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A case of plantar actinomycetoma without risk factors is presented, which was diagnosed by hystopatological analysis of a foot biopsy because of the suspicion of neoplasia. Since the patient did not fully respond to the first-line therapy antibiotics, a 24-weeks doxycycline regime was started, achieving a satisfactory response. Finally, a brief discussion on plantar mycetomas is presented.

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Resumen Se presenta un caso clínico de un actinomicetoma plantar en un paciente sin factores de riesgo, cuyo diagnóstico fue realizado mediante una biopsia de tejido plantar por sospecha de una neoplasia. Dado que el paciente no respondió satisfactoriamente a la terapia de primera línea, debió completar 24 semanas de tratamiento con doxiciclina, a lo cual evolucionó favorablemente. Finalmente, se desarrolla una breve discusión sobre los micetomas plantares.

A case of plantar actinomycetoma without risk factors is presented, which was diagnosed by hystopatological analysis of a foot biopsy because of the suspicion of neoplasia. Since the patient did not fully respond to the first-line therapy antibiotics, a 24-weeks doxycycline regime was started, achieving a satisfactory response. Finally, a brief discussion on plantar mycetomas is presented.

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BACKGROUND: Mycetoma is a chronic, localized infection caused by fungi and bacteria. It usually affects the skin, subcutaneous tissue, and bone of exposed areas with deformity of the affected limb, ulcers, and fistula; however, pain is not severe, therefore the patient comes late to hospital for care. OBJECTIVE: To establish the diagnosis of mycetoma in the foot by imaging and identify the principal radiological signs. MATERIALS AND METHODS: Six patients with foot mycetoma were evaluated with plain x-ray, ultrasound, and magnetic resonance (MR) after confirming the diagnosis by histopathology and culture. RESULTS: All patients presented the MR "dot-in-circle" sign; four presented "punched out" bone lesions on plain x-ray. The six patients had fistulas, ulceration, a seropurulent exudate, edema, and a foot deformity. Four patients had N. brasiliensis infection with positive anti-Nocardia IgG antibodies, and only half presented bone lesions. CONCLUSION: Characteristic findings were foot deformity, edema, bone lesions, ulcers, fistulas and the presence of the "dot-in-circle" sign. We recommend a comprehensive study of patients with plain x-ray and MR.

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Chicken feet have become an important commodity in the international market, representing a significant portion of poultry products exported by countries such as Brazil and the USA. However, the presence of pododermatitis in the footpad is an important barrier to exportation, since importing countries do not accept injured feet or allow the use of automatic equipments to remove the affected tissue. The objective of this research was to evaluate the impact of using an automatic equipment to remove injuries of pododermatitis on histological and microbiological traits of broiler feet processed according to commercial practices. A total of 240 broiler feet obtained from a commercial processing plant was visually classified according to the degree of pododermatitis and distributed in a 4 × 2 factorial arrangement, totalizing eight treatments with 30 replications. Factors were feet classification (1 to 4) and injury removal (yes or no). Feet were sampled for microbiological and histological analysis before and after the mechanical removal of pododermatitis injuries by an automatic machine that promoted footpad epidermal scarification. No significant interaction between feet classification and injury removal was detected for any of the analyzed variables. Also, no significant effect of feet classification was detected on aerobic plate counts, total coliforms and Escherichia coli. Feet inflammation score tended to increase (P = 0.06) according to the downgrading of feet classification, but the mechanical removal of pododermatitis injuries reduced feet inflammation score (P < 0.01), total coliform counts (P = 0.01), and E. coli (P = 0.01) independently of feet classification. Together, these results demonstrate the efficacy of the automatic equipment in removing both the inflammatory tissue and its associated microbiota in broiler feet affected by pododermatitis. Therefore, in addition to the already authorized use of blades, the use of automatic equipments for epidermal scarification in the processing of broiler feet deserves further consideration by the regulatory agencies.

