MYCETOMA / MADURA FOOT

This is a chronic localised infection which can be caused by various
species of fungi (eumycetoma) and bacteria, actinomycetes and nocardia
(actinomycetoma). These micro-organisms live in the soil and enter the
skin usually after a penetrating injury. The most common localisation is
therefore the foot or lower leg in barefoot persons but lesions may
appear anywhere on the body. A painless subcutaneous nodule or
induration is followed by more nodules which may discharge pus with
grains (small hard pinhead sized particles) through fistules, form abscesses
and ulcers and spread to underlying bones and joints. The colour and
hardness of the grain may help in deciding on the causative agent.
Management of mycetoma
- Smaller lesions which can be surgically removed without causing disability should
be radically excised.
- Decide on fungal or bacterial origin before installing drug therapy. Direct microscopy
(in 20% potassium hydroxide) of pus containing grains may help: after the grains are
crushed eumycetomas show hyphae, actinomycetomas small slender filaments.
Culture allows final identification. When in doubt, refer.
- Eumycetoma (caused by fungi) are virtually untreatable: antifungals e.g.
itraconazole, fluconazole, ketaconazole, miconazole, and griseofulvin have a success
rate of less than 30%. Actinomycetoma (caused by bacteria): dapsone or
cotrimoxazole combined with streptomycin. Streptomycin can be substituted by
amikacin, sulfonamides by rifampicin.
- Drug therapy often fails. Radical surgery / amputation is then the only option.