- "Mycetoma" redirects here. For the bacterial disease formerly known as "actinomycetoma", see Actinomycosis.
| Mycetoma |
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Madura Foot
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| Classification and external resources |
| ICD-10 |
B47.0 |
| DiseasesDB |
8472 |
| eMedicine |
med/30 derm/280 derm/147 |
| Patient UK |
Eumycetoma |
| MeSH |
D008271 |
Eumycetoma is a chronic granulomatous[1] fungal disease[2] of humans, affecting mainly the limbs, and sometimes the abdominal and chest walls or the head.[3] Mycetoma pedis (mycetoma of the foot), the most common form of mycetoma, is known widely as the Madura foot. The infection is endemic in Africa, India and the Central and South Americas.[4]
Contents
- 1 Signs and symptoms
- 2 Cause
- 3 Pathogenesis
- 4 Diagnosis
- 4.1 Differential diagnosis
- 5 Prevention
- 6 Treatment
- 7 Epidemiology
- 8 History
- 9 References
- 10 External links
Signs and symptoms
The initial lesion is a small subcutaneous swelling following minor trauma. Later, sinuses that discharge purulent and seropurulent exudates containing grains which are fungal colonies are formed.[3][5] Destruction of deeper tissues, and deformity and loss of function in the affected limbs may occur in late stages.
Cause
Mycetoma may be caused by bacteria from the phylum Actinomycetes, or by fungi (Eumycetes) where it is called Eumycetoma.[3][5] Bacterial and fungal species that can cause mycetoma are listed below under their characteristic colours of discharge from infected wounds:
Red discharge
White or Yellow discharge
- Acremonium strictum
- Actinomadura madurae
- Aspergillus nidulans
- Noetestudina rosatii
- Phaeoacremonium krajdenii[6]
- Pseudallescheria boydii[7]
Black discharge
- Aspergillus terreus
- Curvularia lunata
- Cladophialophora bantiana
- Exophiala jeanselmei[8]
- Leptosphaeria senegalensis
- Leptosphaeria tompkinsii
- Madurella grisea[9]
- Madurella mycetomatis[10]
- Pyrenochaeta romeroi
Some species of the bacterial genus Nocardia (including Nocardia asteroides and Nocardia brasiliensis) which can cause mycetoma produce a yellow coloured discharge, and those of the bacterial genus Streptomyces (including Streptomcyes somaliensis) produce an yellow or red coloured discharge.
Pathogenesis
The disease is usually seen in field workers like farmers, and generally affects men between 20 and 40 years. The disease is acquired by inoculation of grains of fungal spores from the soil through a breach in the skin produced by minor trauma like a thorn prick. The disease then spreads to deeper tissues and also forms sinus tracts leading to skin surface.[5] Mature lesions are characterised by a grainy discharge from these sinuses. These discharges contain fungal colonies and are infective. Spread of infection internally through blood or lymph is uncommon.
Infections that produce a black discharge mainly spread subcutaneously. In the red and yellow varieties deep spread occurs early, infiltrating muscles and bones but sparing nerves and tendons, which are highly resistant to the invasion.[4]
Botryomycosis, also known as bacterial pseudomycosis, produces a similar clinical picture and is caused usually by Staphylococcus aureus.[11] Other bacteria may also cause botryomycosis.[12]
Diagnosis
Diagnosis of mycetoma is usually established clinically in endemic areas. X rays and ultrasonography may be employed in evaluating the extent of the disease. X rays findings are extremely variable. The disease is most often observed at an advanced stage that exhibits extensive destruction of all bones of the foot. Rarely, a single lesion may be seen in the tibia where the picture is identical with chronic osteomyelitis.Cytology of fine needle aspirate or pus from the lesion, and tissue biopsy may be undertaken sometimes.[3] MRI - Some publications have stated a "dot in a circle sign" as a characteristic MRI feature for this condition (this feature has also been described on ultrasound. Etymology.
Differential diagnosis
The following clinical conditions may be considered before diagnosing a patient with mycetoma:
- Tuberculous ulcer
- Kaposi's sarcoma, a vascular tumour of skin usually seen in AIDS.
