Fakultas Kedokteran Universitas Tarumanagara

Mycetoma/Madura Foot chronic infection

bacteria (Actinomycetoma) or fungi
(Eumycetoma)
Case clinical features & response of
treatment.
- Chronic granulamatous infection of dermal skin,
subcutaneous tissues extend to the underlying bone.

- Caused by : traumatic inoculation of a fungus
(Eumycetoma) / bacterium (Actinomycetoma).

- tropic/subtropic areas
- Farmers foot, lower legs, hand.

Formation of grains containing aggregates of
the causative organism may be discharged
onto skin surface through multiple sinuses.
Bacteria-induced mycetoma antibacterial
Fungi-induced mycetoma antifungal
Infection extend to the adjacent bone surgery
60 y.o
Farmer
Thanh Hoa
province
National Hospital of Dermato-Venereology
Trauma in
his foot leg
9 y.ago
A single
papule
Successive nodules
( intermitten
discharge seen hard
white grains)
Dorsum&sole surface
of the left foot
Antibiotic partially
relieved lession
-Severe pain &
swelling of lesion,
hardened with
multiple
discharging sinus
- No enlargement
of regional lymph
node
7 y.ago 1 mo.ago
Now to hospital
-swell mass
-discharging
sinus
-no pain
X-ray osteitis (left foot)
Histopathology(HE) unspesific dermatitis.
Culture bacterium(-), fungus(-) past
antibiotic therapy

Upon characteristics as epidemiology+color
of grains actynomycetoma
Osteitis curettage welsh regimen.

Mycetoma(1842) = madura foot (Madurai-India)
Microaerophilic actinomycetes actynomycetoma
True fungi eumycetoma
Young adults ( males 20 -40 y.o) in developing
countries, low socioeconomic status, manual workers
( agricultural workers, laborers, herdsmen)
Foot traumatic inoculation of fungi/bacteria into
subcutaneus tissue)
Lesion : subcutaneus swelling nodules
sinus containing grains osteolisis.
Triad :
- painless
-subcutaneus mass,multiple,sinuss
-discharge containing grains.
Actinomycetoma Eumycetoma
Areas where the average rainfall is
scarce ( <350 mm)
Abundant rainfall ( > 600mm)
Grains can be picked out by naked eyes
red/white
Microscope black/white
-Hispathology
Granulamatous inflammation
Abscess formation
Fibrosis

-Smears of the discharge / Tissue biopsy
-Grains colour,size,PAS,Ziehn-Neelsen,inflamation cells composition.
-organism cultures depends on : a paucity of grains within sampling error,
contamination of other bacterial organism, fibrosis.
-ELISA IgM antibodies
-PCR identification of species.
Eumycetoma antifungal surgery
Actinomycetomas Welsh regimen iv
amikacin + oral cotrimoxazole
(trimethoprim+sulfamethoxazol) + osteitis
curettage + nodules drainage.
Culture in mycetoma can be negative
because of many reason
Clinical manifestations are very important
treat early avoiding complication ( osteitis
& amputation )