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Interdigital foot infections are mostly caused initially by dermatophytes, yeasts and less frequently by bacteria. Erythrasma caused by Corynebacterium minutissimum can be confused with superficial mycoses. The aim of the study was to determine the prevalence of the etiologic agents of superficial mycoses and the frequency of Corynebacterium minutissimum in interdigital foot infections. All the samples obtained from the 121 patients with interdigital foot infections were examined directly with the use of 20% potassium hydroxide mounts and Gram stain under the microscope and cultured on Sabouraud's dextrose agar plates. In identification of superficial mycoses, the rate was found to be 14% with the cultural method and 14% with direct microscopic examination. Using a combination of direct microscopic examination and culture, a 33.8% ratio was achieved. In the culture of these samples, the most isolated factor was Trichophyton rubrum (33.7%). In 24 of the patients (19.8%) Corynebacterium minutissimum was detected by Gram staining, in 6 of these patients Trichophyton rubrum was found, Trichophyton mentagrophytes was found in 2 and Trichosporon spp. was found in 1. The examination of interdigital foot lesions in the laboratory, the coexistence of erythrasma with dermatophytes and yeast should be considered.

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Interdigital foot infections are mostly caused initially by dermatophytes, yeasts and less frequently by bacteria. Erythrasma caused by Corynebacterium minutissimum can be confused with superficial mycoses. The aim of the study was to determine the prevalence of the etiologic agents of superficial mycoses and the frequency of Corynebacterium minutissimum in interdigital foot infections. All the samples obtained from the 121 patients with interdigital foot infections were examined directly with the use of 20% potassium hydroxide mounts and Gram stain under the microscope and cultured on Sabouraud's dextrose agar plates. In identification of superficial mycoses, the rate was found to be 14% with the cultural method and 14% with direct microscopic examination. Using a combination of direct microscopic examination and culture, a 33.8% ratio was achieved. In the culture of these samples, the most isolated factor was Trichophyton rubrum (33.7%). In 24 of the patients (19.8%) Corynebacterium minutissimum was detected by Gram staining, in 6 of these patients Trichophyton rubrum was found, Trichophyton mentagrophytes was found in 2 and Trichosporon spp. was found in 1. The examination of interdigital foot lesions in the laboratory, the coexistence of erythrasma with dermatophytes and yeast should be considered.

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Interdigital foot infections are mostly caused initially by dermatophytes, yeasts and less frequently by bacteria. Erythrasma caused by Corynebacterium minutissimum can be confused with superficial mycoses. The aim of the study was to determine the prevalence of the etiologic agents of superficial mycoses and the frequency of Corynebacterium minutissimum in interdigital foot infections. All the samples obtained from the 121 patients with interdigital foot infections were examined directly with the use of 20% potassium hydroxide mounts and Gram stain under the microscope and cultured on Sabouraud's dextrose agar plates. In identification of superficial mycoses, the rate was found to be 14% with the cultural method and 14% with direct microscopic examination. Using a combination of direct microscopic examination and culture, a 33.8% ratio was achieved. In the culture of these samples, the most isolated factor was Trichophyton rubrum (33.7%). In 24 of the patients (19.8%) Corynebacterium minutissimum was detected by Gram staining, in 6 of these patients Trichophyton rubrum was found, Trichophyton mentagrophytes was found in 2 and Trichosporon spp. was found in 1. The examination of interdigital foot lesions in the laboratory, the coexistence of erythrasma with dermatophytes and yeast should be considered.

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An unusual case of a 3-year-old girl with a brucellar foot abscess is reported. Although direct microscopic examination of samples from the lesion did not reveal micro-organisms of any kind, a 7 day culture of caseous material yielded small colonies of Gram-negative cocobacilli in Löwenstein-Jensen medium. These were biochemically and molecularly identified as Brucella melitensis. The possibility of foot abscess being caused by Brucella should be considered in countries where brucellosis is endemic.

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BACKGROUND: Mycetoma is a chronic infection caused by aerobic actinomycetes and filamentous fungi. It is an occupational disease frequent in tropical countries and is uncommon in children. METHODS: A retrospective (25 years) report of mycetomas was conducted in children less than 15 years of age. Each of the cases was studied clinically and proven with microbiologic tests: direct examinations (to identify and classify the grains), cultures and identification based on morphology and biochemical tests. The therapeutic experience of the cases was also reviewed. RESULTS: In a 25-year period, a total of 334 mycetomas were seen at our institution, 15 of which (4.5%) were in patients 15 years of age and younger (mean age: 11.2 years, age range: 6-15 years). Twelve cases were males and 3 females. The main clinical location was the foot in 10 of 15 (66.6%). Etiologies included 13 actinomycetomas and 2 eumycetomas. Etiologic agents were Nocardia brasiliensis in 12 cases, Nocardia asteroides in one and Madurella mycetomatis in 2. Eleven of the13 cases of actinomycetomas treated with trimethoprim-sulfamethoxazole plus diaminodiphenylsulfone were cured. The 2 failures were successfully treated with amoxicillin/clavulanate. One of the eumycetomas was cured with itraconazole therapy, whereas the other failed various treatments eventuating in surgical amputation. CONCLUSIONS: Mycetomas are exceptional in children; in our setting, actinomycetomas are more frequent than eumycetomas. The clinical and microbiologic diagnosis is simple. Overall, treatment response is better for actinomycetomas than for eumycetomas.