- Leprosy
- Syphilis
- Malignant Neoplasm
- Tropical ulcer[4]
- Botryomycosis,[5] a skin infection usually caused by the bacteria Staphylococcus aureus.
Prevention
No vaccine is available. Simple hygienic precautions like wearing shoes or sandals while working in fields, and washing hands and feet at regular intervals may help prevent the disease.
Treatment
Drugs like ketoconazole,[13] voriconazole,[14] and itraconazole[3] are generally employed in treating the infection. Actinomycetes usually respond well to medical treatment, but the eumycetes are generally resistant and may require surgical interventions including amputation.[5]
Epidemiology
The disease is endemic in tropical and subtropical regions.[3][5] The exact incidence and geographical distribution of mycetoma throughout the world is not known as the disease is usually painless, slowly progressive and presented to health centres only in late stages by majority of patients. Mycetoma has an uneven worldwide distribution.
History
Madura foot or maduromycosis or maduramycosis,[15] is described in ancient writings of India as Padavalmika, which, translated means Foot anthill.[5] The first modern description of Madura foot was made in 1842 from Madurai (the city after which the disease was named Maduramycosis) in India, by Gill.[5] The fungal etiology of the disease was established in 1860 by Carter.[5]
References
- ^ Motswaledi HM, Mathekga K, Sein PP, Nemutavhanani DL (August 2009). "Paecilomyces lilacinus eumycetoma". Int. J. Dermatol. 48 (8): 858–61. doi:10.1111/j.1365-4632.2008.04047.x. PMID 19659864.
- ^ Brownell I, Pomeranz M, Ma L (2005). "Eumycetoma". Dermatol. Online J. 11 (4): 10. PMID 16403382.
- ^ a b c d e f Davidson's principles and practice of medicine (20 ed.). Churchill Livingstone Elsevier. p. 373. ISBN 9780443101335.
- ^ a b c Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery ISBN 0-7506-0625-8
- ^ a b c d e f g h i R Ananthanarayan BA MBBS DB PhD, CK Jayaram Paniker MD. Textbook of Microbiology (7 ed.). Orient Longman Private Ltd. p. 618. ISBN 8125028080.
- ^ Hemashettar BM, Siddaramappa B, Munjunathaswamy BS et al. (December 2006). "Phaeoacremonium krajdenii, a cause of white grain eumycetoma". J. Clin. Microbiol. 44 (12): 4619–22. doi:10.1128/JCM.01019-06. PMC 1698411. PMID 17005754.
- ^ "Filamentous Fungi".
- ^ Severo LC, Oliveira FM, Vettorato G, Londero AT (March 1999). "Mycetoma caused by Exophiala jeanselmei. Report of a case successfully treated with itraconazole and review of the literature". Rev Iberoam Micol 16 (1): 57–9. PMID 18473595.
- ^ Vilela R, Duarte OM, Rosa CA et al. (November 2004). "A case of eumycetoma due to Madurella grisea in northern Brazil" (PDF). Mycopathologia 158 (4): 415–8. doi:10.1007/s11046-004-2844-y. PMID 15630550.
- ^ Ahmed AO, Desplaces N, Leonard P et al. (December 2003). "Molecular detection and identification of agents of eumycetoma: detailed report of two cases". J. Clin. Microbiol. 41 (12): 5813–6. doi:10.1128/JCM.41.12.5813-5816.2003. PMC 309011. PMID 14662990.
- ^ http://web.archive.org/web/20080905182716/http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/two/000014143.htm
- ^ "Skin-nontumor Infectious disorders Botryomycosis". PathologyOutlines.com, Inc.
- ^ Capoor MR, Khanna G, Nair D et al. (April 2007). "Eumycetoma pedis due to Exophiala jeanselmei". Indian J Med Microbiol 25 (2): 155–7. doi:10.4103/0255-0857.32726. PMID 17582190.
- ^ Loulergue P, Hot A, Dannaoui E et al. (December 2006). "Successful treatment of black-grain mycetoma with voriconazole". Am. J. Trop. Med. Hyg. 75 (6): 1106–7. PMID 17172376.
- ^ "Infectious Disorders (Specific Agent) Madura foot/Mycetoma/Maduramycosis". MedTech USA, Inc.
