Actinomadura meyerae osteitis following wound contamination with hay in a woman in France: a case report
© Bonnet et al; licensee BioMed Central Ltd. 2011
Received: 7 May 2010
Accepted: 26 January 2011
Published: 26 January 2011
Mycetoma is a chronic granulomatous infection caused by environmental fungi or bacteria. It affects dermal and subcutaneous tissues, with putative contiguous extension to muscles or bones. While common in tropical and subtropical areas, mycetoma is rare in Europe.
We describe a case of Actinomadura meyerae osteitis in a 49-year-old Caucasian woman who suffered a tibia open fracture contaminated with hay; to the best of our knowledge the first case of autochthonous A. meyerae infection reported in France. The bacterium was cultivated from a bone biopsy. Following surgical osteosynthesis and six months of treatment with cotrimoxazole, our patient made a full recovery.
Our case report suggests that A. meyerae is a potential agent of wound infection in farm workers in contact with hay.
Infections caused by Actinomadura species, Gram-positive bacilli that belong to the family Thermomonosporaceae within the order Actinomycetales, are common in tropical and subtropical areas . They are mostly caused by Actinomadura madurae and Actinomadura pelletieri. In Europe, only four cases of Actinomadura infections have been reported to date, caused by Actinomadura sp. [2, 3], A. madurae and Actinomadura sputi. We report the first case of Actinomadura meyerae infection in a patient who developed osteitis following contamination of an open fracture wound with hay.
Actinomadura species are usually found in surface layers of the soil in semi-desertified areas of tropical and subtropical countries. Most human Actinomadura infections are caused by A. madurae and A. pelletieri. Both species are agents of mycetoma, a chronic and destructive cutaneous infection that may spread to the bones. Cases of Actinomadura infections have mostly been reported in India, the Middle East, Africa, and South America .
In Europe, Actinomadura infections have almost exclusively been diagnosed in immigrants from purported endemic areas , but rare endemic cases have also been reported. In Albania, a 45-year-old man with no history of travel to tropical or subtropical areas was diagnosed as having Actinomadura sp. infection of the foot . In Greece, a 38-year-old man who reported no history of travel abroad presented with a chronic osteitis of the left foot caused by A. madurae. A third autochthonous European case of Actinomadura sp. infection was described in Italy . Recently A. sputi was isolated from the sputum of a German patient .
Our report is the fifth reported case of autochthonous Actinomadura infection in Europe, and the first in France. In addition, to the best of our knowledge, this is the first case of A. meyerae infection. As we isolated it in pure culture from a bone biopsy, we are confident that it was the causative agent of our patient's bone infection. A. meyerae was first described as Actinomadura meyerii in 2003 . The type strain was isolated from a garden soil in Mexico City . Our patient had not travelled to the usual endemic zones of mycetoma, but had a specific history of wound contamination with hay. This is the likely source of infection, as Actinomadura infection in mycetoma results from the introduction of this agent by minor percutaneous trauma, often associated with plant debris and/or soil. Using cotrimoxazole for six months due to the presence of internal fixation material, the infection improved rapidly, bone healing was obtained and our patient's infection was considered as cured one year later.
Our report highlights the potential risk of Actinomadura infection in France, in particular in workers exposed to hay in agricultural settings, and identifies A. meyerae as a new pathogenic Actinomadura species.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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