IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 5849 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
   Article in PDF (228 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed3877    
    Printed84    
    Emailed0    
    PDF Downloaded221    
    Comments [Add]    
    Cited by others 5    

Recommend this journal

 


 
LETTER TO EDITOR
Year : 2008  |  Volume : 74  |  Issue : 5  |  Page : 515-516

Eumycetoma due to Curvularia lunata


1 Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
2 Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India

Correspondence Address:
Atul Garg
Department of Microbiology, JIPMER, Pondicherry - 605 006
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0378-6323.44327

Rights and Permissions



How to cite this article:
Garg A, Sujatha S, Garg J, Parija S C, Thappa D M. Eumycetoma due to Curvularia lunata. Indian J Dermatol Venereol Leprol 2008;74:515-6

How to cite this URL:
Garg A, Sujatha S, Garg J, Parija S C, Thappa D M. Eumycetoma due to Curvularia lunata. Indian J Dermatol Venereol Leprol [serial online] 2008 [cited 2019 Aug 18];74:515-6. Available from: http://www.ijdvl.com/text.asp?2008/74/5/515/44327


Sir,

Mycetoma is a chronic granulomatous, suppurative, and progressive inflammatory disease that usually involves the subcutaneous tissue and bones after traumatic inoculation of the causative organism. The condition may be caused by true fungi or by higher bacteria and therefore is classified as eumycetoma or actinomycetoma respectively. [1] It is mainly seen in Africa, India, Mexico, and parts of South America. In India actinomycotic mycetoma is prevalent in south India, southeast Rajasthan, and Chandigarh; while eumycetoma, which constitutes one third of the total cases, is mainly reported from north India and central Rajasthan. [2] The common etiological agents of eumycetoma reported from different centers are Madurella mycetomatis , M. grisea , Acremonum spp., Aspergillus spp. and Fusarium spp. [3]

We report here a rare instance of eumycetoma caused by Curvularia lunata in a 65-year-old male farmer, who presented to the dermatology outpatient clinic of our hospital in September 2007, with swelling of right foot, multiple nodules, and sinuses discharging black-colored granules. His problem started 6 years back as a single nodular swelling on the plantar surface of the foot following trauma. After a few months, painless multiple nodules developed on both plantar and dorsal surfaces of the foot. Some of the nodules broke down, forming openings discharging black-colored granules.

Physical examination of the patient revealed non-tender, gross swelling of the right foot with multiple discharging sinuses and crusts. The skin over the entire foot was hyperpigmented and thickened; regional lymph nodes did not show any significant enlargement, and systemic examination was unremarkable. All the routine investigations, including foot radiographs and hematological and biochemical tests, were within normal limits. A few black, irregular granules of variable size measuring 0.5 to 2 mm were collected from the patient and subjected to microscopy and culture. Potassium hydroxide (KOH) wet mount revealed brown-colored, septate hyphae approximately 2 × 4 µm in width, interwoven with each other. On Sabouraud's dextrose agar (containing chloramphenicol without cycloheximide), black-colored colonies with white aerial hyphae were isolated after 1 week of incubation. Microscopically, lactophenol cotton blue wet mount of the colony showed erect, unbranched, septate, flexuous, brown-colored conidiophores, along with conidia. The conidia were approximately 20-30 × 8-10 µm in size, smooth walled, olivaceous brown in color, were four-celled with 3 septae and had a larger sub-terminal cell [Figure 1]. The fungal isolate was identified as Curvularia lunata. The patient was treated with oral itraconazole 200 mg twice daily. The patient started improving as shown by the reduction of swelling with resolution of the sinuses. He is currently under observation with continued medical treatment.

Curvularia infections in humans are relatively uncommon despite the ubiquitous presence of this soil-dwelling dematiaceous fungus in the environment. There are 31 known species, and the most commonly recovered species in man has been C. lunata, followed by C. geniculata . [4] Originally thought to be solely a pathogen of plants, Curvularia has been described as a pathogen of humans and animals in the last half century, causing respiratory tract, corneal, and cerebral infections. However, only a few cases of mycetoma have been reported till date. [5]

Proper management of mycetoma strongly depends on the identification of the causative organism; as eumycetoma should be treated with adequate antifungal therapy and surgery, whereas actinomycetoma generally responds well to antibacterial treatment and, in a few cases, surgery is indicated. Early cases are curable, but advanced cases are difficult to treat and may require amputation. Currently, itraconazole and ketoconazole are the best treatment options for eumycetoma, and Mycetoma Research Center (Khartoum, Sudan) recommends ketoconazole (400-800 mg daily) or itraconazole (400 mg daily) for first-line use. In the present case, treatment of the patient was commenced with itraconazole, with signs of improvement.

 
  References Top

1.Ahmed AO, Van Leeuwen W, Fahal A, Van de Sande W, Verbrugh H, Van Belkum A. Mycetoma caused by Madurella mycetomatis: A neglected infectious burden. Lancet Infect Dis 2004;4:566-74.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Chakrabarti A, Singh K. Mycetoma in Chandigarh and surrounding areas. Indian J Med Microbiol 1998;16:64-5.  Back to cited text no. 2    
3.Rippon JW. The pathogenic fungi and pathogenic actinomycetes. Medical Mycology. 3 rd ed. London: WB Saunders; 1988. p. 80-118.  Back to cited text no. 3    
4.Hay RJ. Agents of eumycotic mycetomas. In: Topley and Wilsons. Text Book of Microbiology. Vol 4. 9 th ed. 1998. p. 487-96.  Back to cited text no. 4    
5.Janaki C, Sentamilselvi G, Janaki VR, Devesh S, Ajithados K. Eumycetoma due to Curvularia lunata. Mycoses 1999;42:345-6.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]


    Figures

  [Figure 1]

This article has been cited by
1 Subcutaneous Mycoses: An Aetiological Study of 15 Cases in a Tertiary Care Hospital at Dibrugarh, Assam, Northeast India
Pallabi Bordoloi,Reema Nath,Mondita Borgohain,M. M. Huda,Shyamanta Barua,Debajit Dutta,Lahari Saikia
Mycopathologia. 2015;
[Pubmed] | [DOI]
2 Synthesis and Biological Evaluation of Organoruthenium Complexes with Azole Antifungal Agents. First Crystal Structure of a Tioconazole Metal Complex
Jakob Kljun,Antony James Scott,Tea Lanišnik Rižner,Jennifer Keiser,Iztok Turel
Organometallics. 2014; 33(7): 1594
[Pubmed] | [DOI]
3 Curvularia lunata: A rare cause of black-grain eumycetoma
R. Gunathilake,P. Perera,G. Sirimanna
Journal de Mycologie Médicale / Journal of Medical Mycology. 2013;
[Pubmed] | [DOI]
4 Novel Inhibitors of Trihydroxynaphthalene Reductase with Antifungal Activity Identified by Ligand-Based and Structure-Based Virtual Screening
Mojca Brunskole Švegelj, Samo Turk, Boris Brus, Tea Lanišnik Rižner, Jure Stojan, Stanislav Gobec
Journal of Chemical Information and Modeling. 2011; 51(7): 1716
[VIEW] | [DOI]
5 Tiny keratotic brown lesions on the interdigital web between the toes of a healthy man caused by Curvularia species infection and a review of cutaneous Curvularia infections
Makoto Yanagihara, Masako Kawasaki, Hiroshi Ishizaki, Kazushi Anzawa, Shun-ichi Udagawa, Takashi Mochizuki, Yukio Sato, Nobuyuki Tachikawa, Hiroyoshi Hanakawa
Mycoscience. 2010;
[VIEW] | [DOI]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow