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Other names: Madura foot, maduramycosis[1]
Mycetoma foot
SpecialtyInfectious diseases
SymptomsTriad: painless firm skin lump, multiple weeping sinuses, grainy discharge[1]
Usual onsetSlowly progressive[2]
Diagnostic methodUltrasound, fine needle aspiration[2]

Mycetoma is a long-term infection deep in the skin, resulting in a triad of symptoms; painless firm skin lumps, weeping sinuses, and a discharge that contains grains.[1] 80% occur in feet.[2]

It is caused by either bacteria (actinomycetoma) or fungi (eumycetoma).[2] Most eumycetoma is caused by M. mycetomatis, whereas most actinomycetoma is caused by Nocardia brasiliensis, Streptomyces somaliensis, Actinomadura madurae and Actinomadura pelletieri.[2] People who develop mycetoma likely have a weakened immune system.[2] It can take between 3 months to 50 years from time of infection to first seeking healthcare advice.[2]

Diagnosis requires ultrasound and fine needle aspiration.[2]

While most cases of mycetoma occur in Sudan, Venezuela, Mexico, and India, its true prevalence and incidence are not well-known.[3][4] 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.[2] It has been described in ancient Sanskrit scriptures as "anthill foot", and was reported by John Gill in 1842 in Madurai, India..[1] The disease is listed by the World Health Organization (WHO) as a neglected tropical disease.[5]

Symptoms and signs

Mycetoma's presentation is that of a small mass under the skin, usually in the lower extremities (foot)[6]

Risk factor

Frequent exposure to penetrating wounds by thorns or splinters is a risk factor.[7] This risk can be reduced by disinfecting wounds and wearing shoes.[8]


Mycetoma is caused by common saprotrophs found in the soil and on thorny shrubs in semi-desert climates.[8] The most common causative agents are:[2]

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.[8]

The first visible symptom of mycetoma is a typically painless swelling beneath the skin; over several years, this will grow to a nodule (lump).[7] 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.[7] In many instances, the underlying bone is affected.[9][8] Some people with mycetoma will not experience pain or discomfort, while others will report itching and/or pain.[7]


There are currently no rapid diagnostic tools for mycetoma.[4] Mycetoma is diagnosed through microscopic examination of the grains in the nodule and by analysis of cultures.[8] 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.[3] Magnetic resonance imaging is a very valuable diagnostic tool. However, its results should be closely correlated with the clinical, laboratory and pathological findings.[9][10]


While treatment will vary depending on the cause of the condition, it may include antibiotics or antifungal medication.[7] Actinomycetoma, the bacterial form, can be cured with antibiotics.[3] Eumycetoma, the fungal form, is treated with antifungals.[10] Surgery in the form of bone resection may be necessary in late presenting cases or to enhance the effects of medical treatment.[9] In the more extensive cases amputation is another surgical treatment option.[11][8] For both forms, extended treatment is necessary.[3]


Human Mycetoma in India in 2013[12]

Mycetoma is endemic in some regions of the tropics and subtropics.[2] India, Sudan and Mexico are most affected.[2]


It has been described in ancient Sanskrit scriptures as "anthill foot", and was reported by John Gill in 1842 in India..[1]

Social and cultural

It generally affects people living in poverty in rural regions.[2] It is listed by the World Health Organization (WHO) as a neglected tropical disease.[4]

Other animals

In cats, mycetoma can be treated with complete surgical removal. Antifungal drugs are rarely effective.[13]


  1. 1.0 1.1 1.2 1.3 1.4 Chander, Jagdish (2018). "11. Mycetom". Textbook of Medical Mycology (4th ed.). New Delhi: Jaypee Brothers Medical Publishers Ltd. pp. 203–228. ISBN 978-93-86261-83-0. Archived from the original on 2023-05-02. Retrieved 2023-05-02.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 Zijlstra, Eduard E.; Sande, Wendy W. J. van de; Welsh, Oliverio; Mahgoub, El Sheikh; Goodfellow, Michael; Fahal, Ahmed H. (1 January 2016). "Mycetoma: a unique neglected tropical disease". The Lancet Infectious Diseases. 16 (1): 100–112. doi:10.1016/S1473-3099(15)00359-X. ISSN 1473-3099. Archived from the original on 7 July 2020. Retrieved 30 August 2021.
  3. 3.0 3.1 3.2 3.3 Welsh O, Al-Abdely HM, Salinas-Carmona MC, Fahal AH (October 2014). "Mycetoma medical therapy". PLOS Neglected Tropical Diseases. 8 (10): e3218. doi:10.1371/journal.pntd.0003218. PMC 4199551. PMID 25330342.
  4. 4.0 4.1 4.2 van de Sande WW, Maghoub El S, Fahal AH, Goodfellow M, Welsh O, Zijlstra E (March 2014). "The mycetoma knowledge gap: identification of research priorities". PLOS Neglected Tropical Diseases. 8 (3): e2667. doi:10.1371/journal.pntd.0002667. PMC 3967943. PMID 24675533.
  5. Yotsu, Rie R. (14 November 2018). "Integrated Management of Skin NTDs—Lessons Learned from Existing Practice and Field Research". Tropical Medicine and Infectious Disease. 3 (4). doi:10.3390/tropicalmed3040120. ISSN 2414-6366. PMID 30441754. Archived from the original on 30 August 2021. Retrieved 30 August 2021.
  6. "Mycetoma | Fungal Diseases | CDC". 16 September 2020. Archived from the original on 13 June 2021. Retrieved 20 July 2021.
  7. 7.0 7.1 7.2 7.3 7.4 "Mycetoma". Genetic and Rare Diseases Information Center (GARD). National Institutes of Health. Archived from the original on 2018-04-18. Retrieved 2018-04-17.
  8. 8.0 8.1 8.2 8.3 8.4 8.5 RESERVED, INSERM US14 -- ALL RIGHTS. "Orphanet: Mycetoma". Archived from the original on 2018-04-18. Retrieved 2018-04-17.
  9. 9.0 9.1 9.2 El-Sobky, TA; Haleem, JF; Samir, S (2015). "Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy". Case Reports in Pathology. 2015: 129020. doi:10.1155/2015/129020. PMC 4592886. PMID 26483983.
  10. 10.0 10.1 Karrakchou, B; Boubnane, I; Senouci, K; Hassam, B (10 January 2020). "Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region". BMC Dermatology. 20 (1): 1. doi:10.1186/s12895-019-0097-1. PMC 6953183. PMID 31918687.
  11. Efared, Boubacar; Tahiri, Layla; Boubacar, Marou Soumana; Atsam-Ebang, Gabrielle; Hammas, Nawal; Hinde, El Fatemi; Chbani, Laila (December 2017). "Mycetoma in a non-endemic area: a diagnostic challenge". BMC Clinical Pathology. 17 (1): 1. doi:10.1186/s12907-017-0040-5. ISSN 1472-6890. PMC 5288886. PMID 28167862.
  12. Sande, Wendy W. J. van de (7 November 2013). "Global Burden of Human Mycetoma: A Systematic Review and Meta-analysis". PLOS Neglected Tropical Diseases. 7 (11): e2550. doi:10.1371/journal.pntd.0002550. ISSN 1935-2735. PMID 24244780. Archived from the original on 13 June 2021. Retrieved 16 October 2021.
  13. Eldredge, Debra M.; Carlson, Delbert G.; Carlson, Liisa D.; Giffin, James M. (2008). Cat Owner's Home Veterinary Handbook. Howell Book House. p. 160.

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