Successful treatment of human eumycetomas caused by Aspergillus species with voriconazole
Keywords:Eumycetoma, voriconazole, Aspergillus niger, Aspergillus flavus, Aspergillus fumigatus.
AbstractBackground Mycetoma is a chronic, granulomatous infection of skin, soft tissues and bones which developed after traumatic inoculation of pathogenic spores deep in to the tissues. Classical triad consists of swollen tissues, draining sinuses and coloured grains. Objective This study aimed to document clinical impact, side effects and safety profile of voriconazole in Aspergillus eumycetomas. Methods Retrospective study of clinical, histopathological and culture proven cases of Aspergillus eumycetomas treated with voriconazole between October 2017 to March 2020. Voriconazole 400 mg/day was given for six to 15 months. Results Six patients were selected for the study. Male to female ratio was 1:1. Mean age of cases was 45.33 years; five belonged to rural areas; most common occupation was farmer; feet were involved in five while knee was involved in one case only. Mean delay in diagnosis was 9.33 years. KOH mount showed filamentous, septate, acute-angled, dichotomously branched hyphae in all cases. Histopathology was diagnostic in four cases. Culture was positive in all cases and reported Aspergillus flavus in three, Aspergillus niger in two and Aspergillus fumigatus in one case. Bone involvement was none to minimal. Cultures became negative after three months of therapy while clinical improvement required at least six months of drug treatment. Surgical intervention was required in four cases. None of the case ended up for amputation. Five cases achieved complete clinical and microbiological cure. Conclusion Voriconazole is safe and efficacious for treatment of eumycetomas caused by Aspergillus species.
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