Mycetoma

Last Updated: 2020-06-01

Author(s): Anzengruber, Navarini

  • Gill 1842.
  • Carter 1861.

Madura foot, Mycetoma.

Chronic fungal infection, which only affects the skin and is partly tumour-like.

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

Pathogens

  • 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 localized on plants, can penetrate through skin lesions (mostly when walking barefoot). 
  • Tumor-like skin changes, swellings, fistula ducts and emptying of blackish, whitish or yellowish granules (drusen).
  • Secondary impetiginisation is often seen.
  • Clinical features.
  • Pathogen detection from Drusen.
  • Myco. smear.
  • Biopsy.
  • Especially on the feet (Madura foot).

Unfavourable, usually lethal in case of organ infestation.

Early diagnosis!

Systemic therapy:

  • In case of bacteria detection:
    • Antibiotic therapy after resistogram.
  • In case of mycotic detection:
    • Itraconazole (e.g. Sporanox®) p.o. 200 mg 1x a day
    • Terbinafine (Lamisil®) p.o. up to 1000 mg! daily
    • Posaconazole (Noxafil®)p.o. 400 mg 2x a day
  • Surgical therapy: surgical excision, if necessary removal 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.