MYCETOMA

Dr.T.V.Rao MD

Dr.T.V.Rao MD 1
 What is Mycetoma
• Mycetoma is a chronic granulomatous,
progressive inflammatory disease that
involves the subcutaneous tissue after a
traumatic inoculation of the causative
organism. It may be caused by true fungi
(eumycetes) or by higher bacteria
(actinomycetes) and therefore it is classified
into eumycetoma and actinomycetoma
respectively.
Dr.T.V.Rao MD 2
 Mycetoma
• Mycetoma is a chronic subcutaneous
infection caused by actinomycetes or
fungi. This infection results in a
granulomatous inflammatory
response in the deep dermis and
subcutaneous tissue, which can
extend to the underlying bone.
Dr.T.V.Rao MD 3
 Mycetoma
• Mycetoma is characterized by the
formation of grains containing aggregates
of the causative organisms that may be
discharged onto the skin surface through
multiple sinuses. Mycetoma was first
described in the mid 1800s and initially
named Madura foot, after the region of
Madura in India where the disease was
first identified.Dr.T.V.Rao MD 4
 Mycetoma
• Mycetoma caused by
Microaerophilic
actinomycetes is
termed
actinomycetoma,
and mycetoma
caused by true fungi
is called
eumycetoma.
Dr.T.V.Rao MD 5
 Presentation of Mycetoma
• The characteristic triad of a painless
subcutaneous mass, sinuses and the discharge
of grains is pathognomic of mycetoma. The
lesion usually presents as a slowly progressive
painless swelling at the site of previous
trauma and gradually increases in size. It may
spread to involve the skin and deep structures
resulting in destruction of bone, deformity
and loss of function with serious social and
economic implications.
Dr.T.V.Rao MD 6
 Madura foot
• Madura foot is a chronic granulomatous
infection of the bones and soft tissues of the
foot resulting in mycetoma formation and
gross deformity. It occurs in Sudan, North
Africa and the west coast of India, principally
among those who walk barefoot and are
therefore prone to contamination of foot
injuries by soil-derived organisms.

Dr.T.V.Rao MD 7
Madura foot
• A common causative
organism is
Actinomadura madurae,
but Madura foot is also
caused by other
actinomycetes including
Streptomyces
somaliensis and by
fungi

Dr.T.V.Rao MD 8
Aetiological Agents of Mycetoma
• More than 20
species of fungi and
bacteria can cause
mycetoma. The ratio
of mycetoma cases
caused by bacteria
(actinomycetoma) to
those caused by true
fungi (eumycetoma)
Dr.T.V.Rao MD 9
Actinomadura spp

Dr.T.V.Rao MD 10
 Mycetoma
• The body parts affected most
commonly in persons with
mycetoma include the foot or lower
leg, with infection of the dorsal
aspect of the forefoot being typical.
The hand is the next most common
location; however, mycetoma lesions
can occur anywhere on the body.
Dr.T.V.Rao MD 11
 Mycetoma Lesions
• Lesions on the chest
and back are
frequently caused by
Nocardia species,
whereas lesions on
the head and neck
are usually caused
by Streptomyces
somaliensis.
Dr.T.V.Rao MD 12
 Pathogenesis
• The causative organism enters through sites of
local trauma (eg, cut on the hand, foot
splinter, local trauma related to carrying soil-
contaminated material). A neutrophilic
response initially occurs, which may be
followed by a granulomatous reaction. Spread
occurs through skin facial planes and can
involve the bone. Haematogenous or
lymphatic spread is uncommon.
Dr.T.V.Rao MD 13
 Actinomycetoma can be caused by the
following:

• Actinomadura
madurae
• Actinomadura
pelletieri
• Streptomyces
somaliensis
• Nocardia species

Dr.T.V.Rao MD 14
Clinical Presentations of Mycetoma

Dr.T.V.Rao MD 15
Clinical Presentations of Mycetoma

Dr.T.V.Rao MD 16
 Eumycetoma
• Eumycetoma is
mainly caused
by P boydii (S
apiospermum)
or Madurella
mycetomatis.
Dr.T.V.Rao MD 17
 Botryomycosis
• Botryomycosis is a chronic, Suppurative
infection characterized by a granulomatous
inflammatory response to bacterial
pathogens; it may present with cutaneous or,
less commonly, visceral involvement . The
term botryomycosis is derived from the Greek
word botrys (meaning "bunch of grapes") and
mycosis (a misnomer, due to the presumed
fungal etiology in early descriptions).
Dr.T.V.Rao MD 18
 Botryomycosis
• Other terms used to
describe
botryomycosis
include bacterial
pseudomycosis,
staphylococcal
actinophytosis,
granular bacteriosis,
and actinobacillosis
Dr.T.V.Rao MD 19
Fine needle Aspiration Cytology of
Mycetoma:
• Mycetoma can be
accurately diagnosed by
Fine Needle Aspiration
(FNA) cytology. Mycetoma
lesion has a distinct
appearance in a cytology
smear characterised by the
presence of polymorphous
inflammatory cells
consisting of an admixture
of neutrophils,
lymphocytes, plasma cells,

Dr.T.V.Rao MD 20
 Identification of pathogens
• The mycetoma causative organisms can be
identified by their textural description,
morphological and biological activities in pure
culture. The biological activity may include
acid fastness, optimal temperature,
proteolytic activity, utilization of sugars and
nitrogenous compounds. The grains are the
source of the culture and they should be alive
and free of contaminants and they are usually
obtained by deep surgical biopsy.
Dr.T.V.Rao MD 21
 Treatment of Mycetoma
• The treatment of mycetoma depends
mainly on its aetiological agent and
the extent of the disease. Until
recently, in many centres, the only
available treatment for mycetoma
was amputation or mutilating
surgical excision of the affected part
Dr.T.V.Rao MD 22
 Treatment of Mycetoma
• Actinomycetoma is amenable to medical
treatment with antibiotics and other
chemotherapeutic agents. Combined drug
therapy is always preferred to a single drug to
avoid drug resistance and to eradicate residual
infection.
• The common drugs regimes are:
• 1- Amikacin sulphate (15 mg/kg) in combination
with Co-trimoxazole(14 mg/kg twice daily) is the
first line for actinomycetoma treatment.
•
Dr.T.V.Rao MD 23
 Surgical Treatment
• Surgical excision is recommended for small
localized lesions, debulking of massive lesions;
for better response to medical treatment and
for lesions became well encapsulated by
medical treatment.
• Amputation rarely done nowadays. It is done
for very advanced lesions with bad general
condition and as a life saving procedure.

Dr.T.V.Rao MD 24
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