Welsh O, Salinas-Carmona MC, Vera-Cabrera L

Language: Spanish
References: 5
Page: 125-127
PDF size: 36.43 Kb.

ABSTRACT

In Mexico, mycetoma is produced mainly by actinobacteria, being Nocardia brasiliensis the most commonly isolated species. The infection is chronic and produces destruction of the subcutaneous tissue, fascia, and in some cases bones. During the infection, antibodies against immunodominant antigens of 61-, 26 and 24 kDa of N. brasiliensis take place; the detection of this humoral immune response has been useful in the confirmation of the diagnosis, and in the prognosis of the disease. Although these antibodies are not related to a resistance state, there is experimental evidence that early IgM type inmunoglobulins produce resistance to the infection in a murine experimental model, although the specificity of these antibodies is not yet known. The treatment of actinomycetoma becomes difficult by the presence of abundant pus and fibrosis that prevent the diffusion of antimicrobials. The most effective treatment is the use of the combination trimetoprim-sulfametoxazol with amikacin with a rate of cure rate of 95%. In patients resistant to this treatment, other antimicrobials such as netilmycin, and amoxicillinclavulanic acid have been used. The study of the antimicrobial susceptibility of Nocardia in vitro and in experimental mouse models has demonstrated the possible utility of some compounds available in the market like linezolid, gatifloxacin, moxifloxacin, and garenoxacin, and of experimental drugs such as DA-7867 and DA-7218 that could be therapeutically useful in the future.

REFERENCES

1. Welsh O, Vera-Cabrera L, Salinas-Carmona MC. Mycetoma. Clin Dermatol 2007;25:195-202.

2. Salinas-Carmona MC, Pérez-Rivera I. Humoral immunity through immunoglobulin M protects mice from an experimental actinomycetoma infection by Nocardia brasiliensis. Infect Immunol 2004;72:5597-5604.

3. Vera-Cabrera L, González E, Rendón A, Ocampo-Candiani J, Welsh O, Velázquez-Moreno VM, et al. In vitro activities of DA-7157 and DA-7218 against Mycobacterium tuberculosis and Nocardia brasiliensis. Antimicrob Agents Chemother 2006;50:3170-3172.

4. Salinas-Carmona MC, Welsh O, Casillas SM. Enzyme-linked immunosorbent assay for serological diagnosis of Nocardia brasiliensis and clinical correlation with mycetoma infections. J Clin Microbiol 1993;31:2901-2906.

5. Welsh O, Sauceda E, González J, Ocampo J. Amikacin alone and in combination with trimethoprim-sulfamethoxazole in the treatment of actinomycotic mycetoma. J Am Acad Dermatol 1987;17:443-448.