[Mycetomas in Africa]

Abstract

Mycetoma is the pathological process in which exogenous fungal or actinomycotic etiological agents generate grains. These agents belong to two groups: fungi and aerobic actinomycetes. Eumycetoma (caused by fungi) and actinomycetoma (caused by actinomycetes) must be distinguished as their treatments are different. These causative agents are introduced by traumas. Mycetomas are frequent in the northern tropical zones of America in Mexico and Venezuela, Africa in Senegal, Mauritania and Sudan and Asia in India, but can also be observed beyond these areas. In Africa, a high endemicity has been noted in a Sahelian band spanning from Senegal and Mauritania in the west to Somalia and the Republic of Djibouti in the east where there are long dry seasons and short rainy seasons. In this zone, M. mycetomatis (fungi) and S. somaliensis (actinomycetes) are predominant. A. pelletieri is common only in West Africa. Rainfall influences the distribution of these agents. S. somaliensis is more often found in desert areas, and A. pelletieri in more rainy areas. Mycetoma is more frequent in males and affects the age group between the second and fourth decades. Most of the patients are outdoor workers. In Africa, the foot is the most frequent localisation of the disease followed by the leg. Mycetoma is characterized by tumefaction, subcutaneous nodules and in most cases discharging sinuses that drain exudate containing grains. It gradually invades the tissues and bones causing a functional disability. Bone involvement depends on the duration of the disease, the site of the lesion and the causative agent. Invasion of lymph nodes is observed in rare cases, usually with actinomycetes.(ABSTRACT TRUNCATED AT 250 WORDS)