External links
- Centraalbureau voor Schimmelcultures/The Fungus Research Center Fungal Biodiversity Center
- DermNet fungal/mycetoma
|
Fungal infection and mesomycetozoea (B35–B49, 110–118)
|
|
Superficial and
cutaneous
(dermatomycosis):
Tinea = skin;
Piedra (exothrix/
endothrix) = hair |
| Ascomycota |
Dermatophyte
(Dermatophytosis) |
| By location |
- Tinea barbae/tinea capitis
- Tinea corporis
- Tinea cruris
- Tinea manuum
- Tinea pedis (athlete's foot)
- Tinea unguium/onychomycosis
- White superficial onychomycosis
- Distal subungual onychomycosis
- Proximal subungual onychomycosis
- Tinea corporis gladiatorum
- Tinea faciei
- Tinea imbricata
- Tinea incognito
- Favus
|
|
| By organism |
- Epidermophyton floccosum
- Microsporum canis
- Microsporum audouinii
- Trichophyton interdigitale/mentagrophytes
- Trichophyton tonsurans
- Trichophyton schoenleini
- Trichophyton rubrum
|
|
|
| Other |
- Hortaea werneckii
- Piedraia hortae
|
|
|
| Basidiomycota |
- Malassezia furfur
- Tinea versicolor
- Pityrosporum folliculitis
- Trichosporon
|
|
|
Subcutaneous,
systemic,
and opportunistic |
| Ascomycota |
Dimorphic
(yeast+mold) |
| Onygenales |
- Coccidioides immitis/Coccidioides posadasii
- Coccidioidomycosis
- Disseminated coccidioidomycosis
- Primary cutaneous coccidioidomycosis. Primary pulmonary coccidioidomycosis
- Histoplasma capsulatum
- Histoplasmosis
- Primary cutaneous histoplasmosis
- Primary pulmonary histoplasmosis
- Progressive disseminated histoplasmosis
- Histoplasma duboisii
- Lacazia loboi
- Paracoccidioides brasiliensis
|
|
| Other |
- Blastomyces dermatitidis
- Blastomycosis
- North American blastomycosis
- South American blastomycosis
- Sporothrix schenckii
- Penicillium marneffei
|
|
|
| Yeast-like |
- Candida albicans
- Candidiasis
- Oral
- Esophageal
- Vulvovaginal
- Chronic mucocutaneous
- Antibiotic candidiasis
- Candidal intertrigo
- Candidal onychomycosis
- Candidal paronychia
- Candidid
- Diaper candidiasis
- Congenital cutaneous candidiasis
- Perianal candidiasis
- Systemic candidiasis
- Erosio interdigitalis blastomycetica
- C. glabrata
- C. tropicalis
- C. lusitaniae
- Pneumocystis jirovecii
- Pneumocystosis
- Pneumocystis pneumonia
|
|
| Mold-like |
- Aspergillus
- Aspergillosis
- Aspergilloma
- Allergic bronchopulmonary aspergillosis
- Primary cutaneous aspergillosis
- Exophiala jeanselmei
- Fonsecaea pedrosoi/Fonsecaea compacta/Phialophora verrucosa
- Geotrichum candidum
- Pseudallescheria boydii
|
|
|
| Basidiomycota |
- Cryptococcus neoformans
- Cryptococcosis
- Trichosporon spp
- Trichosporonosis
|
|
Zygomycota
(Zygomycosis) |
Mucorales
(Mucormycosis) |
- Rhizopus oryzae
- Mucor indicus
- Lichtheimia corymbifera
- Syncephalastrum racemosum
- Apophysomyces variabilis
|
|
Entomophthorales
(Entomophthoramycosis) |
- Basidiobolus ranarum
- Conidiobolus coronatus/Conidiobolus incongruus
|
|
|
Microsporidia
(Microsporidiosis) |
- Enterocytozoon bieneusi/Encephalitozoon intestinalis
|
|
|
| Mesomycetozoea |
|
|
| Ungrouped |
- Alternariosis
- Fungal folliculitis
- Fusarium
- Granuloma gluteale infantum
- Hyalohyphomycosis
- Otomycosis
- Phaeohyphomycosis
|
|
|
Index of fungal disease
|
|
| Description |
|
|
| Disease |
|
|
| Treatment |
|
|
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