2017, Number 03
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Ginecol Obstet Mex 2017; 85 (03)
Actinomycetoma in pregnancy. Case report: what to do, how to handle?
Espinosa S, Perales D, Ponce RM, Buitrón-García R, Bonifaz A
Language: Spanish
References: 13
Page: 190-195
PDF size: 229.05 Kb.
ABSTRACT
Background: Mycetoma is an infection caused by fungi and aerobic actinomycetes. It is a frequent condition in Mexico; it presents less in women than men (1:3). It is characterized by increased volume deformity of the region and sinuses.
Objetive: We present a case of actinomycetoma in a pregnant patient and to analyze the behavior in its therapeutic management
Clinical case: We present female, 29 years old, attending her fourth pregnancy at 29 weeks of gestation. It began 13 years ago with a localized dermatosis of the lower left limb, constituted by a painless nodule, remained unchanged until the beginning of the current gestation, developed multiple nodules and sinuses. A direct examination of the secretion was performed, observing grains,
Nocardia brasiliensis was identified. After product birth, lactation was allowed for 4 months and discontinued with bromocriptine. The dermatosis extended to double without bone affection, treatment with sulfamethoxazole/trimethoprim + dapsone was given. Total time was 15 months and follow-up without medication for one year. Clinical and microbiological cure was achieved.
Conclusions: The development of mycetoma in pregnant women is rare, it is important to know the etiology, in eumycetoma all the antimycotics are teratogenic and in actinomycetoma most antibiotics cannot be used in pregnancy with some exceptions. If mycetoma is located in an area that does not compromise other organs or does not spread it is best to leave the course of pregnancy and lactation and then start treatment.
REFERENCES
Bonifaz A, Tirado-Sánchez A, Calderón L, Saúl A. Araiza J, Hernández M, et al. Mycetoma: experience of 482 cases in a single center of Mexico. PLOS Negl Trop Dis 2014;8(8):e3102. Doi:10.1301/journal.pntd.003102
van de Sande W. Global burden of human mycetoma: a systematic review and meta-analysis. PLoS Negl Trop Dis 2013;7(11):e2550. doi:10.1371/journal.pntd.0002550
López-Martínez R, Méndez-Tovar L, Bonifaz A, et al. Actualización de la epidemiología del micetoma en México. Revisión de 3,933 casos. Gac Med Mex 2013;149:586-92.
Padilla M, Novales J, Juárez V, Flores AP. Minimicetoma. Presentación de un caso. Rev Cent Dermatol Pascua 2004;13:41-44.
Fahal A. Mycetoma: a thorn in the flesh. Trans R Soc Trop Med Hyg 2004; 98:3-11
Welsh O, Vera-Cabrera L, Salinas-Carmona M: Mycetoma. Clin Dermatol 2007;25:195-202.
Yeh I, Dhanireddy S. Madura foot caused by Actinomadura madurae in a pregnant woman. Arch Dermatol 2010;146:1189-1190.
Hernández-Hernández F, López Martínez R, Méndez Tovar, et al. Nocardia braisliensis: in vitro and in vivo growth response to steroid sex hormones. Mycopatologia 1995;132:79-85.
Méndez-Tovar LJ, Bievre C, López-Martínez R, et al. Effets des hormones sexuelles humanines sur le development in vitro des agents D’eumycétomes. J Mycol Med 1991;118:141-143.
Ramírez-Tamayo T. Determinación de hormonas sexuales esteroideas en pacientes con micetoma por Nocardia brasiliensis y Actinomadura madurae. Tesis de especialización en dermatología. Facultad de Medicina, UNAM, México, 1998.
Buhimschi C, Weiner C. Medications in pregnancy and lactation. Obstet Gynecol 2009;113:166-88.
Howland R. Evaluating the safety of medications during pregnancy and lactation. J Psychosoc Nurs Ment Health Serv 2009;47:19-22.
Henderson E, Mackillop L. Prescribing in pregnancy and during breast feeding: using principles in clinical practice. Postgrad Med J 2011;87:349-354.