SMX + DDS

33. TMS-SMX + DDS

34. TMS-SMX + DDS

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

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

38. Mycetomas are exceptional in children
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

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