[Actinomycotic mycetoma. Apropos of 27 cases in Dakar; medical treatment with cotrimoxazole].

Actinomycotic mycetoma is frequent in Senegal and the treatment has changed greatly over the last decades. We observed 27 cases due to Actinomadura pelletieri (n = 21), Actinomadura madurae (n = 5) and Streptomyces somaliensis (n = 1). The diagnosis was based on clinical and histological arguments. All the patients were treated with cotrimoxazole for several months. The mycetoma was situated on the foot in 15/27 patients. Extrapodal localizations were frequent for red grains due to A. pelletieri (11/21). These mycetomas, the most frequent in Senegal, are extremely severe lesions with rapid local and distance extension. We were able to obtain 8 clinical cures. One death occurred in patient with an abdominal localization and multiorgan invasion. Mid-term outcome could not be determined in the other cases since they were lost to follow-up after initial improvement with cotrimoxazole. As sole treatment, cotrimoxazole should lead to cure in most cases.