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

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Presentation on theme: "Bonifaz A, Ibarra G, Saúl A, Carrasco E. Dermatology & Micology Department General Hospital of Mexico Hospital Infantil de Mexico MYCETOMA IN CHILDREN."— Presentation transcript:

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

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

5 Background 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: MYCETOMA IN CHILDREN

6 Background Factors to development mycetoma: MYCETOMA IN CHILDREN Factors Patients condition Hormonal Inoculum

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

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

9 Clinical 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 MYCETOMA IN CHILDREN

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

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

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

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

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

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29 Etiology

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

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

32 TMS-SMX + DDS

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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

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38 Conclusions 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: 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: MYCETOMA IN CHILDREN

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


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