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Mycetoma Fungal Infection

Synonyms and related keywords: mycetoma, maduromycosis, Madura foot, actinomycetes, fungi, fungus, fungal infection, bacterial infection, bacteria, bacterium, actinomycetoma, eumycetoma, disfigurement, deformity, Pseudallescheria boydii, P boydii, Actinomadura madurae, A madurae, Actinomadura pelletieri, A pelletieri, Streptomyces somaliensis, S somaliensis, Nocardia, pulmonary mycetoma, Scedosporium apiospermum, S apiospermum, Streptomyces paraguayensis, S paraguayensis, Leptosphaeria, Madurella mycetomatis, M mycetomatis

A grayish-brown subcutaneous (skin) infection commonly associated with lymphatic filariasis and is endemic in the tropics and subtropics. Mycetoma Madura is named after the region of India where it was first described in 1842..  Cases of mycetoma with primary lymphedema and/or secondary lymphedema are rare. Can be caused by mycotic (fungus) or bacteria.  There are more then 20 species of both that cause the disease.

Clinical manifestations:

Mycetoma is a chronic, suppurative infection of the subcutaneous tissue and contiguous bone. The clinical features are fairly uniform, regardless of the organism involved. The feet are the most common site for infection and account for at least two-thirds of cases. Other sites include the lower legs, hands, head, neck, chest, shoulder and arms. Most cases start out as a small hard painless nodule which over time begins to soften on the surface and ulcerate to discharge a viscous, purulent fluid containing grains. The infection slowly spreads to adjacent tissue, including bone, often causing considerable deformity. Sinuses continue to discharge serosanguinous fluid containing the granules which vary in size, colour and degree of hardness, depending on the aetiologic species. These grains are the hallmark of mycetoma.

Mycology (principal fungi)

Eumycotic mycetoma (granule color)

Actinomycetoma (bacterial)

Eumycetoma

Treatment

Treatment will depend on whether the mycetoma is fungal or bacterial.  Antibiotics and./or antifungal medicines are standard treatment for localized or limited mycetoma.

Surgery is recommended for localized lesions. 

Antibiotics used include:

Trimethoprim-sulfamethoxazole (Bactrim DS, Septra)

Amikacin (Amikin)

Dapsone (Avlosulfon)

Rifampin (Rimactane, Rifadin)

Imipenem and cilastatin (Primaxin)

Antifungal medications:

Ketoconazole (Nizoral)

Itraconazole (Sporanox)

Amphotericin B (Fungizone)

Voriconazole (VFEND)

With proper treatment, the prognosis is general good as the disease responds well to both antibiotic and antifungal medications. The disease a a sow progressing and somewhat painless condition in the early stages, thus it is usually at a serious, advanced state when diagnosed and treated. 

Immunocompromised patients may develop an invasive infection. Other complications can include toxicity due to the prolonged use of antimicrobial or antifungal therapy. Unless properly treated, however,  the effected limb may have to be amputated.

Voriconazole (VFEND)

With proper treatment, the prognosis is general good as the disease responds well to both antibiotic and antifungal medications. The disease a a sow progressing and somewhat painless condition in the early stages, thus it is usually at a serious, advanced state when diagnosed and treated. 

Immunocompromised patients may develop an invasive infection. Other complications can include toxicity due to the prolonged use of antimicrobial or antifungal therapy. Unless properly treated, however,  the effected limb may have to be amputated.

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Two cases with unusual mycetoma localizations in upper respiratory system. 

Nov-Dec 2011

Bektaş D, Ural A, Caylan R, Bahadır O, Kul N, Caylan R.

Source

Department of Otolaryngology, Medicine Faculty of Karadeniz Technical University, Trabzon, Turkey.

Abstract

Fungus balls or mycetomas are extramucosal and noninvasive accumulations of degenerating fungal hyphae. In head and neck they may localized most frequently in the paranasal sinuses, especially in the maxillary sinus. These indolent infections are mostly caused by Aspergillus spp. In this article, we present two rare fungus ball cases: one occurring in an automastoidectomy cavity of a temporal bone and the other in a concha bullosa. Typically, both patients admitted with vague symptoms consistent with chronic infection resistant to conventional antibacterial medication.

http://www.ncbi.nlm.nih.gov/pubmed/22014300

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Fusarium soloni mycetoma.

2011 May
Katkar VJ, Tankhiwale SS, Kurhade A.

Source

Department of Microbiology, Government Medical College, Nagpur, India.

Abstract

A young apparently healthy, non-diabetic, HIV non-reactive woman presented with a mycetoma-like lesion on right buttock. Discharge was scanty, and mycotic grains were not seen. Biopsy of sinus track was obtained for microscopy and culture. Microscopic examination revealed plenty of fungal hyphae in direct microscopic examination of grounded tissues in saline; KOH, Gram's, and H and E-stained smears. All the three inoculated slants of Sabouraud's media yielded heavy growth of Fusarium solani. Presence of numerous hyphal fragments in direct microscopy and heavy growth of F. solani in all three slants indicative of etiological role of fungus in the present case. It is probably a first report of F. soloni mycetoma from India.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132913/?tool=pubmed

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Actinomycetes mycetoma

Jan 2011

Hogade S, Metgud SC, Swoorooparani.

Source

Department of Microbiology, J. N. Medical College, Belgaum, Karnataka, India.

