Open Access Highly Accessed Case report

Actinomycetoma in SE Asia: the first case from Laos and a review of the literature

Sayaphet Rattanavong1, Sivay Vongthongchit2, Khamhou Bounphamala2, Phouvong Vongphakdy3, Jacques Gubler4, Mayfong Mayxay156, Rattanaphone Phetsouvanh16, Ivo Elliott16, Julie Logan7, Robert Hill8, Paul N Newton16 and David Dance16*

Author Affiliations

1 Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR

2 Surgery Unit, Xiengkhuang Provincial Hospital, Xiengkhuang, Lao PDR

3 General Surgery Department, Mahosot Hospital, Vientiane, Lao PDR

4 Department of Medicine, Infectious Diseases, Kantonsspital, Winterthur, Switzerland

5 Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR

6 Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, UK

7 Department for Bioanalysis and Horizon Technologies, Health Protection Agency Microbiology Services Colindale, 61 Colindale Avenue, London, NW9 5HT, UK

8 Antibiotic Resistance Monitoring & Reference Laboratory (ARMRL), Health Protection Agency Microbiology Services Colindale, 61 Colindale Avenue, London, NW9 5EQ, UK

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BMC Infectious Diseases 2012, 12:349  doi:10.1186/1471-2334-12-349

Published: 12 December 2012

Abstract

Background

Mycetoma is a chronic, localized, slowly progressing infection of the cutaneous and subcutaneous tissues caused either by fungi (eumycetoma or implantation mycosis) or by aerobic actinomycetes (actinomycetoma). It is acquired by traumatic implantation, most commonly in the tropics and subtropics, especially in rural agricultural communities. Although well recognized elsewhere in Asia, it has not been reported from the Lao People’s Democratic Republic (Laos).

Case presentation

A 30 year-old female elementary school teacher and rice farmer from northeast Laos was admitted to Mahosot Hospital, Vientiane, with a massive growth on her left foot, without a history of trauma. The swelling had progressed slowly but painlessly over 5 years and multiple draining sinuses had developed. Ten days before admission the foot had increased considerably in size and became very painful, with multiple sinuses and discharge, preventing her from walking. Gram stain and bacterial culture of tissue biopsies revealed a branching filamentous Gram-positive bacterium that was subsequently identified as Actinomadura madurae by 16S rRNA gene amplification and sequencing. She was treated with long-term co-trimoxazole and multiple 3-week cycles of amikacin with a good therapeutic response.

Conclusion

We report the first patient with actinomycetoma from Laos. The disease should be considered in the differential diagnosis of chronic skin and bone infections in patients from rural SE Asia.

Keywords:
Mycetoma; Madura foot; Actinomadura madurae; Lao PDR; Laos; Southeast Asia