Mycetoma: a retrospective study of 41 cases seen in São Paulo, Brazil, from 1978 to 1989.

Clinical and epidemiological aspects of 41 cases of mycetoma seen in São Paulo city from January 1978 to December 1989 are presented. Twenty-eight cases (68%) were caused by actinomycetes, while 13 (32%) were caused by true fungi. In only 22 (78%) actinomycetoma cases was it possible to identify the agent. Nocardia brasiliensis, by far the commonest actinomycete isolated, was responsible for 13 cases. Among eumycetomata, Madurella grisea was isolated from 3 cases, Scedosporium apiospermum from 2 cases, and Madurella mycetomatis from 1 case, and in 7 cases the agent was not identified. Distribution by sex and age was similar to that reported in the literature. Feet and legs were the commonest sites affected. The mean age of actinomycetoma patients was 33.2 years, while patients with eumycetomata were an average of 32.8 years. Mean duration of the disease was 6.8 and 9.8 years respectively. Most patients came from rural areas in the north-eastern region of the country and worked as field labourers. Bone involvement was frequent for both actinomycetomata and eumycetomata and was characterized by osteoporosis, periostal reaction and cavitation. The authors' elected treatment consists of combining sulfamethoxazole (800 mg) and trimethoprim (100 mg) with prednisone (10 mg) orally, daily.