Acanthamoeba keratitis in Sudan: outcome of ketoconazole treatment in six patients

In an exploration of the acanthamoebic aetiology of chronic keratitis cases (not responding to antibiotics, antiviral or antifungal therapy), 138 Sudanese patients were seen over a 2-year period at two teaching eye hospitals in Khartoum State. Six (4.3%) of these patients were found to be suffering from Acanthamoeba keratitis. The present study focuses on the good outcome of oral ketoconazole in four patients at 18 months follow up period. The drug oral route, convenient frequency of doses, minimal side effects and availability at reasonable price favour ketoconazole therapy. Sudan Journal of Medical Sciences Vol. 1(1) 2006: 34-3

The Combination of Amoxicillin-Clavulanic Acid and Ketoconazole in the Treatment of Madurella mycetomatis Eumycetoma and Staphylococcus aureus Co-infection

Eumycetoma is a chronic progressive disabling and destructive inflammatory disease which is commonly caused by the fungus Madurella mycetomatis. It is characterized by the formation of multiple discharging sinuses. It is usually treated by antifungal agents but it is assumed that the therapeutic efficiency of these agents is reduced by the co-existence of Staphylococcus aureus co-infection developing in these sinuses. This prospective study was conducted to investigate the safety, efficacy and clinical outcome of combined antibiotic and antifungal therapy in eumycetoma patients with superimposed Staphylococcus aureus infection. The study enrolled 337 patients with confirmed M. mycetomatis eumycetoma and S. aureus co-infection. Patients were allocated into three groups; 142 patients received amoxicillin-clavulanic acid and ketoconazole, 93 patients received ciprofloxacin and ketoconazole and 102 patients received ketoconazole only. The study showed that, patients who received amoxicillin-clavulanic acid and ketoconazole treatment had an overall better clinical outcome compared to those who had combined ciprofloxacin and ketoconazole or to those who received ketoconazol

Merits and pitfalls of currently used diagnostic tools in mycetoma

Treatment of mycetoma depends on the causative organism and since many organisms, both actinomycetes (actinomycetoma) and fungi (eumycetoma), are capable of producing mycetoma, an accurate diagnosis is crucial. Currently, multiple diagnostic tools are used to determine the extent of infections and to identify the causative agents of mycetoma. These include various imaging, cytological, histopathological, serological, and culture techniques; phenotypic characterisation; and molecular diagnostics. In this review, we summarize these techniques and identify their merits and pitfalls in the identification of the causative agents of mycetoma and the extent of the disease. We also emphasize the fact that there is no ideal diagnostic tool available to identify the causative agents and that future research should focus on the development of new and reliable diagnostic tools

Showing massive anterior abdominal wall, perineal, vulval and upper thigh actinomycetoma

<p>Showing massive anterior abdominal wall, perineal, vulval and upper thigh actinomycetoma</p

Showing knee region X-ray with type finding of eumycetoma; soft tissue mass, periosteal reaction of the lower part of the femur, patella and upper tibia and multiple bone cavities in the upper part of the tibia.

<p>Showing knee region X-ray with type finding of eumycetoma; soft tissue mass, periosteal reaction of the lower part of the femur, patella and upper tibia and multiple bone cavities in the upper part of the tibia.</p

Showing massive back and gluteal eumycetoma.

<p>Showing massive back and gluteal eumycetoma.</p

Showing massive hand and forearm eumycetoma with massive deformity.

<p>Showing massive hand and forearm eumycetoma with massive deformity.</p

Showing massive foot eumycetoma with multiple sinuses and discharge with black grains.

<p>Showing massive foot eumycetoma with multiple sinuses and discharge with black grains.</p