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Mycetoma

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Mycetoma, Maduramycosis, Actinomycetoma, Eumycetoma

  • See Also
  1. Nodular Lymphangitis
  2. Cellulitis
  3. Subcutaneous Nodule
  • Definitions
  1. Mycetoma (Maduramycosis)
    1. Chronic progressive subcutaneous, Granulomatous infection
    2. Caused by non-acid fast Bacteria (Actinomycetoma) and fungi (Eumycetoma)
  2. Actinomycetoma
    1. Chronic subcutaneous, Granulomatous lesions due to Actinomycetes, non-acid fast Bacteria
    2. Actinomycetes include soil-based Bacteria, Actinomadura, Nocardia, Streptomyces
    3. Growth is more aggressive than Eumycetoma
  3. Eumycetoma
    1. Chronic subcutaneous, Granulomatous lesions due to fungal infection
  • Epidemiology
  1. Actinomycetoma
    1. Most cases found in Mexico and Venezuela (sporadic cases in United States and Europe)
  2. Eumycetoma
    1. Most cases found in Sudan, Senegal, Nigeria, Somalia, Mauritania, and India
  • Findings
  1. Subcutaneous Lesions
    1. Nodules
    2. Skin Abscesses
    3. Skin fistulae
    4. Localized swelling
  2. Distribution
    1. Typically on legs
    2. May involve hands
  • Labs
  • Histology
  1. Mycetoma
    1. Suppurative Granulomas
    2. Neutrophil infiltrates
    3. Palisaded histiocytes
  2. Actinomycetoma
    1. Thin filaments (0.5 to 1 um) on Gram Stain or methenamine silver stain
  3. Eumycetoma
    1. Thick fungal hyphae
  • Differential Diagnosis
  1. See Subcutaneous Nodule (e.g. Rheumatoid Nodule)
  2. Nodular Lymphangitis
  3. Cellulitis with ascending lymphangitis
  • Management
  1. Surgical debulking may be attempted but high recurrence rate
  2. Actinomycetoma
    1. Dapsone
    2. Streptomycin
    3. Trimethoprim-Sulfamethoxazole
    4. Amikacin
    5. Rifampin
    6. Amoxicillin-clavulanic acid
  3. Eumycetoma
    1. Systemic Antifungals specific to organism
  • Complications
  1. Local disfiguring lesions
  2. Osteomyelitis or ankylosis (if untreated)
  3. Systemic spread to Pelvis, lungs, spinal cord (rare, high mortality)
  • References
  1. Arenas (2017) Cutis 99(2): E11-5 [PubMed]
  2. Cárdenas-de la Garza (2020) PLoS Negl Trop Dis 14(2):e0008123 +PMID: 32097417 [PubMed]
  3. Fahal (2018) Trop Med Infect Dis 3(3): 97 [PubMed]
  4. Relhan (2017) Indian J Dermatol 62(4): 332-40 [PubMed]
  5. Zeller (2022) Am Fam Physician 105(4): 425-6 [PubMed]