Mycetoma

Mycetoma is a granulomatous infection affecting mainly the feet and lower extremities. It can be caused either by aerobic, branched actinomycetes or by eumycetes. Most cases are found in tropical and subtropical regions. The infection is usually produced by the introduction of the etiologic agents through minor wounds caused by thorns and wood splinters. Clinically the disease begins as small, firm nodules that can enlarge to form extensive lesions with fistulae and abscesses with pus containing granules of the causative microorganisms. Antimicrobials and surgery are used in the management of mycetoma. The actinomycetomas generally respond well to antimicrobials. For eumycetomas, surgery may be required. New therapeutic options for drug-resistant cases are discussed.     

Mycetoma

Mycetoma is a chronic granulomatous infection that is present worldwide and endemic in tropical and subtropical regions. The infection is caused by the traumatic inoculation of a fungus (eumycetoma) or a bacterium (actinomycetoma) and generally remains localized, causing cutaneous and subcutaneous tissue swelling, nodule formation, and drainage through sinus tracts. This review details the history of mycetoma, which may date as far back as the Byzantine period (300-600 AD), the epidemiology of the disease, which is characterized by an endemic region located between the latitudes of 15 degrees south and 30 degrees north, and the clinical presentation and treatment of mycetoma, focusing on the differences between eumycete and actinomycete infections. Diagnosis is established by identifying the type of grains found in the discharge, which guides treatment. Mycetoma caused by bacteria can usually be managed effectively with antibacterial medication alone, while infections with fungi require antifungal medication and surgery. Without proper treatment, mycetoma can lead to deformity, amputation, and death.     

Mycetoma of the foot

A forty-year-old woman suffering from maduromycosis of the right sole is described with a disease history of 17 years. After a contusion and surgery for fibroma she developed an edema on the skin of the right sole, then ulcers with purulent discharge. She was repeatedly treated on an outpatient basis and in hospital by surgeons, phthisiologist, and dermatologist for osteomyelitis, tuberculosis of the bones, and Kaposi's sarcoma without effect. The diagnosis of maduromycosis of the sole was confirmed by laboratory examinations and histologically by detecting Actinomyces elements. Since conservative therapy has proved ineffective, surgical treatment was recommended.     

Mycetoma

We have reviewed the outstanding facts about mycetoma, including the history, first reports in India, the different causal agents according to their geographic distribution, mycologic characteristics, pathology, microbiology, behavior, evolution, immunology, experimental inoculations, associated bacterial complications, and osseous lesions. Various drugs available for treatment are mentioned and recommended. Therapeutic results depend on the age of the disease, and, above all, the bony involvement. N. brasiliensis mycetoma is one of the most frequent species and causes the greatest number of mycetoma cases in America, especially in Mexico.     

Mycetoma

Mycetoma is the most common deep mycosis in humans. It is a chronic, progressive, and destructive disease primarily caused by actinomycetes (98%). Mycetoma involves the skin and soft tissues, often bone, and occasionally the central nervous system, lungs, and other internal organs. It is found mainly in men working in the fields of countries located in tropical areas. Management with chemotherapy (trimethoprim-sulfamethoxazole, sulfonamides, amikacin, and others) is mandatory.     

Mycetoma sans sinuses

Mycetoma is a chronic suppurative infection involving the skin, subcutaneous tissue and bone. The hallmark of mycetoma is tumefaction, draining sinuses and the presence of microcolonies called grains. Sinuses develop in all patients with mycetoma within a year of the appearance of the lesion. The following case is reported as no sinuses had developed despite the presence of the lesion for 9 years, posing a diagnostic dilemma.     

星形诺卡菌性足菌肿

报告1例星形诺卡菌性足菌肿。患者男,29岁。左踝部外伤后出现肿块、结节,并形成窦道,有脓液溢出,逐渐加重9年。皮损组织病理检查示脓肿中央液化坏死,可见颗粒,颗粒周围有菌鞘。深部组织脓液培养见放线菌生长,但菌种鉴定为星形诺卡菌,诊断为足菌肿。给予青霉素G联合复方磺胺甲口恶唑治疗,病情好转。