ACTINOMYCOTIC MYCETOMA - 27 CASES FROM DA KAR (SENEGAL), MEDICAL-TREATMENT WITH COTRIMOXAZOLE

Actinomycotic mycetoma is frequent in Senegal and the treatment has ch anged greatly over the last decades. We observed 27 cases due to Actin omadura pelletieri (n = 21), Actinomadura madurae (n = 5) and Streptom yces somaliensis (n = 1). The diagnosis was based on clinical and hist ological arguements. All the patients were treated with cotrimoxazole for several months. The mycetoma was situated on the foot in 15/27 pat ients. Extrapodal localizations were frequent for red grains due to A. pelletieri (11/21). These mycetomas, the most frequent in Senegal, ar e extremely severe lesions with rapid local and distance extension. We were able to obtain 8 clinical cures. One death occurred in.patient w ith an abdominal localization and multiorgan invasion. Mid-term outcom e could not be determined in the other cases since they were lost to f ollow-up after initial improvement with cotrimoxazole. As sole treatme nt, cotrimoxazole shoud lead to cure in most cases.