Servicio de Dermatología, Facultad de Medicina y Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
PLoS One. 2020 May 8;15(5):e0232556. doi: 10.1371/journal.pone.0232556. eCollection 2020.
Mycetoma is a chronic, granulomatous infection of subcutaneous tissue, that may involve deep structures and bone. It can be caused by bacteria (actinomycetoma) or fungi (eumycetoma). There is an epidemiological association between mycetoma and the environment, including rainfall, temperature and humidity but there are still many knowledge gaps in the identification of the natural habitat of actinomycetes, their primary reservoir, and their precise geographical distribution. Knowing the potential distribution of this infection and its ecological niche in endemic areas is relevant to determine disease management strategies and etiological agent habitat or reservoirs.
METHODOLOGY/PRINCIPAL FINDINGS: This was an ambispective descriptive study of 31 patients with actinomycetoma. We determined the biophysical characteristics including temperature, precipitation, soil type, vegetation, etiological agents, and mapped actinomycetoma cases in Northeast Mexico. We identified two disease cluster areas. One in Nuevo Leon, with a predominantly kastanozems soil type, with a mean annual temperature of 22°, and a mean annual precipitation of 585.2 mm. Herein, mycetoma cases were produced by Actinomadura pelletieri, Actinomadura madurae, Nocardia brasiliensis, and Nocardia spp. The second cluster was in San Luis Potosí, where lithosols soil type predominates, with a mean annual temperature of 23.5° and a mean annual precipitation of 635.4 mm. In this area, all the cases were caused by N. brasiliensis. A. madurae cases were identified in rendzinas, kastanozems, vertisols, and lithosols soils, and A. pelletieri cases in xerosols, kastanozems, and rendzinas soils. Previous thorn trauma with Acacia or Prosopis plants was referred by 35.4% of subjects. In these states, the presence of thorny plants, such as Acacia spp., Prosopis spp., Senegalia greggi, Vachellia farnesiana and Vachellia rigidula, are common.
CONCLUSIONS/SIGNIFICANCE: Mapping this neglected tropical infection aids in the detection of disease cluster areas, the development of public health strategies for early diagnosis and disease prediction models; this paves the way for more ecological niche etiological agent research.
足菌肿是一种慢性肉芽肿性皮下组织感染，可累及深部结构和骨骼。它可由细菌（放线菌肿）或真菌（真菌肿）引起。足菌肿与环境之间存在流行病学关联，包括降雨、温度和湿度，但在放线菌的自然栖息地、其主要宿主以及其确切的地理分布方面仍存在许多知识空白。了解这种感染在流行地区的潜在分布及其生态位，对于确定疾病管理策略以及病因宿主或储主的生态位至关重要。
方法/主要发现：这是一项对 31 例放线菌肿患者的前瞻性描述性研究。我们确定了包括温度、降水、土壤类型、植被、病因等生物物理特征，并在墨西哥东北部绘制了放线菌肿病例图。我们确定了两个疾病聚集区。一个在新莱昂州，主要土壤类型为栗钙土，年平均温度为 22°C，年平均降水量为 585.2 毫米。在这里，放线菌肿病例由游动放线菌、马杜拉放线菌、巴西诺卡氏菌和诺卡氏菌属引起。第二个聚集区在圣路易斯波托西州，以片岩土壤类型为主，年平均温度为 23.5°C，年平均降水量为 635.4 毫米。在该地区，所有病例均由巴西诺卡氏菌引起。在淋溶土、栗钙土、变性土和片岩土壤中发现了马杜拉放线菌病例，在荒漠土、栗钙土和淋溶土中发现了佩莱蒂放线菌病例。35.4%的患者曾有过荆棘植物的刺伤史。在这些州，刺槐属、银合欢属、金合欢属、三叶豆属、银荆属和银荆属等带刺植物很常见。
结论/意义：绘制这种被忽视的热带感染图谱有助于发现疾病聚集区，制定公共卫生策略以进行早期诊断和疾病预测模型；这为更多的生态位病因研究铺平了道路。
