Mycetoma is a local chronic
and progressive infection of the skin, subcutaneous tissues and bone. It
is characterized by swelling that is often grotesque and disfiguring and
by multiple sinus tracts that drain granule-containing pus.
Mycetoma is caused by at
least 20 species of actinomycetes and fungi. The most common infecting
agents are Nocardia spp and Madurella mycetomi.
PATHOLOGY AND CLINICAL SYMPTOMS:
The disease is acquired by
traumatic implantation in the skin. The microorganisms grow through the
subcutaneous tissue into the bone. As this occurs, there is hyperplasia
of the tissues, formation of pus containing granules (which are actually
colonies of microorganisms), expression of pus to the surface of the skin
and granuloma formation at the periphery of the infected area. The classical
triad of symptoms is:
Gross deformity of the infected area
Granules in the pus
DIAGNOSIS AND TREATMENT:
Diagnosis is made by the
presence of the classical triad of symptoms and by culture of the pus draining
from the wound. Treatment is initially with trimethoprim-sulfamethoxazole
Nocardia or Amphotericin B for fungi. If the fungal infection
does not respond to amphotericin B then amputation is required.