Journal of Global Infectious DiseasesOfficial Publishing of INDUSEM and OPUS 12 Foundation, Inc. Users online:1059  
Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size     
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
 


 
LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 2  |  Issue : 2  |  Page : 194-195
Mycetoma due to Nocardia farcinica


1 Department of Microbiology, Sikkim Manipal Institute of Medical Sciences (SMIMS) and Central Referral Hospital (CRH), 5th Mile, Tadong, Gangtok, Sikkim-737 102, India
2 Department of Surgery, Sikkim Manipal Institute of Medical Sciences (SMIMS) and Central Referral Hospital (CRH), 5th Mile, Tadong, Gangtok, Sikkim-737 102, India
3 Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences (SMIMS) and Central Referral Hospital (CRH), 5th Mile, Tadong, Gangtok, Sikkim-737 102, India

Click here for correspondence address and email

Date of Web Publication30-Apr-2010
 

How to cite this article:
Adhikari L, Dey S, Pal R. Mycetoma due to Nocardia farcinica. J Global Infect Dis 2010;2:194-5

How to cite this URL:
Adhikari L, Dey S, Pal R. Mycetoma due to Nocardia farcinica. J Global Infect Dis [serial online] 2010 [cited 2019 Aug 18];2:194-5. Available from: http://www.jgid.org/text.asp?2010/2/2/194/62868


Sir,

Mycetoma is a tropical superficial chronic progressive granulomatous fungal infection of the skin and subcutaneous tissue with sporadic occurrence in India. [1]

A 60-year-old female presented an infection due to  Nocardia farcinica Scientific Name Search and demonstrated successful intervention with surgical exploration and prolonged combined chemotherapy. She was brought with a history of multiple discharging sinuses over the right foot and swelling of the same foot since two months after a thorn prick. Physical examination showed chronic skin changes on the leg, with swelling and yellow fluid-draining sinuses. She was admitted in the surgery in-patients, and under strict aseptic conditions, pus and two swabs were collected from the discharging sinuses.

Gram's staining of granules revealed Gram positive filamentous bacilli with branching and segmented fragmentation. Modified Ziehl-Neelsen's staining of granules using 1% sulphuric acid revealed acid fast filamentous bacilli. [Figure 1] and [Figure 2] Small, soft, irregular white granules were collected from the pus. Sterile plate showing granules as white particle against the dark background [Figure 3] on saline wet mount revealed multilobulated granules with sun ray appearance. [Figure 3] The granules were inoculated on blood agar, Lowenstein-Jensen medium and Sabouraud's dextrous agar slants (with or without chloramphenicol) and incubated at 25΀C and 37΀C and observed daily for growth. Small, white, wrinkled, heaped colonies appeared after 72 hours of incubation on Lowenstein-Jensen medium [Figure 4] and Sabourauds dextrose agar, where as blood agar got contaminated. Light pink pigmentation appeared after 10 days of incubation. The isolate was identified as N. farcinica by its characteristic growth, Gram reaction, acid fastness on modified Ziehl-Neelsen staining using 1% sulphuric acid, positive urease test, positive nitrate reduction test and negative degration of casein (skim milk medium) and positive growth at 45΀C for 3 days. [2] The isolate was sensitive to streptomycin, co-trimoxazole, rifampicin. Histopathological examination of the tissue biopsy revealed amorphous aggregates of eosinophilic granules of large clusters of microorganisms resembling fungal hyphae and bacteria, in a background of chronic suppurative inflammation of mixed inflammatory infiltrate cells and stained positively by PAS and Gomori's methenamine silver stain.

Conservative exploration was carried out on the patient after proper written informed consent. She was initially treated with co-trimoxazole and streptomycin and later with dapsone, rifampicin and streptomycin. The patient improved after three months of chemotherapy, the swelling diminished and grain extrusion has ceased. The patient has been able to resume ambulation with normal footwear and recovered uneventfully. In our study, we reported a case of mycetoma due to N. farcinica. The actinomycotic mycetoma varies species wise from country to country and place to place. Nocardia brasiliensis mycetoma is more commonly reported from different countries like Africa, South America, Mexico, and other parts of India. [3,4] Maiti et al. reported from Calcutta that pricking was the most common injury associated with eumycetomas. Lesions in exposed area were more common among agricultural workers with a remarkably lower incidence of Nocardia.[5]

The mycetoma of the leg in this case could have been diagnosed early and promptly treated with a high index of suspicion.

 
   References Top

1.Samaila MO, Mbibu HN, Oluwole OP. Human mycetoma. Surg Infect (Larchmt) 2007;8:519-22.   Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Ahmed AA, van de Sande WW, Fahal A, Bakker-Woudenberg I, Verbrugh H, van Belkum A. Management of mycetoma: Major challenge in tropical mycoses with limited international recognition. Curr Opin Infect Dis 2007;20:146-51.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Zarei Mahmoudabadi A, Zarrin M. Mycetomas in Iran: A review article. Mycopathologia 2008; 165:135-41.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Fukuda H, Saotome A, Usami N, Urushibata O, Mukai H. Lymphocutaneous type of nocardiosis caused by Nocardia brasiliensis: A case report and review of primary cutaneous nocardiosis caused by N. brasiliensis reported in Japan. J Dermatol 2008; 35:346-53.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Maiti P K, Ray A, Bandyopadhyay S. Epidemiological aspects of mycetoma from a retrospective study of 264 cases in West Bengal. Trop Med Int Health 2002; 7:788-92.  Back to cited text no. 5      

Top
Correspondence Address:
Ranabir Pal
Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences (SMIMS) and Central Referral Hospital (CRH), 5th Mile, Tadong, Gangtok, Sikkim-737 102
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.62868

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed1536    
    Printed100    
    Emailed0    
    PDF Downloaded68    
    Comments [Add]    

Recommend this journal

Sitemap | What's New | Feedback | Copyright and Disclaimer | Contact Us
2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008