Mycetoma

Introduction:

• Mycetoma is a chronic infection that develops after traumatic inoculation of the skin with either of the following:
  1. Actinomycetes: Actinomycetoma
  2. True fungi: Eumycetoma.
• MC cause of mycetoma in India: Actinomycetes
• MC fungus responsible for mycetoma: Madurella
• MC site of involvement: Foot
• Clinical features:
  1. Swelling
  2. Grains:
     • Black grain: Eumycetoma
     • White grain: Actinomycetoma
  3. Purulent discharge
  4. Sinus formation
  5. Osteolysis in severe cases.

 Actinomycetes:

• Obligate anaerobe
• Normal habitat: Oral cavity
• Gram stain: Non-spore-forming Gram-positive rods
• Histopathology:
  • Sulfur granules (constituted by conglomeration of bacteria trapped in biofilm)
    • Sunray appearance
  • Blood agar:
    • Actinomyces israelii: ‘Molar tooth‘ appearance

Madurella:

‘Dot in circle‘ sign: Seen in high resolution MRI.

Treatment:

• Actinomycetoma: WAISH regimen:
  1. Cotrimoxazole
  2. Amikacin
  3. Rifampicin
• Eumycetoma: Oral Itraconazole.

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