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MICROBIOLOGY SECTION - BRIEF COMMUNICATION Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 1  |  Page : 154-155
Incidence and changing pattern of mycetoma in western Rajasthan


Department of Pathology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India

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   Abstract 

Histopathologic analysis of 73 cases of mycetoma occurring in western Rajasthan was done from January 2001 to December 2005. Maduromycotic mycetoma remains commonest in this region as compared to actinomycotic mycetoma, which is more common in the southern part of Rajasthan. The incidence of actinomycotic mycetoma has increased during the last five years in this part of Rajasthan due to changes in climatic conditions, like heavy rainfall, increased irrigation by Rajasthan Canal, urbanization of villages, and modification in agriculture. The ratio of prevalence of maduromycotic mycetoma to the prevalence of actinomycotic mycetoma has decreased from 4:1 to 1.91:1 during the last five years in western Rajasthan.

Keywords: Mycetoma, eumycotic, actinomycotic, western Rajasthan

How to cite this article:
Bakshi R, Mathur DR. Incidence and changing pattern of mycetoma in western Rajasthan. Indian J Pathol Microbiol 2008;51:154-5

How to cite this URL:
Bakshi R, Mathur DR. Incidence and changing pattern of mycetoma in western Rajasthan. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 Oct 21];51:154-5. Available from: https://www.ijpmonline.org/text.asp?2008/51/1/154/40433



   Introduction Top


Mycetoma is a chronic progressive granulomatous exogenous infection of subcutaneous tissue characterized by swelling and presence of granules of the etiological agent, which may spread contiguously to involve adjoining skin with formation of multiple sinuses, discharge of pus and granules.

It may be caused by true fungi (Eumycetes) or by higher bacteria (actinomycetes); therefore, it is classified into eumycetoma and actinomycetoma respectively.

The disease is prevalent in almost all parts of India.

Eumycetoma is more common in north India, [1] where the average rainfall is low, i.e., less than 350 mm; while actinomycetoma is common in south India, where the average rainfall is high, i.e., more than 600 mm. [2],[3],[4]

Mostly, discharging granules in cases of mycetoma are black, yellow, and white. [2] The red-grain mycetoma caused by Actinomadurae pelletieri is actinomycotic mycetoma, which is rare in western Rajasthan; [5],[6],[7],[8],[9] only a few cases have been reported from this region in the last 30 years. [10]

The predisposing factors for mycetoma are a variety of environmental and social factors, such as rainfall, temperature, soil and abundance of thorny sharp vegetable material on the land which is capable of inoculation of mycetoma agents, and a habit of walking barefoot and/or carrying goods on the back. [1],[5]


   Materials and Methods Top


A retrospective study was undertaken on 73 cases of histologically proved and treated cases of mycetoma recorded during the last five years (from 2001 to 2005) at the Associated Group of Hospitals, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan.

Special emphasis was given to the correct histological typing of causative agents of mycetoma. Initially the sections were stained with hematoxylin and eosin, and morphology of fungal grains was examined carefully. Actinomycetoma and maduromycetoma were further classified by doing special staining like periodic acid schiff, silver methanamine, Zeihl Neelson stain and Gram's stain for fungal granules.


   Results Top


A total 73 cases were histologically identified as mycetoma. A maximum number of cases were recorded in the active age group of 21-30 years. Men are more commonly affected by mycetoma as compared to women (sex ratio 1.61:1). Farmers constituted a large number of cases of mycetoma, foot is the commonest site of involvement, and the possible mode of inoculation was thorn prick.

Out of the 73 histologically proved cases during the five years of this study, 48 cases belonged to the maduromycotic group and 25 cases were of actinomycotic group. The ratio of the number of cases of the maduromycotic group to that of the actinomycotic group was 1.92:1.

Out of the 48 cases of maduromycotic mycetoma, Madurella mycetomatis accounted for the maximum number of cases (43 cases); Madurella grisea and Aspergillus nidulans accounted for three cases and 1 case respectively. In one case, mixed infection of both Madurella mycetomatis and Madurella grisea was observed.

In actinomycotic mycetoma group, out of 25 cases, 21 cases were of Actinomadura somaliensis , three cases were of Actinomadura madurae , and one case was of Actinomadura pelletieri .


   Discussion Top


The present study was conducted as a remedy for the lack of knowledge of geographical pathology of mycetoma in India. The purpose of this study was to find out the incidence of mycetoma and its present trend in western part of Rajasthan (as the causative etiological agents differ from those prevailing in other parts of Rajasthan) and the change in pattern of causative agents of mycetoma due to heavy rains, irrigation by Rajasthan Canal, urbanization of villages, and modification in agriculture in western Rajasthan.

Mycetoma is quite common in western Rajasthan and in some areas of eastern Rajasthan also.

It was observed that the prevalence of maduromycotic mycetoma was more in the areas termed as '1 arid hot areas' by virtue of their climate, prolonged hot sunshine and due to scanty annual rainfall. These areas are so-called desert areas with annual rainfall ranging from 250 to 350 mm.

