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Mycetoma

Chronic skin infection of bacteria or fungi

Field	Value
name	Mycetoma
synonyms
specialty	Infectious diseases
symptoms	Triad: painless firm skin lump, multiple weeping sinuses, grainy discharge
onset	Slowly progressive
types	*Actinomycetoma (bacterial)
* Eumycetoma (fungal)<ref name	Zijlstra2016/
risks
diagnosis	Ultrasound, fine needle aspiration
treatment

Eumycetoma (fungal) Mycetoma is a chronic infection in the skin caused by either bacteria (actinomycetoma) or fungi (eumycetoma), typically resulting in a triad of painless firm skin lumps, the formation of weeping sinuses, and a discharge that contains grains. 80% occur in feet.

Most eumycetoma is caused by M. mycetomatis, whereas most actinomycetoma is caused by N. brasiliensis, S. somaliensis, A. madurae, and Actinomadura pelletieri. People who develop mycetoma likely have a weakened immune system. It can take between 3 months to 50 years from the time of infection to first seeking healthcare advice.

Diagnosis requires ultrasound and fine needle aspiration.

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 rural areas, particularly in farmers and shepherds, who are often men between 20 and 40 years old earning the primary income for their families. Physicians in these areas are usually unfamiliar with the disease-specific manifestations and need to exercise extra vigilance regarding those patients who are at high risk of contracting mycetoma infections. Recent evidence suggests that Egypt, which borders sub-Saharan Africa, is a low-endemic country. Unlike bacterial acute hematogenous osteomyelitis and septic arthritis, misdiagnosed or delayed diagnosis of mycetoma osteomyelitis can result in amputation or radical resection. The disease is listed by the World Health Organization (WHO) as a neglected tropical disease.

Risk

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

Pathogenesis

Mycetoma is caused by common saprotrophs found in the soil and on thorny shrubs in semi-desert climates. Some common causative agents are:

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.

Diagnosis

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 valuable diagnostic tool. However, its results should be closely correlated with the clinical, laboratory, and pathological findings.

Treatment

Currently, itraconazole is used to treat mycetoma. Recent research found that fosravuconazole can also treat the disease.

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. For both forms, extended treatment is necessary.

Epidemiology

Mycetoma is endemic in some regions of the tropics and subtropics. Pakistan is probably a moderate-endemic country. Egypt is probably a low-endemic country.

Other animals

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

References

(1 January 2016). "Mycetoma: a unique neglected tropical disease". The Lancet Infectious Diseases.
(October 2014). "Mycetoma medical therapy". PLOS Neglected Tropical Diseases.
(March 2014). "The mycetoma knowledge gap: identification of research priorities". PLOS Neglected Tropical Diseases.
(9 September 2022). "A scoping review of mycetoma profile in Egypt: revisiting the global endemicity map.". Transactions of the Royal Society of Tropical Medicine and Hygiene.
(2014). "Autochthonous cases of mycetoma in Europe: report of two cases and review of literature.". PLOS ONE.
(19 April 2021). "Mikolojik Tanının Önemi: 20 Yıl İhmal Edilen Bir Scedosporium apiospermum Kompleks Miçetoma Olgusu". Mikrobiyoloji Bulteni.
(29 July 2022). "Reporting of mycetoma cases from skin and soft tissue biopsies over a period of ten years: A single center report and literature review from Pakistan". PLOS Neglected Tropical Diseases.
RESERVED, INSERM US14 -- ALL RIGHTS. "Orphanet: Mycetoma".
(March 2019). "Mycetoma: reviewing a neglected disease". Clinical and Experimental Dermatology.
"Mycetoma". National Institutes of Health.
(2015). "Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy.". Case Reports in Pathology.
(10 January 2020). "Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region.". BMC Dermatology.
(23 November 2023). "Cheap over-the-counter nail drug found to work on crippling flesh-eating disease". [[The Guardian]].
(December 2017). "Mycetoma in a non-endemic area: a diagnostic challenge". BMC Clinical Pathology.
(7 November 2013). "Global Burden of Human Mycetoma: A Systematic Review and Meta-analysis". PLOS Neglected Tropical Diseases.
(June 2010). "[Mycetoma in Tunisia: a 15-case series].". Médecine Tropicale.
(2008). "Cat Owner's Home Veterinary Handbook". Howell Book House.

Info: Wikipedia Source

This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.

animal-fungal-diseases infectious-diseases tropical-diseases fungal-diseases

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