|Other names: Madura foot, maduramycosis|
|Symptoms||Triad: painless firm skin lump, multiple weeping sinuses, grainy discharge|
|Usual onset||Slowly progressive|
|Diagnostic method||Ultrasound, fine needle aspiration|
It is caused by either bacteria (actinomycetoma) or fungi (eumycetoma). Most eumycetoma is caused by M. mycetomatis, whereas most actinomycetoma is caused by Nocardia brasiliensis, Streptomyces somaliensis, Actinomadura madurae and Actinomadura pelletieri. People who develop mycetoma likely have a weakened immune system. It can take between 3 months to 50 years from time of infection to first seeking healthcare advice.
While most cases of mycetoma occur in Sudan, Venezuela, Mexico, and India, its true prevalence and incidence are not well-known. It appears most frequently in people living in rural areas, particularly farmers and shepherds; men between 20 and 40 years who tend to be the breadwinners. It has been described in ancient Sanskrit scriptures as "anthill foot", and was reported by John Gill in 1842 in Madurai, India.. The disease is listed by the World Health Organization (WHO) as a neglected tropical disease.
Symptoms and signs
Mycetoma's presentation is that of a small mass under the skin, usually in the lower extremities (foot)
- Madurella mycetomatis (fungus)
- Nocardia brasiliensis (bacteria)
- Actinomadure madura (bacteria)
- Streptomyces somaliensis (bacteria)
- Actinomadura pelletieri (bacteria)
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.
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 infection of the foot share similar clinical and radiological features, diagnosis can be a challenge. Magnetic resonance imaging is a very valuable diagnostic tool. However, its results should be closely correlated with the clinical, laboratory and pathological findings.
While treatment will vary depending on the cause of the condition, it may include antibiotics or antifungal medication. Actinomycetoma, the bacterial form, can be cured with antibiotics. Eumycetoma, the fungal form, is treated with antifungals. Surgery in the form of bone resection may be necessary in late presenting cases or to enhance the effects of medical treatment. In the more extensive cases amputation is another surgical treatment option. For both forms, extended treatment is necessary.
It has been described in ancient Sanskrit scriptures as "anthill foot", and was reported by John Gill in 1842 in India..
Social and cultural
In cats, mycetoma can be treated with complete surgical removal. Antifungal drugs are rarely effective.
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