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Case report: Actinomycetoma caused by Nocardia aobensis from Lao PDR with favourable outcome after short-term antibiotic treatment.

Vongphoumy I, Dance DA, Dittrich S, Logan J, Davong V, Rattanavong S, Blessmann J - PLoS Negl Trop Dis (2015)

Bottom Line: Although slight improvement was noted the patient left the hospital after 14 days and did not take any more antibiotics.Over the following 22 weeks the swelling of his foot subsequently diminished together with healing of discharging sinuses.A treatment course of only 14 days with amikacin and trimethoprim-sulfamethoxazole was apparently sufficient to cure the infection, although long-term treatment up to one year is currently recommended.

View Article: PubMed Central - PubMed

Affiliation: Provincial Health Department, Savannakhet, Lao People's Democratic Republic.

ABSTRACT

Background: Mycetoma is a neglected, chronic, localized, progressively destructive, granulomatous infection caused either by fungi (eumycetoma) or by aerobic actinomycetes (actinomycetoma). It is characterized by a triad of painless subcutaneous mass, multiple sinuses and discharge containing grains. Mycetoma commonly affects young men aged between 20 and 40 years with low socioeconomic status, particularly farmers and herdsmen.

Methodology/principal findings: A 30 year-old male farmer from an ethnic minority in Phin District, Savannakhet Province, Lao PDR (Laos) developed a painless swelling with multiple draining sinuses of his right foot over a period of approximately 3 years. X-ray of the right foot showed osteolysis of tarsals and metatarsals. Aerobic culture of sinus discharge yielded large numbers of Staphylococcus aureus and a slow growing Gram-positive rod. The organism was subsequently identified as Nocardia aobensis by 16S ribosomal RNA gene sequencing. The patient received antimicrobial treatment with amikacin and trimethoprim-sulfamethoxazole according to consensus treatment guidelines. Although slight improvement was noted the patient left the hospital after 14 days and did not take any more antibiotics. Over the following 22 weeks the swelling of his foot subsequently diminished together with healing of discharging sinuses.

Conclusion: This is the first published case of Actinomycetoma caused by Nocardia aobensis and the second case of Actinomycetoma from Laos. A treatment course of only 14 days with amikacin and trimethoprim-sulfamethoxazole was apparently sufficient to cure the infection, although long-term treatment up to one year is currently recommended. Treatment trials or prospective descriptions of outcome for actinomycetoma should investigate treatment efficacy for the different members of Actinomycetales, particularly Nocardia spp., with short-term and long-term treatment courses.

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Related in: MedlinePlus

(A) Gram stain preparation showing branching Gram-positive rods, (B) Chocolate agar showing heavy growth of Staphylococcus aureus with scattered colonies of Nocardia aobensis (5 days’ incubation).
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pntd.0003729.g003: (A) Gram stain preparation showing branching Gram-positive rods, (B) Chocolate agar showing heavy growth of Staphylococcus aureus with scattered colonies of Nocardia aobensis (5 days’ incubation).

Mentions: Aerobic culture of sinus discharge yielded large numbers of Staphylococcus aureus and a slow growing Gram-positive rod, which was apparent after 5 days’ incubation (Fig 3B). Gram stain preparation showed branching Gram-positive rods (Fig 3A). The organism was identified as Nocardia aobensis in two independent laboratories after amplification and sequencing of the 16S ribosomal RNA gene (839bp: coverage 839/839, identity 100%, e-value 0.00, Accession Number KP250991; 670bp [hypervariable regions V3–V7]: coverage 670/670, identity 100%, e-value 0.00, Accession Number KP404096) and blast analysis against the NCBI database [6].


Case report: Actinomycetoma caused by Nocardia aobensis from Lao PDR with favourable outcome after short-term antibiotic treatment.

Vongphoumy I, Dance DA, Dittrich S, Logan J, Davong V, Rattanavong S, Blessmann J - PLoS Negl Trop Dis (2015)

(A) Gram stain preparation showing branching Gram-positive rods, (B) Chocolate agar showing heavy growth of Staphylococcus aureus with scattered colonies of Nocardia aobensis (5 days’ incubation).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400045&req=5

pntd.0003729.g003: (A) Gram stain preparation showing branching Gram-positive rods, (B) Chocolate agar showing heavy growth of Staphylococcus aureus with scattered colonies of Nocardia aobensis (5 days’ incubation).
Mentions: Aerobic culture of sinus discharge yielded large numbers of Staphylococcus aureus and a slow growing Gram-positive rod, which was apparent after 5 days’ incubation (Fig 3B). Gram stain preparation showed branching Gram-positive rods (Fig 3A). The organism was identified as Nocardia aobensis in two independent laboratories after amplification and sequencing of the 16S ribosomal RNA gene (839bp: coverage 839/839, identity 100%, e-value 0.00, Accession Number KP250991; 670bp [hypervariable regions V3–V7]: coverage 670/670, identity 100%, e-value 0.00, Accession Number KP404096) and blast analysis against the NCBI database [6].

Bottom Line: Although slight improvement was noted the patient left the hospital after 14 days and did not take any more antibiotics.Over the following 22 weeks the swelling of his foot subsequently diminished together with healing of discharging sinuses.A treatment course of only 14 days with amikacin and trimethoprim-sulfamethoxazole was apparently sufficient to cure the infection, although long-term treatment up to one year is currently recommended.

View Article: PubMed Central - PubMed

Affiliation: Provincial Health Department, Savannakhet, Lao People's Democratic Republic.

ABSTRACT

Background: Mycetoma is a neglected, chronic, localized, progressively destructive, granulomatous infection caused either by fungi (eumycetoma) or by aerobic actinomycetes (actinomycetoma). It is characterized by a triad of painless subcutaneous mass, multiple sinuses and discharge containing grains. Mycetoma commonly affects young men aged between 20 and 40 years with low socioeconomic status, particularly farmers and herdsmen.

Methodology/principal findings: A 30 year-old male farmer from an ethnic minority in Phin District, Savannakhet Province, Lao PDR (Laos) developed a painless swelling with multiple draining sinuses of his right foot over a period of approximately 3 years. X-ray of the right foot showed osteolysis of tarsals and metatarsals. Aerobic culture of sinus discharge yielded large numbers of Staphylococcus aureus and a slow growing Gram-positive rod. The organism was subsequently identified as Nocardia aobensis by 16S ribosomal RNA gene sequencing. The patient received antimicrobial treatment with amikacin and trimethoprim-sulfamethoxazole according to consensus treatment guidelines. Although slight improvement was noted the patient left the hospital after 14 days and did not take any more antibiotics. Over the following 22 weeks the swelling of his foot subsequently diminished together with healing of discharging sinuses.

Conclusion: This is the first published case of Actinomycetoma caused by Nocardia aobensis and the second case of Actinomycetoma from Laos. A treatment course of only 14 days with amikacin and trimethoprim-sulfamethoxazole was apparently sufficient to cure the infection, although long-term treatment up to one year is currently recommended. Treatment trials or prospective descriptions of outcome for actinomycetoma should investigate treatment efficacy for the different members of Actinomycetales, particularly Nocardia spp., with short-term and long-term treatment courses.

Show MeSH
Related in: MedlinePlus