The treatment of mycetomas varies according to their etiological agents and the clinical state of the patient. For the treatment of eumycetomas, the
azole derivatives are the drugs of choice, with
itraconazole rendering better results than
ketoconazole and presenting better tolerance. Actinomycetomas are treated according to different therapeutic schemes:
dapsone plus sulfamethoxazol-
trimethoprim (SMT), and
streptomycin or
amikacin or
amoxicillin plus
clavulanic acid. The first therapeutic scheme is very useful in the treatment of Nocardia
mycetoma, while the association of
amikacin plus SMT is the best treatment for those cases produced by Actinomadura madurae.
Ciprofloxacin is a very useful
drug for the treatment of actinomycotic mycetomas with bone lesions. Although there are several criteria for evaluating clinical outcome there is no accepted criterion of cure. During the 1990s, there was a remarkable increase in the incidence of
coccidioidomycosis in California, USA. An almost ten-fold increase in the number of cases was registered during 1992 and 1993 over the usual incidence. A gradual reduction in
coccidioidomycosis cases was observed in the late 1990s. This particular
coccidioidomycosis outbreak took place in areas of low endemicity, as well as in those of usual high endemicity. Among the factors believed to have influenced this phenomenon were a drought followed by abundant winter/spring rainfall, increased immigration of susceptible individuals, increase in excavation/construction work and a better diagnosis of the
infection, particularly in the last part of the decade. The majority of patients presented the usual clinical manifestations of symptomatic primary
infection but an unusual number of cases with acute
respiratory failure were observed.