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Review
. 2017 Jul-Aug;62(4):332-340.
doi: 10.4103/ijd.IJD_476_16.

Mycetoma: An Update

Vineet Relhan  1 , Khushbu Mahajan  2 , Pooja Agarwal  3 , Vijay Kumar Garg  1
Affiliations
Review

Mycetoma: An Update

Vineet Relhan et al. Indian J Dermatol. 2017 Jul-Aug.

Abstract

Mycetoma is a localized chronic, suppurative, and deforming granulomatous infection seen in tropical and subtropical areas. It is a disorder of subcutaneous tissue, skin and bones, mainly of feet, characterized by a triad of localized swelling, underlying sinus tracts, and production of grains or granules. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is entirely different, a definite diagnosis after histopathological and microbiological examination is mandatory, though difficult. Serological test exists but is not so reliable; however, molecular techniques to identify relevant antigens have shown promise. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Actinomycetoma responds to antibiotic therapy, but prolonged treatment is necessary. This review focuses on the etiopathogenesis, clinical features, laboratory diagnosis, and treatment of mycetoma.

Keywords: Actinomycetoma; Madura foot; eumycetoma.

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Conflict of interest statement

There are no conflicts of interest. What is new? Greater frequency of disease in men may not be just attributable to environmental factors but also to hormonal factorsVarious serological and molecular tests have also found place in diagnosis of mycetoma allowing early diagnosis and identification of new species and phylogenetic relationshipsMagnetic resonance imaging provides the most comprehensive method for assessment of the bone and soft tissue involvement and may also be useful in evaluating the differential diagnosis of the swellingCombination antibiotic therapy is a must in case of actinomycetomasSeveral newer antifungals have been tried for eumycetomas though in vivo studies are lacking.

Figures

Figure 1
Figure 1
(a and b) A female patient with gross swelling of the left foot and ulcers in various stages of healing, with serosanguinous discharge from the active ulcer. Furthermore, evident is the pigmentary changes on the overlying skin
Figure 2
Figure 2
(a and b) A male patient with mycetoma with multiple papules, pustules, and nodules breaking down to form draining sinuses on the skin surface. Dorsum of foot of the same patient showing hyperpigmentation of skin with signs of both old healed and active sinuses
Figure 3
Figure 3
Skin biopsy, stained with H and E, ×40 view showing granulomas surrounded by a mixed inflammatory infiltrate comprising lymphocytes, plasma cells, eosinophils, macrophages are seen. Some amount of fibrosis can be seen in the periphery
Figure 4
Figure 4
X-ray left foot anteroposterior view showing periosteal reaction, osteoporosis, and osteolysis
See this image and copyright information in PMC

References

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