Mycetoma

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Mycetoma
SpecialtyInfectious diseases
SymptomsTriad: painless firm skin lump, multiple weeping sinuses, grainy discharge[1]
Usual onsetSlowly progressive[1]
Types
Diagnostic methodUltrasound, fine needle aspiration[1]

Mycetoma is a chronic infection in the skin caused by either bacteria (actinomycetoma) or fungi (eumycetoma), typically resulting in a triad of painless firm skin lumps, the formation of weeping sinuses, and a discharge that contains grains.[1] 80% occur in feet.[1]

Most eumycetoma is caused by M. mycetomatis, whereas most actinomycetoma is caused by N. brasiliensis, S. somaliensis, A. madurae and Actinomadura pelletieri.[1] People who develop mycetoma likely have a weakened immune system.[1] It can take between 3 months to 50 years from time of infection to first seeking healthcare advice.[1]

Diagnosis requires ultrasound and fine needle aspiration.[1]

While most cases of mycetoma occur in Sudan, Venezuela, Mexico, and India, its true prevalence and incidence are not well-known.[2][3] It appears most frequently in people living in rural areas, particularly in farmers and shepherds, who are often men between 20 and 40 years earning the primary incomes for their families.[1] It has been reported since 1840.[4] The disease is listed by the World Health Organization (WHO) as a neglected tropical disease.[3]

Risk[]

Frequent exposure to penetrating wounds by thorns or splinters is a risk factor.[5] This risk can be reduced by disinfecting wounds and wearing shoes.[6]

Pathogenesis[]

Mycetoma is caused by common saprotrophs found in the soil and on thorny shrubs in semi-desert climates.[6] The most common causative agents are:[citation needed]

Infection is caused as a result of localized skin trauma, such as stepping on a needle or wood splinter, or through a pre-existing wound.[6]

The first visible symptom of mycetoma is a typically painless swelling beneath the skin; over several years, this will grow to a nodule (lump).[5] Affected people will experience massive swelling and hardening of the area, in addition to skin rupture and the formation of sinus tracts that discharge pus and grains filled with organisms.[5] In many instances, the underlying bone is affected.[7][6] Some people with mycetoma will not experience pain or discomfort, while others will report itching and/or pain.[5]

Diagnosis[]

There are currently no rapid diagnostic tools for mycetoma.[3] Mycetoma is diagnosed through microscopic examination of the grains in the nodule and by analysis of cultures.[6] Since the bacterial form and the fungal form of mycetoma infection of the foot share similar clinical and radiological features, diagnosis can be a challenge.[2] Magnetic resonance imaging is a very valuable diagnostic tool. However, its results should be closely correlated with the clinical, laboratory and pathological findings.[7][8]

Treatment[]

While treatment will vary depending on the cause of the condition, it may include antibiotics or antifungal medication.[5] Actinomycetoma, the bacterial form, can be cured with antibiotics.[2] Eumycetoma, the fungal form, is treated with antifungals.[8] Surgery in the form of bone resection may be necessary in late presenting cases or to enhance the effects of medical treatment.[7] In the more extensive cases amputation is another surgical treatment option.[9][6] For both forms, extended treatment is necessary.[2]

Epidemiology[]

Human Mycetoma in India in 2013[4]

Mycetoma is endemic in some regions of the tropics and subtropics.[1] India, Sudan and Mexico are most affected.[1]

Other animals[]

In cats, mycetoma can be treated with complete surgical removal. Antifungal drugs are rarely effective.[10]

References[]

  1. ^ Jump up to: a b c d e f g h i j k l m n Zijlstra, Eduard E.; Sande, Wendy W. J. van de; Welsh, Oliverio; Mahgoub, El Sheikh; Goodfellow, Michael; Fahal, Ahmed H. (1 January 2016). "Mycetoma: a unique neglected tropical disease". The Lancet Infectious Diseases. 16 (1): 100–112. doi:10.1016/S1473-3099(15)00359-X. ISSN 1473-3099.
  2. ^ Jump up to: a b c d Welsh O, Al-Abdely HM, Salinas-Carmona MC, Fahal AH (October 2014). "Mycetoma medical therapy". PLOS Neglected Tropical Diseases. 8 (10): e3218. doi:10.1371/journal.pntd.0003218. PMC 4199551. PMID 25330342.
  3. ^ Jump up to: a b c d van de Sande WW, Maghoub El S, Fahal AH, Goodfellow M, Welsh O, Zijlstra E (March 2014). "The mycetoma knowledge gap: identification of research priorities". PLOS Neglected Tropical Diseases. 8 (3): e2667. doi:10.1371/journal.pntd.0002667. PMC 3967943. PMID 24675533.
  4. ^ Jump up to: a b Sande, Wendy W. J. van de (7 November 2013). "Global Burden of Human Mycetoma: A Systematic Review and Meta-analysis". PLOS Neglected Tropical Diseases. 7 (11): e2550. doi:10.1371/journal.pntd.0002550. ISSN 1935-2735. PMC 3820768. PMID 24244780.
  5. ^ Jump up to: a b c d e "Mycetoma". Genetic and Rare Diseases Information Center (GARD). National Institutes of Health. Retrieved 2018-04-17.
  6. ^ Jump up to: a b c d e f RESERVED, INSERM US14 -- ALL RIGHTS. "Orphanet: Mycetoma". www.orpha.net. Retrieved 2018-04-17.
  7. ^ Jump up to: a b c El-Sobky, TA; Haleem, JF; Samir, S (2015). "Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy". Case Reports in Pathology. 2015: 129020. doi:10.1155/2015/129020. PMC 4592886. PMID 26483983.
  8. ^ Jump up to: a b Karrakchou, B; Boubnane, I; Senouci, K; Hassam, B (10 January 2020). "Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region". BMC Dermatology. 20 (1): 1. doi:10.1186/s12895-019-0097-1. PMC 6953183. PMID 31918687.
  9. ^ Efared, Boubacar; Tahiri, Layla; Boubacar, Marou Soumana; Atsam-Ebang, Gabrielle; Hammas, Nawal; Hinde, El Fatemi; Chbani, Laila (December 2017). "Mycetoma in a non-endemic area: a diagnostic challenge". BMC Clinical Pathology. 17 (1): 1. doi:10.1186/s12907-017-0040-5. ISSN 1472-6890. PMC 5288886. PMID 28167862.
  10. ^ Eldredge, Debra M.; Carlson, Delbert G.; Carlson, Liisa D.; Giffin, James M. (2008). Cat Owner's Home Veterinary Handbook. Howell Book House. p. 160.

External links[]

  • DermNet NZ: an online resource about skin diseases from the New Zealand Dermatological Society Incorporated.
  • Orphanet: a reference portal from Europe that provides information on rare diseases and orphan drugs.
  • ClinicalTrials.gov: a list of clinical trials related to mycetoma.
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