Mycetomas: an epidemiological, etiological, clinical, laboratory and therapeutic review

Abstract

Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue, characterized by a symptomatic triad: tumor, fistulas and grains. It can be caused by fungi (eumycetoma) and bacteria (actinomycetoma), with similar clinical features. Diagnosis is based on the clinical presentation and identification of the etiological agents in the tissue, by mycological/bacteriological, histopathological and immunohistochemical tests. It is important to specify the fungal or bacterial etiology, because the treatments are different. An approach that involves early diagnosis, the use of systemic antibiotics or antifungal agents, including surgical removal of lesions, is the basis for the treatment of these diseases. In this review, the most commonly used diagnostic methods and treatments will be discussed. Also, we will review the history of the disease through epidemiological and etiological aspects.

Figure 1

A) Actinomycetoma - Nocardia brasiliensis. B) After clinical and surgical treatment. C) Actinomycetoma grain on histopathology (Hematoxylin & eosin, X40). D) Typical colony of Nocardia brasiliensis

Figure 2

A) Eumycetoma - Madurella mycetomatis. B) After deep surgical debridement. C) 30 days after surgical procedure. D) Six months after surgical procedure. E) Magnetic resonance imaging (MRI) of the tumor. F) Patient after mycological and clinical cure

Figure 3

A) Eumycetoma - Scedosporium apiospermum. B) Eumycetoma grain on histopathology (Hematoxylin & eosin, X40). C and D) After clinical and surgical treatment. E) Cultures in specific media. F) Strands of hyphae and conidia - Synnema (Lactophenol cotton blue X20)

Figure 4

A) Clinical aspect of the symptomatic triad: tumefaction, sinuses and grains. B) Surgical procedure demonstrating debridement. C) MRI of the foot