Eumycetoma: A Peruvian case series

Abstract

Objective: To report the epidemiological and clinical characteristics of eumycetoma patients diagnosed in a referral tertiary hospital of Lima-Peru. Methods: Patients with a diagnosis of eumycetoma evaluated at the Cayetano Heredia Hospital between 2000 and 2017. Diagnosis of eumycetoma required demonstration of grains at clinical or histopathological examination. Epidemiological and clinical data was extracted from clinical and mycology laboratory records. The isolates were identified on the basis of cultural and morphological characteristics. When it was possible a molecular diagnostic test was used for the identification of the species. Results: 19 eumycetoma patients were diagnosed, most of them were males, median age of 37. The median duration of disease was 65 months, and eleven out of 14 patients reported history of agricultural activity before the onset of the disease. Most patients were residents of two regions, Piura and Lambayeque. Lesions were located on the foot in 17 patients, on the leg in one patient and on the hand in another patient. 17 patients had the classic clinical triad. Ten out of 15 patients with imaging evaluation presented bone lesions. Among 17 patients with presence of macroscopic grains, 12 were black and 5 were white-yellowish grains. In the other two patients, the presence of grains was only evidenced in the histopathology. Ten of the 12 patients with black grain eumycetoma acquired the disease in the regions of Lambayeque and Piura. The etiological agent was isolated in 12 patients; Madurella mycetomatis in eight, Fusarium spp in two, Scedosporium apiospermum specie complex in one, and Phaeoacremonium sphinctrophorum in another patient. Most patients received itraconazole for treatment. Conclusion: In Peru, eumycetoma patients are diagnosed lately, when disease has already reached an advanced stage. Limited data suggest that eumycetoma acquisition in Peru occurs mainly in arid and sandy areas of northern regions.