Deep mycoses and pseudomycoses of the foot: a single-center retrospective study of 160 cases, in a tertiary-care center in Mexico. (March 2021)

• Record Type: Journal Article
• Authors: Bonifaz, Alexandro; Tirado-Sánchez, Andrés; Araiza, Javier; Treviño-Rangel, Rogelio; González, Gloria M.
• Is Part Of: Foot. Volume 46(2021)
• Publication Date: 2021-03
• Subjects: Deep endemic mycoses -- Pseudomycoses -- Implantation mycoses -- Mycetoma -- Chromoblastomycosis -- Sporotrichosis; Foot -- Diseases -- Periodicals; Foot -- Surgery -- Periodicals; Foot Diseases -- Periodicals; Foot -- surgery -- Periodicals; Pied -- Maladies -- Périodiques; Pied -- Chirurgie -- Périodiques; Pied -- Lésions et blessures -- Périodiques; Foot -- Diseases; Foot -- Surgery; Periodicals; Electronic journals; Electronic journals; 617.585005
• DOI: 10.1016/j.foot.2020.101770
• Languages: English
• ISSNs: 0958-2592

Abstract

Highlights: Deep mycoses and pseudomycoses of the foot are generally due to trauma that inoculates the etiological agent. The three most frequent diseases are endemic, such as mycetoma, chromoblastomycosis, and sporotrichosis. The clinical pictures of these mycoses and pseudomycoses of the foot often lead to misdiagnosis; therefore, diagnostic tests are mandatory. Most of mycoses of the foot are due to the implantation of fungi. Abstract: Background: Deep mycoses and pseudomycoses (DMP) may cause significant disability and even death; however, the reports regarding these diseases, mainly affecting the foot, are scarce. Objective: To describe the epidemiological, clinical, and diagnostic characteristics of DMP of the foot in 160 patients. Methods: A retrospective and observational study of DMP affecting the foot was carried out in a tertiary-care center in Mexico for 20 years (from January 2000 to December 2019). Cases with confirmatory microbiological studies were included; the identification of the isolated fungi was based on the forms of reproduction. For actinomycetes, morphological analysis in an automated system ATB Vitek® 1574 (Biomèrieux) was used. The fungi were identified by PCR, using several primers from the ITS regions and for actinomycetes in the 16S rRNA region. Data from histopathological studies were also collected. Results: One hundred and sixty proven cases of DMP of the foot were included. The cases were categorized into nine types of infections including mycetoma (actinomycetoma and eumycetoma) in 102 cases (63.7%); sporotrichosis in 21 cases (13.1%); chromoblastomycosis, 18 cases (11.2%); phaeohyphomycosis, 3 cases (1.8%); histoplasmosis, 12 cases (7.5%); coccidioidomycosis 2 cases (1.2%) and botryomycosis and nocardiosis with one case respectively (0.6%). Most cases developed after traumatic implantation (147 cases, 91.8%). One hundred fifteen cases (71.8%) were men. The evolution was chronic in 125 cases (78.2%); bone involvement was observed in 64 cases (40%). Parasitic forms were observed In 139 cases (86.8%). The isolation and identification of the etiological agents were confirmed in all cases. Conclusion: The main DMP affecting the foot were infections due to traumatic implantation; most were endemic mycoses. The clinical characteristics and the evolution of the diseases are easily misdiagnosed, and thus, diagnostic tests are usually required.