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| Mycetoma Classification and external resources |
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| Actinomycetoma | |
| ICD-10 | B47. |
| DiseasesDB | 8472 |
| eMedicine | med/30 derm/280 derm/147 |
| MeSH | D008271 |
Mycetoma, is a chronic, specific, granulomatous, progressive inflammatory disease; it usually involves the subcutaneous tissue after a traumatic inoculation of the causative organism. Mycetoma may be caused by true fungi or by higher bacteria and hence it is usually classified into eumycetoma and actinomycetoma respectively. Tumefaction and formation of sinus tracts characterize mycetoma. The sinuses usually discharge purulent and seropurulent exudate containing grains. It may spread to involve the skin and the deep structures resulting in destruction, deformity and loss of function, very occasionally it could be fatal.
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Types
There are two known forms of mycetoma. The two forms of mycetoma are bacterial mycetoma and fungal mycetoma: bacterial mycetoma is known as actinomycetoma while the fungal form is called eumycetoma. Even at the level of electron microscopy the two forms of mycetoma are difficult to distinguish from one another.
Epidemiology
The true incidence and the geographical distribution of mycetoma throughout the world is not exactly known due to the nature of the disease which is usually painless, slowly progressive which may lead to the late presentation of the majority of patients. Mycetoma has a worldwide distribution but this is extremely uneven. It is endemic in tropical and subtropical regions. The African continent seems to have the highest prevalence. It prevails in what is known as the mycetoma belt stretching between the latitudes of 15 south and 30 north. The belt includes Sudan, Somalia, Senegal, India, Yemen, Mexico, Venezuela, Colombia, Argentina and others.
The geographical distribution of the individual mycetoma organism shows considerable variations, which can be convincingly explained on an environmental basis. Areas where mycetoma prevails are relatively arid zones with a short rainy season with a relative humidity.
The organisms are usually present in the soil in the form of grains. The infecting agent is implanted into the host tissue through a breach in the skin produced by trauma caused by sharp objects such as thorn pricks, stone or splinters.
Pathogenesis
The disease is usually acquired while performing agricultural work, and it generally afflicts men between 20 and 40 years old.The disease is acquired by contacting grains of bacterial or fungal spores that have been discharged onto the soil. Infection usually involves an open area or break in the skin. Pseudoallescheria boydii is one of many fungi spp. that causes the fungal form of madura foot (see below). The disease is characterized by a yogurt-like discharge upon maturation of the infection. Hematogenous or lymphatic spread is uncommon. Infections normally start in the foot or hand and travel up the leg or arm.
Diagnosis
Diagnosis of mycetoma is usually accomplished by radiology, ultrasound or by fine needle aspiration of the fluid within an afflicted area of the body.
Treatment
There are several clinical treatments available for this disease. They include surgery, ketoconazole, voriconazole,[1] itraconazole and amputation. There is no sure-fire treatment available at this date. Nor is there available at this date a vaccine for mycetoma.
Scientists at such institutions as The Mycetoma Research Center at The University of Khartoum in the Sudan are working on a cure.
Causative species
Species of bacteria that cause Mycetoma include:
- Nocardia veterana[2]
- Nocardia transvalensis[3]
- Actinomadura madurae
- Actinomadura pelletieri
- Streptomyces somaliensis'
Species of fungus that cause Mycetoma include:
- Exophiala jeanselmei[4]
- Madurella grisea
- Madurella mycetomatis
- Leptosphaeria senegalensis
- Scedosporium apiospermum
- Pseudallescheria boydii[5]
References
- ^ Loulergue P, Hot A, Dannaoui E, et al (December 2006). "Successful treatment of black-grain mycetoma with voriconazole". Am. J. Trop. Med. Hyg. 75 (6): 1106–7. PMID 17172376.
- ^ Kano R, Hattori Y, Murakami N, et al (2002). "The first isolation of Nocardia veterana from a human mycetoma". Microbiol. Immunol. 46 (6): 409–12. PMID 12153118.
- ^ Mirza SH, Campbell C (January 1994). "Mycetoma caused by Nocardia transvalensis". J. Clin. Pathol. 47 (1): 85–6. PMID 8132817. PMC:501765.
- ^ Severo LC, Oliveira FM, Vettorato G, Londero AT (March 1999). "Mycetoma caused by Exophiala jeanselmei. Report of a case successfully treated with itraconazole and review of the literature". Rev Iberoam Micol 16 (1): 57–9. PMID 18473595.
- ^ "Filamentous Fungi".
External links
- Centraalbureau voor Schimmelcultures/The Fungus Research Center Fungal Biodiversity Center
- The Mycetoma Research Center at University of Khartoum
- DermNet fungal/mycetoma
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