Mycetoma

• Gill, 1842
• Carter, 1861

Madura foot, Mycetoma.

Chronic fungal infection which is confined to the skin and is sometimes tumour-like.

• Worldwide, especially in tropical and subtropical areas (South America, India, Africa)
• Men:women = 5:1
• Mainly among rural populations
• In Europe, Bulgaria and Romania are particularly affected

• Exciter
  • Bacteria e.g
    • Actinomyces spp. (e.g.: A. israeli, A. bovis)
    • Nocardia spp. (N. brasiliensis, N. asteroides)
  • Fungi: Madurella (e.g. Madurella mycetomi, Madurella grisea)
  • Pseudallescheria

• The pathogens, which are mostly localised on plants, can penetrate through skin lesions (mostly when walking barefoot)

• Tumour-like skin changes, swellings, fistulous ducts and discharge of blackish, whitish or yellowish granules (drusen)
• Frequently, secondary impetiginisation
is seen

• Clinic
• Drusen pathogen detection
• Myco. smear
• Biopsy

• V.a. on the feet (madura foot)

Unfavourable, usually lethal in organ infestation.

• Early diagnosis!
• Systhemotherapy
• If bact. is detected:
  • Antibiotic therapy after resistogram.
• In case of myco. detection:
  • Itraconazole p.o. 200 mg 1x tgl.
  • Terbinafine p.o. up to 1000 mg ! tgl.
  • Posaconazole p.o. 400 mg 2x tgl.

• Operative therapy: surgical excision, if necessary clearing of fistula tracts and drainage

1. Foltz, K.D. and L.M. Fallat, Madura foot: atypical finding and case presentation. J Foot Ankle Surg, 2004. 43(5): p. 327-31.
2. Paugam, A., et al., Clinical cure of fungal madura foot with oral itraconazole. Cutis, 1997. 60(4): p. 191-3.
3. Sharma, A.M., et al., Case report: Non-invasive management of Madura foot with oral posaconazole and ciprofloxacin. Am J Trop Med Hyg, 2014. 91(6): p. 1259-62.
4. Afroz, N., et al., Eumycetoma versus actinomycetoma: Diagnosis on cytology. J Cytol, 2010. 27(4): p. 133-5.