Address for correspondence: Dr. S

umati Hogade, E-mail: sumatihogade@ya

hoo.co.in

Abstract

Mycetoma is a chronic infection, frequently seen in tropical and sub-tropical countries and is considered as an occupational disease. Nocardia species though it can infect immunocompetent individuals, it most commonly affects immunocompromised patients. A 50-year-old male, farmer presented to our hospital with serosanguineous discharging swelling over the dorsum of right foot. We have isolated Nocardia asteroides from the tissue sample. Speciation of this isolate was carried out based on phenotypic methods. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118057/?tool=pubmed

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Clinical Studies and Abstracts:

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Variable antibiotic susceptibility patterns among Streptomyces species causing actinomycetoma in man and animals. Jun 2011

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133538/?tool=pubmed

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Mycetoma or synovial sarcoma? A case report with review of the literature. Sept 2011

http://www.jfas.org/article/S1067-2516(11)00193-1/abstract

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Actinomycetoma of the scalp after a car accident.  July 2011

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2011.04874.x/abstract

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Oral cavity eumycetoma.


http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652011000300008&lng=en&nrm=iso&tlng=en

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Clinical Studies and Abstracts:

Functional endoscopic sinus surgery for the treatment of Aspergillus mycetomas of the maxillary sinus.

March 2008

PubMed

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Incidence and changing pattern of mycetoma in western Rajasthan.

Jan-Mar 2008

Indian Journal of Pathology & Microbiology

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Immune Response to Nocardia brasiliensis Extracellular Antigens in Patients with Mycetoma.

Mar 2008

Springer Link

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Efficacy of DA-7218, a new oxazolidinone prodrug, in the treatment of experimental actinomycetoma produced by Nocardia brasiliensis.

Jan 2008

PubMed

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The dot-in-circle sign of mycetoma on MRI.

Dec 2007

Diagnostic and Interventional Radiology

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Lung cavities, mycetomas and hemoptysis

2007

Springer Link

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Human mycetoma

Oct 2007

Mary Ann Liebert, Publisher

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External Links:

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Concurrent mycetoma and chromomycosis. 2011 Oct

http://www.ijmm.org/article.asp?issn=0255-0857;year=2011;volume=29;issue=4;spage=437;epage=439;aulast=Murthy

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Mycetoma. 2011

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205619/?tool=pubmed

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Unexpected Disappearance of a Mycetoma.   2011 Aug 11

http://journals.lww.com/amjmedsci/Citation/publishahead/Unexpected_Disappearance_of_a_Mycetoma.99456.aspx

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Mycetoma

http://www.mycology.adelaide.edu.au/Mycoses/Subcutaneous/Mycetoma/

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Mycetoma

Author: Basilio J Anía, MD, PhD , Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Universidad De Las Palmas De Gran Canaria, Spain

http://www.emedicine.com/med/topic30.htm

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Images - Mycetoma - Dermatlas - Images

http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=-596024176

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Mycetoma

New Zealand DermNet

http://www.dermnetnz.org/index.html

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Mycetoma

Synonyms
Madura foot, maduromycetoma, maduromycosis


http://www.doctorfungus.org/mycoses/human/other/mycetoma.php 

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Pulmonary Aspergilloma (Mycetoma)

Alternate Names : Aspergilloma, Fungus Ball, Mycetoma

Definition

Pulmonary aspergilloma is a mass caused by a fungal infection that usually grows in pre-existing lung cavities. It can also appear in the brain, kidney, or other organs


http://health.allrefer.com/health/pulmonary-aspergilloma-mycetoma-info.html

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Mycetoma

A chronic, progressive, local infection caused by fungi or bacteria, involving the feet, upper extremities, or back and characterized by tumefaction and formation of multiple sinus tracts


http://www.merckmanuals.com/professional/infectious_diseases/fungi/mycetoma.html

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Mycetoma

Last Updated: April 5, 2002


Synonyms and related keywords: maduromycosis, Madura foot, actinomycetes, fungi, fungus, fungal infection, bacterial infection, bacteria, bacterium, actinomycetoma, eumycetoma, disfigurement, deformity, Pseudallescheria boydii, P boydii, Actinomadura madurae, A madurae, Actinomadura pelletieri, A pelletieri, Streptomyces somaliensis, S somaliensis, Nocardia

Author: Basilio J Anía, MD, PhD, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Universidad De Las Palmas De Gran Canaria, Spain

Coauthor(s): Margarita Asenjo, MD, Associate Professor, Department of Radiology, Medical School of the University of Las Palmas De Gran Canaria, Spain; Raphael J Kiel, MD, Associate Program Director, Head of Infectious Disease Section, Associate Professor of Internal Medicine, Department of Internal Medicine, Oakwood Hospital, Wayne State University School of Medicine


http://www.emedicine.com/med/topic30.htm

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Classification and external resources

ICD-10 B47.
Mycetoma
B47.0 Eumycetoma
Madura foot, mycotic
Maduromycosis
B47.1 Actinomycetoma
B47.9 Mycetoma, unspecified
Madura foot NOS

 

DiseasesDB 8472
eMedicine med/30  derm/280 derm/147
MeSH D008271

ICD9 

mycotic (fungal) mycetoma (117.4)

117.4 Mycotic Mycetomas

. 039.0  Actinomycotic Mycetoma

Includes:
actinomycotic mycetoma
infection by Actinomycetales, such as species of Actinomyces, Actinomadura, Nocardia, Streptomyces
maduromycosis (actinomycotic)
schizomycetoma (actinomycotic)
 

039.4 Madura foot

Excludes:
madura foot due to mycotic infection (117.4)

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