Castro L G, Belda Júnior W, Salebian A, Cucé L C
Department of Dermatology, University of São Paulo, Brazil.
Mycoses. 1993 Mar-Apr;36(3-4):89-95. doi: 10.1111/j.1439-0507.1993.tb00694.x.
Clinical and epidemiological aspects of 41 cases of mycetoma seen in São Paulo city from January 1978 to December 1989 are presented. Twenty-eight cases (68%) were caused by actinomycetes, while 13 (32%) were caused by true fungi. In only 22 (78%) actinomycetoma cases was it possible to identify the agent. Nocardia brasiliensis, by far the commonest actinomycete isolated, was responsible for 13 cases. Among eumycetomata, Madurella grisea was isolated from 3 cases, Scedosporium apiospermum from 2 cases, and Madurella mycetomatis from 1 case, and in 7 cases the agent was not identified. Distribution by sex and age was similar to that reported in the literature. Feet and legs were the commonest sites affected. The mean age of actinomycetoma patients was 33.2 years, while patients with eumycetomata were an average of 32.8 years. Mean duration of the disease was 6.8 and 9.8 years respectively. Most patients came from rural areas in the north-eastern region of the country and worked as field labourers. Bone involvement was frequent for both actinomycetomata and eumycetomata and was characterized by osteoporosis, periostal reaction and cavitation. The authors' elected treatment consists of combining sulfamethoxazole (800 mg) and trimethoprim (100 mg) with prednisone (10 mg) orally, daily.
本文介绍了1978年1月至1989年12月在圣保罗市所见的41例足菌肿的临床和流行病学情况。28例(68%)由放线菌引起,13例(32%)由真菌引起。仅在22例(78%)放线菌性足菌肿病例中鉴定出病原体。巴西诺卡菌是最常分离出的放线菌,导致了13例病例。在真菌性足菌肿中,3例分离出灰马杜拉菌,2例分离出尖端赛多孢,1例分离出足菌肿马杜拉菌,7例未鉴定出病原体。性别和年龄分布与文献报道相似。足部和腿部是最常受累的部位。放线菌性足菌肿患者的平均年龄为33.2岁,真菌性足菌肿患者平均为32.8岁。疾病的平均持续时间分别为6.8年和9.8年。大多数患者来自该国东北部的农村地区,从事田间劳动。放线菌性足菌肿和真菌性足菌肿均常累及骨骼,其特征为骨质疏松、骨膜反应和空洞形成。作者选择的治疗方法是口服磺胺甲恶唑(800毫克)、甲氧苄啶(100毫克)和泼尼松(10毫克),每日联合用药。