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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

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

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  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

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