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Does the benefit of salvage amputation always outweigh disability in drug-failure mycetoma?: a tale of two cases.

Maiti PK, Chakraborty B, Ghosh S, De A - Indian J Dermatol (2015 Jan-Feb)

Bottom Line: We present two cases with contrasting treatment options and outcome.He responded poorly to antifungal therapy and refused below-knee amputation 12 years ago.She presented to us after recurrence of mycetoma on an amputated stump and was successfully treated by proper courses of antibiotics after detecting the causal agent, Actinomadura madurae.

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.

ABSTRACT
It is popularly believed that eumycetoma cases should be dealt with using surgical amputation for a better chance of cure especially when chemotherapy has failed. However, amputation leads to disability on one hand and on the other it may also fail to be curative. We present two cases with contrasting treatment options and outcome. In the eumycetoma case reported here, a 40-year-old male presented with right foot swelling for 16 years, from which Scedosporium apiospermum was isolated. He responded poorly to antifungal therapy and refused below-knee amputation 12 years ago. With counseling and wound care his condition improved, and Foot and Ankle Ability Measure (FAAM) score remained almost stable at 90% for 16 years, which is much better than the average functional outcome after amputation. Another 46-year-old female underwent below-knee amputation after receiving incomplete courses of antibiotics and antifungals for mycetoma of unknown etiology. She presented to us after recurrence of mycetoma on an amputated stump and was successfully treated by proper courses of antibiotics after detecting the causal agent, Actinomadura madurae. Her post-amputation disability and depression could have been avoided if the hasty decision of amputation had not been taken. In our opinion, living with drug-non-responsive mycetoma, supported by symptomatic management, may be a better option than amputation and its associated morbidities. So before taking the path of salvage amputation, we must consider many aspects, including patient's livelihood, psychological aspects and chances of recurrence even after the procedure.

No MeSH data available.


Related in: MedlinePlus

Recurrence of actinomycetoma after amputation in the right leg
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Figure 2: Recurrence of actinomycetoma after amputation in the right leg

Mentions: A 46-year-old female patient presented with recurrence of mycetoma on the amputated stump 3 years after below-knee amputation of a right limb [Figure 2]. Initially it started as a nodular swelling in the right foot, 6 months after traumatic implantation of the organism following a bamboo prick, which was clinically diagnosed as mycetoma, with no growth in culture. Treatment was done by short courses of several drug combinations, including co-trimoxazole, streptomycin, dapsone, doxycycline and tetracycline, with no clinical improvement for 9 years. Finally the affected leg was amputated for complete remission. But after 3 years she came to us with recurrence. White grains from sinuses were collected and 1000-1500-μm grains with irregular delicate filaments of < 1 μm diameter were demonstrated in KOH smears. The causal agent was isolated in neutral SDA and identified as Actinomadura madurae by microscopy, growth characteristics and biochemical properties.


Does the benefit of salvage amputation always outweigh disability in drug-failure mycetoma?: a tale of two cases.

Maiti PK, Chakraborty B, Ghosh S, De A - Indian J Dermatol (2015 Jan-Feb)

Recurrence of actinomycetoma after amputation in the right leg
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318067&req=5

Figure 2: Recurrence of actinomycetoma after amputation in the right leg
Mentions: A 46-year-old female patient presented with recurrence of mycetoma on the amputated stump 3 years after below-knee amputation of a right limb [Figure 2]. Initially it started as a nodular swelling in the right foot, 6 months after traumatic implantation of the organism following a bamboo prick, which was clinically diagnosed as mycetoma, with no growth in culture. Treatment was done by short courses of several drug combinations, including co-trimoxazole, streptomycin, dapsone, doxycycline and tetracycline, with no clinical improvement for 9 years. Finally the affected leg was amputated for complete remission. But after 3 years she came to us with recurrence. White grains from sinuses were collected and 1000-1500-μm grains with irregular delicate filaments of < 1 μm diameter were demonstrated in KOH smears. The causal agent was isolated in neutral SDA and identified as Actinomadura madurae by microscopy, growth characteristics and biochemical properties.

Bottom Line: We present two cases with contrasting treatment options and outcome.He responded poorly to antifungal therapy and refused below-knee amputation 12 years ago.She presented to us after recurrence of mycetoma on an amputated stump and was successfully treated by proper courses of antibiotics after detecting the causal agent, Actinomadura madurae.

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.

ABSTRACT
It is popularly believed that eumycetoma cases should be dealt with using surgical amputation for a better chance of cure especially when chemotherapy has failed. However, amputation leads to disability on one hand and on the other it may also fail to be curative. We present two cases with contrasting treatment options and outcome. In the eumycetoma case reported here, a 40-year-old male presented with right foot swelling for 16 years, from which Scedosporium apiospermum was isolated. He responded poorly to antifungal therapy and refused below-knee amputation 12 years ago. With counseling and wound care his condition improved, and Foot and Ankle Ability Measure (FAAM) score remained almost stable at 90% for 16 years, which is much better than the average functional outcome after amputation. Another 46-year-old female underwent below-knee amputation after receiving incomplete courses of antibiotics and antifungals for mycetoma of unknown etiology. She presented to us after recurrence of mycetoma on an amputated stump and was successfully treated by proper courses of antibiotics after detecting the causal agent, Actinomadura madurae. Her post-amputation disability and depression could have been avoided if the hasty decision of amputation had not been taken. In our opinion, living with drug-non-responsive mycetoma, supported by symptomatic management, may be a better option than amputation and its associated morbidities. So before taking the path of salvage amputation, we must consider many aspects, including patient's livelihood, psychological aspects and chances of recurrence even after the procedure.

No MeSH data available.


Related in: MedlinePlus