Mycetoma

Mycetoma is a chronic local, slowly progressive, destructive infection

Begins in subcutaneous tissues, frequently after implantation of vegetative material into tissues during occupational activities

Infection then 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

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

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

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