Mycetoma

Mycetoma

• 2.
   Mycetoma isa chronic subcutaneous infection caused by actinomycetes or fungi. This infection results in a granulomatous inflammatory response in the deep dermis and subcutaneous tissue, which can extend to the underlying bone
• 3.
   Mycetoma wasdescribed in the modern literature in 1694 but was first reported in the mid-19th century in the Indian town of Madura, and hence was initially called Madura foot.
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   Mycetoma commonlyaffects young adults, particularly males aged between 20 and 40 years, mostly in developing countries.
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   Mycetoma causedby microaerophilic actinomycetes is termed as actinomycetoma,  Mycetoma caused by true fungi is called eumycetoma.
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   Actinomycetoma maybe due to  Actinomadura madurae,  Actinomadura pelletieri,  Streptomyces somaliensis,  Nocardia spp.  Eumycetoma is often due to  Pseudallescheria boydii (Scedosporium apiospermum),  Madurella mycetomatis.
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   The feetare the most common site for infection  Other sites include the  Lower legs,  Hands,  Head,  Neck,  Chest,  Shoulder  Arms.
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   Mycetoma typicallypresents in agricultural workers (hands, shoulders and back - from carrying contaminated vegetation and other burdens), or in individuals who walk barefoot in dry, dusty conditions.  Minor trauma allows pathogens from the soil to enter the skin.
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   Transmission occurswhen the causative organism enters the body through minor trauma or a penetrating injury, commonly thorn pricks. There is a clear relationship between mycetoma and individuals who walk barefooted and are manual workers.
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   Mycetoma ischaracterized by a triad of  Painless subcutaneous mass,  Multiple sinuses  Discharge containing grains.  It usually spreads to involve the skin, deep structures and bone resulting in destruction, deformity and loss of function, which may be fatal.  Mycetoma commonly involves the extremities, back and gluteal region.  Secondary bacterial infection is common, and lesions may cause increased pain and disability and fatal septicaemia (severe infections involving the entire human system) if untreated.
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   The causativeorganisms can be detected by examining surgical tissue biopsy as well the lesion sinuses discharge.  Grains microscopy is helpful in detecting the characteristic grains, it is important to culture them to identify the causative organism properly.  DNA sequencing and many imaging techniques
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   Chronic bacterialosteomyelitis,  Tuberculosis,  Buruli ulcer.  Other deep fungal infections such as blastomycosis or coccidiomycosis.  Leishmaniasis, yaws and syphilis should be considered.
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   Actinomycetoma.  Surgicaldebridement, followed by prolonged appropriate antibiotic therapy for several months is required for actinomycetoma.  Combination therapy with trimethoprim- sulfamethoxazole, dapsone and streptomycin has been used.  Rifampin has been used in resistant cases.
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   Eumycetoma  Eumycetomasare only partially responsive to antifungal therapy but can be treated by surgery, due to their normally well circumscribed nature.  Surgery in combination with azole treatment is the recommended regime for small eumycetoma lesions in the extremities.  Madurella mycetomatis may respond to ketoconazole, P. boydii (S. apiospermum) may respond to itraconazole.  Other agents of eumycetoma may respond intermittently to itraconazole or amphotericin B.
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   People livingin or travelling to endemic areas should be advised not to walk barefooted.