Mycetoma of the hand caused by Gordona terrae:: A case report
Mycetoma of the hand caused by Gordona terrae:: A case report
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DOI：
10.1016/j.jhsb.2003.09.011
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发表时间：
2004-04-01
期刊：
影响因子：
--
通讯作者：
Dolmans, WMV
中科院分区：
文献类型：
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作者：
Bakker, XR;Spauwen, PHM;Dolmans, WMV
足菌肿是一种肉芽肿性、感染性、非接触性的皮下组织疾病，主要见于南纬151度至北纬301度之间的赤道周围地区。它在印度、巴基斯坦、印度尼西亚、中美洲（墨西哥）和南美洲（巴西、哥伦比亚和委内瑞拉）、塞内加尔、索马里和苏丹等地区流行。通常情况下，感染发生在轻微受伤后，如刺伤，主要影响20至40岁的男性。病原体存在于土壤和木本植物中。该疾病可以由真真菌（真菌瘤）或需氧放线菌（放线菌瘤）引起（McGinnis，1996）。在70%至80%的病例中，感染是在脚上，因为流行地区的人通常是赤脚的。大约4%至7%的病例涉及手（马埃岛等人，1996; Tautenhahn等人，1977).在轻微受伤后，会有一段沉默期。几个月到几年后，皮下无痛结节在受伤部位发展。这就解释了为什么病人经常不记得创伤史。病变生长缓慢，并延伸到皮肤，其中皮肤窦形成含有真菌或细菌簇的颗粒的引流。皮下结节、窦道形成和颗粒排出三联征是足菌肿特有的（Fahal和哈桑，1992）。继发性感染是痛苦的，并经常产生脓性碎片。鼻窦通常愈合时，粮食被排出，但经过一段时间后，新的鼻窦旁边的发展旧的。在晚期，邻近器官和骨骼可能受到影响，导致器官衰竭，骨折和骨髓炎。淋巴或造血扩散是不常见的，并且该疾病不是致命的，除非在颅面足菌肿的情况下肿瘤穿透诸如硬膜外空间的区域（Baril等人，1999年）。足菌肿的许多病原体是已知的。对于真菌瘤，已经记录了31种不同的真菌（McGinnis，1996）。对于放线菌瘤，迄今已发现六种细菌（Warren，1996）。
Mycetoma is a granulomatous, infectious, non-contagious disease of the subcutaneous tissues, which is mainly seen around the equator between latitudes 151S and 301N. It is endemic in areas of India, Pakistan, Indonesia, Central (Mexico) and South America (Brazil, Colombia and Venezuela), Senegal, Somalia and Sudan. Usually, the infection occurs after a minor injury such as a thorn prick and it mainly affects men aged 20 to 40 years. The causative agents are found in soils and on woody plants. The disease can be caused by either true fungi (eumycetoma) or aerobic actinomycetes (actinomycetoma)(McGinnis, 1996). In 70% to 80% of cases the infection is on the foot, because people in the endemic areas are often barefoot. The hand is involved in approximately 4% to 7% of cases (Mahe et al., 1996; Tautenhahn et al., 1977).After the minor injury a silent period takes place. Months to years thereafter, a subcutaneous, painless nodule develops at the site of injury. This explains why the patient often does not remember a history of trauma. The lesion grows slowly and extends to the skin, where skin sinuses form with drainage of grains containing clusters of fungi or bacteria. The triad of subcutaneous nodule, sinus formation and discharge of grains is specific for mycetoma (Fahal and Hassan, 1992). Secondary infections are painful and often produce purulent debris. The sinuses usually heal when the grains are excreted, but after a period of time new sinuses develop beside the old ones. In the late stages adjacent organs and bones can be affected, causing organ failure, fractures and osteomyelitis. Lymphatic or haematogenic spread is uncommon and the disease is not lethal, except when the tumour penetrates areas such as the extradural space in a case of craniofacial mycetoma (Baril et al., 1999). Many causative agents for mycetoma are known. For eumycetoma 31 different fungi have been documented (McGinnis, 1996). For actinomycetoma six bacteria have been found so far (Warren, 1996).