It is well known that this type of climate is also favorable for growth of bushy and thorny plants, and it has been suggested that thorn prick is one of the major inoculating agents of the fungus. [5],[11],[12]

Mathur et al. revealed reports of 110 cases (from 1991 to 2000, 10-year study), according to which maduromycotic mycetoma was more frequently encountered (80%) than actinomycotic mycetoma (20%), with a ratio of 4:1. In comparison to the above study, the present study showed the incidence of actinomycetoma to be increased, the ratio being 1.92:1.

In western Rajasthan, the mean maximum temperature in summer ranges from 40°C to 45°C, while the mean minimum temperature during night is 23°C to 27°C. Relative humidity of these areas ranges from 50 to 70%.

In areas where the average rainfall ranged between 0 and 350 mm, the frequency of maduromycetoma was found to be 3.2 times that of actinomycetoma; whereas in areas with average annual rainfall between 350 and 550 mm, maduromycetoma was 1.5 times more common as compared to actinomycetoma. Finally in areas with average rainfall above 600 mm, lesser cases of maduromycetoma were reported as compared to actinomycetoma by a ratio of 1:2. These data also explain the higher incidence of maduromycetoma in our study in western Rajasthan, where the average rainfall is scanty and the ratio is 1.92:1. This observation is also in conformity with the earlier observations at Bikaner [1] and Jodhpur. [5] However, higher prevalence of actinomycotic mycetoma was observed by Singhvi et al. [12] According to Joshi et al. [13] differences in prevalence of the causative agents may be related to the annual rainfall or to the nature of soil in these regions.

The prevalence of actinomycotic mycetoma has increased during the last five years. The ratio of prevalence of maduromycotic mycetoma to the prevalence of actinomycotic mycetoma was 4:1, [14] but it was only 1.92:1 in this study. This increased prevalence of actinomycetoma is probably due to urbanization of villages, modification in agriculture, irrigation in the western part of Rajasthan by Rajasthan Canal, and increased rainfall.


   Conclusion Top


The study reveals that mycetoma is endemic in western Rajasthan, and the maximum density of mycetoma has been recorded at Jodhpur, northwest Rajasthan. Maduromycotic mycetoma is more frequently encountered at western Rajasthan than is actinomycotic mycetoma as compared to the southeastern parts of Rajasthan. However, the incidence of actinomycotic mycetoma has increased during the last five years, probably due to increased irrigation by Rajasthan Canal, changing pattern of rainfall, urbanization of villages, and modification in agriculture, all of which has converted desert climate to humid climate.

 
   References Top

1.Singh H. Mycetoma in India. Indian J Surg 1979;41:577-97.  Back to cited text no. 1    
2.Klokke AH, Swami DG, Angul R, Verghese A. The casual agent of mycetoma in South India. Trans Royal Soc Trop Med Hyg 1968;15:17-22.  Back to cited text no. 2    
3.Venugopal TV, Venogopal PV. Mycetoma in Madras. Sabouraudia 1977;15:17-22.  Back to cited text no. 3    
4.Venugopal TV, Venogopal PV. Actinomadura madurae causing mycetoma in Madras. Indian J Pathal Microbial 1991;34:119-25.  Back to cited text no. 4    
5.Mathur DR, Joshi KR, Mathur A. An etiological and pathological study of mycetoma in Western Rajasthan. Curr Med Pract 1979;23:151-61.  Back to cited text no. 5    
6.Joshi KR, Mathur DR, Sharma K. Mycetoma caused by Streptomyces pelletieri in India. Indian J Dermatol Venerol Lepr 1980;46:123-5.  Back to cited text no. 6    
7.Mathur DR, Bharadwaj V, Vaishnav K, Ramdeo IN. Red grain mycetoma caused by Actinomadura pelletieri in western Rajasthan: Report of two cases. Indian J Pathol Microbiol 1993;36:486-8.  Back to cited text no. 7    
8.Pankaj Lakshmi VV, Taralakshmi VV. Red grain mycetoma of scalp due to Actinomycetoma pelletieri in Madurai. Indian J Pathol Microbiol 1990;33:384-6.  Back to cited text no. 8    
9.Mathur DR, Prakash P, Gupta PC. Red grain mycetoma in Western Rajasthan. Indian J Pathol Microbiol 1994;60:99-100.  Back to cited text no. 9    
10.Mathur DR, Vaishnav K, Joshi YR. Red grain mycetoma of foot: Case report. Curr Med Trends 2006;10:1878-80.  Back to cited text no. 10    
11.Mathur DR, Agarwal SC. Mycetoma in Nigeria: A review. Nigerian Med Pract II 1986;3:79-81.  Back to cited text no. 11    
12.Singhvi AM, Singh SP, Malviya S, Makwana S. Extrapedal mycetoma: A study of 108 cases. SDMHJ 1995;19:113-7.  Back to cited text no. 12    
13.Joshi KR, Sharma JC, Vyas MC, Singhvi A. A etiology and distribution of mycetoma in Rajasthan. Indian J Med Res 1987;85:694-8.  Back to cited text no. 13    
14.Mathur D, Mathur DR. A clinicopathologic study of mycetoma in Western Rajasthan with special reference to histological identification of fungi: A study of ten years 1991 to 2000 (an unpublished data).  Back to cited text no. 14    

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Correspondence Address:
Devendra Raj Mathur
A - 194, Shastri Nagar, Jodhpur - 342 003, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.40433

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