Mycetoma is a local, chronic, slowly progressive infection of skin, subcutaneous tissues, fascia, bone, and muscle, most commonly of the foot or hand, characterized by swelling or tumorfaction draining sinuses, and granules; the exudate contains grains that may be yellow, white, red, brown, or black depending on the causative microorganisms.
The first medical reports were from doctors in Madura, India–an alternate name for the disease is Madura foot. The infection is characterized by an abnormal tissue mass beneath the skin, formation of cavities within the mass, and a fluid discharge.
Causes of Mycetoma
Pathogens live in soil and enter through minor traumatic breaks in the skin. Only organisms that can survive at body temperature can produce mycetoma. Infection begins in skin and subcutaneous tissues, extending into fascial planes, destroying contiguous tissues.
Symptoms of Mycetoma
Mycetoma is more common in men than women, particularly those aged 20 to 50. It generally presents as a single lesion on an exposed site and may persist for years. Two thirds arise on the foot.
- It starts as a small hard painless lump under the skin.
- It grows slowly but eventually involves underlying muscles and bones.
- The surface skin is scarred and pale.
- Considerable deformity often makes it difficult to walk.
- Mycetoma may cause no discomfort but it often itches or burns.
Diagnosis
Clinical suspicion confirmed by demonstration of grains in pus and/or by visualization of Medlar bodies on smear of pus or lesional biopsy specimen, and/or isolation of organism on culture. Medlar bodies (granules, grains) are white, black to gray, pinpoint globular grains that can be seen and felt in pus. Can be crushed on slide. They represent globular colonies of organism.
Treatment
Individuals are advised to seek medical attention early.
Surgery Smaller lesions can be cured by surgical excision. More extensive lesions often recur after incomplete excision.
Medicosurgical Approach Bulk reduction surgery is performed; amputation/ disarticulation avoided. Causative agent identified, and effective antimicrobial agent given.
Systemic Antimicrobial Therapy Usually continued for ≥10 months.
Botryomycoses Antimicrobial agents according to sensitivities of isolated organism.
Actinomycotic Mycetoma Streptomycin sulfate combined with either dapsone or trimethoprimsulfamethoxazole.
Eumycetoma Rarely responds to chemotherapy. Some cases caused by M. mycetomatis may respond to ketoconazole or itraconazole.
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