Mycetoma

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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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