Epidemiological And Bacteriological Aspects Of Actinomycetomas In Man And Animals

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Elzein, Salma
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The present study comprised an epidemiological analysis of 1500 patients attending Mycetoma Research Center (MRC) unit, Soba University Hospital, during 1993-1999, a detailed microbiological investigation to some cases (50cases) attended the MRC between January 2000- February 2001 was conducted and a survey for actinomycetomalike syndrome among 892 donkeys at Khartoum State. Out of the 1500 patients attended the MRC, 988 (66.7%) were found to have eumycetoma due to Madurella mycetomi, whereas 512 (33.3%) were actinomycetoma. The details analysis of these patients showed the following results: 31% were from Central Sudan (Gezira), 23.3% were from Khartoum and 17.5% were from Kordofan while 29.81% were from all other states. The main clinical symptoms observed were slowly progressive subcutaneous swellings at the site of previous traumas. The conditions were painless in 69.1%. 26.3% of these patients were farmers, 18.1% were homewives and 16.2% were students. The commonest site of actinomycetoma was the foot (73.2%), leg (6.9%) and hand (4.6%). 45.7% of patients were on treatment of streptomycin and dapson, 13.2% were given streptomycin and septrin, but 4.3% received no treatment. The visual xii examination of the discharged grains of the 270 actinomycetoma cases gave an indication of the causative agents. According to grain colors of these 270 cases, 33.6% were yellow type (Streptomyces somaliensis and Nocardia brasiliensis), 31.2% were white ( Actinomadura madurae) and 6.6% were red (Act. pelletirei). The second part of the study comprised the selective isolation and identification of actinomycetes from patients attended the MRC between January 2000-February 2001. Brain Heart infusion Agar (BHA) and Tryptic Soya Agar (TSA) were found to be the best media to recover actinomycetes form suspected lesions of actinomycetoma. Morphological and biochemical examinations were used to establish a diagnostic scheme. The results were as follows: 45 of the 50 were identified tentatively as actinomycetoma from the grain color and were subsequently subjected to bacteriological examinations. Five were found to be Eumycetoma. Out of the 45, which were identified tentatively as actinomycetes, only 31 revealed growth on BHA and TSA and six samples showed no grains. Eight failed to grow using the present isolation protocol. Of the grown actinomycetes, 20 were Streptomyces somaliensis, two strains were assigned Streptomyces sp., eight were Actinomadura madurae, six were Actinomadura pelletirei and one was Nocardia otitidiscaviarum. The two Streptomyces sp. strains (SD501 and SD509) that were isolated from patients with yellow grains, were tentatively identified as xiii Streptomyces sp. These strains received a detailed morphological, biochemical, chemical and molecular characterization. The 16S rDNA analysis supported the initial identification of the two strains. It further suggested that these two strains were not typical S. somaliensis but related to it. This result need to be supported by more sequence analysis especially for the Streptomyces isolated in this study. In the thired part of this study eight hundreds and ninety two donkeys were examined during a survey conducted between the period from January to April 2001 at Khartoum State for the presence of actinomycetoma-like (Houta syndrome). Twenty (2.02%) of them showed lesions simulating actinomycetoma. Nineteen of these cases were males and the age of diseased animals varied between 2-8 years. The lesions were painful and secondary bacterial infection was observed. The main clinical symptoms observed among the diseased animals were weakness in 16, anemia in 18 donkeys and various forms of skin lesions ranging from saddle sores, chronic subcutaneous abscess involving withers and back to multiple discharging sinuses. Out of the 20 isolated organisms, five were found to be Streptomyces spp. The isolation was done on TSA medium incubated at 37°c aerobically for not less than 10 days. Isolation of such Streptomyces spp. or similar antinomycetes from the remaining 15 cases was not successful using the above scheme due to secondary bacterial infection notably Staphylococcus spp. and Streptococcus spp.