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The administration of killed Propionibacterium acnes suspension to mice enhances macrophage phagocytic and tumoricidal activities, have an adjuvant effect to antibody response and increases resistance to infection. Recent reports demonstrated that P. acnes treatment promotes IL-12 and IL-18 synthesis in mice inducing IFN-gamma release, enhancement of IgG2a switch and inhibition of Th2 cell expansion. These findings led us to investigate whether P. acnes could modulate hypersensitivity type I reaction observed in a murine model. Animals were implanted with heat coagulated hen's egg white (HEW) into the subcutaneous tissue, followed by OVA-challenge in the footpad. The observed reaction was characterized by elevated Th2 cytokine levels, especially IL-4 and increase in eosinophil infiltration as occurs in the late phase reaction (LPR) of type I hypersensitivity, a pattern observed in allergic asthma in human. Two different biological effects were induced by killed P. acnes depending on the experimental protocol used. When mice were treated with one dose of P. acnes per week during 3 weeks and the last dose administrated at the same time of HEW implantation, a strong adjuvant effect on type I hypersensitivity reaction with intense eosinophilic infiltration was observed. On the other hand, when the HEW implant was made 1 week after the administration of the last dose of P. acnes, animals developed a typical delayed type hypersensitivity reaction, and a cytokines pattern characteristic of the Th1 immune response.

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O propósito deste estudo foi avaliar aspectos físico-químicos e microbiológicos do sulfato de cobre a 5 por cento e cloridrato de polihexametileno biguanida (P.H.M.B.) a 1 por cento como soluçöes desinfetantes em pedilúvio para tratamento de diversas afecçöes podais em bovinos associado a procedimentos cirúrgicos e à antibioticoterapia parenteral. As análises físico-químicas constaram da determinaçäo do pH e da concentraçäo do cobre e cloridrato de polihexametileno biguanida (P.H.M.B.). As análises microbiológicas realizadas foram a contagem de microorganismos aeróbios ou facultativos mesófilos e anaeróbios mesófilos. Os resultados obtidos permitem afirmar que as características físico-químicas das duas soluçöes mantiveram-se praticamente constantes e que a soluçäo de PHMB a 1 por cento apresentou menores contagens de microorganismos aeróbios ou facultativos mesófilos e anaeróbios mesófilos do que a soluçäo de sulfato de cobre a 5 por cento.

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Presentamos el caso de un niño de ocho años que desarrolló una infección del pie despúes de un trauma plantar. El estudio bacteriologico demostró la presencia de mycobacterium chelonei ssp.abscessus en el exudado de la lesión . se hace un reseña de la evolucion clinica, que finalmente fue satisfactoria despues del tratamiento por varias semanas con antimicrobianos apropiados y drenajes quirurgicos. se hace una revisión de la literatura para llamar la arención sobre este tipo de infecciones en nuestro medio

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Presentamos el caso de un niño de occho años que desarrolló una infección del pie despues de un trauma plantar. El estudio bacteriológico demostró la presencia de Mycobacterium chelonei ssp. abscessus en el exudado de la lesión. Se hace una reseña de ña evolución clínica, que finalmente fue satisfactoria después del tatamiento por varias semanas con antimicrobianos y drenajes quirúrgicos. Se hace uma revisión de la literatura para llamar la atención sobre este tipo de infecciones en nuestro medio

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39 consecutive cases of plantar ulcers with underlying chronic osteomyelitis admitted in the Sacred Heart Hospital during 1975/1976 were studied for the infecting organisms and their sensitivity to easily available antibiotics. Single organism was iasolated in only 10 cases, the infection in the rest being a mixed one. The commonest organisms were Staphylococcus, Streptococcus and Proteus mirabilis. In a few cases Pseudomonas and E-Coli were also isolated. Chloramphenicol was the most effective antibiotic in general and Streptomycin the least. 70% of the staphylococcus strains isolated were found to be resistant to Penicillin. Empirical use of antibiotics especially Penicillin and Streptomycin is hence deprecated.

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