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Key Features

  • Mycetoma is a chronic local, slowly progressive, destructive infection

  • Begins in subcutaneous tissues, frequently after implantation trauma, and spreads to contiguous structures with sinus tracts and extruding grains

  • Eumycetoma (also known as maduromycosis) is mycetoma caused by true fungi

  • Actinomycetoma is mycetoma caused by Actinomadura, Streptomyces, and Nocardia

Clinical Findings

  • Lesion begins as a papule, nodule, or abscess that, over months to years, forms multiple abscesses and sinus tracts ramifying deep into the tissue

  • Secondary bacterial infection may occur in large open ulcers

Diagnosis

  • Radiographs may show destructive changes in underlying bone

  • Causative species can often be suggested by the color of the characteristic grains and hyphal size within the infected tissues

  • Definitive diagnosis requires culture

Treatment

  • Prognosis of eumycetoma is poor

    • However, surgical debridement with prolonged oral itraconazole therapy (200 mg twice daily) or combination therapy including itraconazole and terbinafine yields a response rate of 70%

  • For actinomycetoma

    • Trimethoprim-sulfamethoxazole, 8/40/mg/kg/day orally for 5 week cycle plus

    • Amikacin, 15 mg/kg/day intravenously or intramuscularly in two divided doses for first 3 weeks of cycle

    • Debridement assists healing

    • Amputation is necessary in far-advanced cases

  • Prognosis of actinomycetoma is good because it usually responds to sulfonamides plus aminoglycosides

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