LYMPHEDEMA MYCETOMA SKIN FUNGUS

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.

The infection can be caused by true fungi (eumycetoma) in 40%, or filamentous bacteria (actinomycetoma) in 60%.
Actinomycetoma may be due to Actinomadura madurae, Actinomadura pelletieri, Streptomyces somaliensis, Nocardia species
Eumycetoma is often due to Pseudallescheria boydii (Scedosporium apiospermum).
Infection enters through sites of local trauma, e.g. cut or splinter, causing a granulomatous reaction. Spread occurs through skin facial planes and can involve the bone.
It most commonly involves the foot but can involve the hands, back or shoulders.

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.

Eumycotic mycetoma (granule color)

Acremonium falciforme (white)
Acremonium recifei (white)
Aspergillus nidulans (white)
Exophiala jeanselmei (black)
Leptosphaeria senegalensis (black)
Madurella grisea (black)
Madurella mycetomatis(black)
Neotestudina rosatii (white)
Pseudallesheria boydii (white to yellow)
Pyrenochaeta romeroi (black)

Actinomycetoma (bacterial)

Actinomadura madurae
Actinomadura pelletieri
S somaliensis
Nocardia species

Eumycetoma

P boydii (S apiospermum).

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.

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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:

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.htm

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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.merck.com/mmpe/sec14/ch180/ch180j.html#sec14-ch180-ch180j-1666

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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

B 47.

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

Infection by various genera and species of Ascomycetes and Deuteromycetes, such as Acremonium [Cephalosporium] falciforme, Neotestudina rosatii, Madurella grisea, Madurella mycetomii, Pyrenochaeta romeroi, Zopfia [Leptosphaeria] senegalensis
Madura foot, mycotic
Maduromycosis, mycotic
Excludes: actinomycotic mycetomas (039.0-039.9)

. 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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Diagnostic Images

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