Eumycetoma

Excerpt

Mycetoma is a progressive chronic granulomatous infection that affects the skin and subcutaneous tissue. Mycetoma can be classified as "eumycetoma" when it is caused by fungi or "actinomycetoma" when caused by bacteria in the order Actinomycetes. Eumycetoma is, therefore, a deep fungal infection of the skin and subcutaneous tissue caused by filamentous fungi. Morphologically and histologically, eumycetoma is characterized by a deep fungal infection that induces deep granulomatous inflammation and results in the formation of grains, which destroys deep tissues, muscles, bones, joints, and tendons.

The World Health Organization (WHO) recognizes mycetoma as a neglected tropical disease with a significant disease burden, which primarily affects individuals in tropical and subtropical regions who come into direct contact with soil. The foot is particularly the most common site of fungal infections, as it frequently comes into contact with fungi in the soil through skin trauma due to the natural exposure of soil-borne fungi that breach the skin. In less frequent instances, other areas, such as the legs or hands, may also be affected, as these infections usually enter through skin damage and, in rare cases, spread via hematogenous dissemination to other sites.

The most common filamentous fungi causing an eumycetoma is Madurella mycetomatis. These organisms are found in the soil and implanted in the skin after minor trauma. Slow progressive subcutaneous swelling develops, followed by the formation of multiple nodules that evolve into suppurative lesions with numerous draining sinus tracts, from which colonies of causative organisms are discharged. Managing eumycetoma poses significant challenges and necessitates a prolonged treatment regimen that often combines systemic antifungal therapy for an extended duration (6 months or more) with surgical interventions. Neglected infections may lead to severe tissue destruction, underscoring the medical significance and treatment complexities associated with eumycetoma. In endemic areas, eumycetomas lead to socio-economic consequences involving affected patients and their families.