Mycetoma

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Mycetoma
Synonyms	Madura foot, Maduromycosis, Madura mycosis
Pronounce	N/A
Specialty	N/A
Symptoms	Swelling, discharge of granules, pain
Complications	Bone destruction, deformity, secondary infection
Onset	Gradual
Duration	Chronic
Types	N/A
Causes	Fungal or bacterial infection
Risks	Barefoot walking, agricultural work
Diagnosis	Clinical examination, imaging, microbiological culture
Differential diagnosis	Chronic osteomyelitis, tuberculosis, actinomycosis
Prevention	Wearing shoes, protective clothing
Treatment	Antifungal or antibiotic therapy, surgery
Medication	N/A
Prognosis	Variable, depends on extent and treatment
Frequency	Endemic in tropical and subtropical regions
Deaths	N/A

Mycetoma is a chronic subcutaneous infection caused by aerobic actinomycetic bacteria (actinomycetoma) or fungi (eumycetoma).

Risk

Frequent exposure to penetrating wounds by thorns or splinters is a risk factor. This risk can be reduced by disinfecting wounds and wearing shoes.

Pathogenesis

Mycetoma is caused by common saprotrophs found in the soil and on thorny shrubs in semi-desert climates. The most common causative agents are:

• Madurella mycetomatis (fungus)
• Nocardia brasiliensis (bacteria)
• Actinomadure madura (bacteria)
• Streptomyces somaliensis (bacteria)
• Actinomadura pelletieri (bacteria)

Mycetoma

Infection is caused as a result of localized skin trauma, such as stepping on a needle or wood splinter, or through a pre-existing wound. The first visible symptom of mycetoma is a typically painless swelling beneath the skin; over several years, this will grow to a nodule (lump). Affected people will experience massive swelling and hardening of the area, in addition to skin rupture and the formation of sinus tracts that discharge pus and grains filled with organisms. In many instances, the underlying bone is affected. Some people with mycetoma will not experience pain or discomfort, while others will report itching and/or pain.

Actinomycotic Mycetoma, Foot

Diagnosis

There are currently no rapid diagnostic tools for mycetoma. Mycetoma is diagnosed through microscopic examination of the grains in the nodule and by analysis of cultures. Since the bacterial form and the fungal form of mycetoma share similar features, diagnosis can be a challenge.

Treatment

While treatment will vary depending on the cause of the condition, it may include antibiotics or antifungal medication.

External links

• DermNet NZ: an online resource about skin diseases from the New Zealand Dermatological Society Incorporated.
• Orphanet: a reference portal from Europe that provides information on rare diseases and orphan drugs.