Summary about Disease
Madura foot, also known as mycetoma, is a chronic, progressive, destructive infectious disease that typically affects the foot, although it can occur in other parts of the body. It's characterized by tumefaction (swelling), draining sinuses, and the presence of grains (colonies of the causative organism) in the discharge. The disease is caused by true fungi (eumycetoma) or bacteria (actinomycetoma). It is more common in tropical and subtropical regions.
Symptoms
Painless subcutaneous swelling, usually on the foot
Multiple sinus tracts that drain pus containing granules
Deformity of the affected area
Pain in later stages
Spread to deeper tissues, including muscle and bone
Limitation of movement
Causes
Madura foot is caused by:
Eumycetoma: Fungal infections caused by various fungi like Madurella mycetomatis, *Exophiala jeanselmei*, *Trematosphaeria grisea* and others.
Actinomycetoma: Bacterial infections caused by aerobic actinomycetes like Nocardia brasiliensis, *Streptomyces somaliensis*, *Actinomadura madurae*, and *Actinomadura pelletieri*. The organisms are usually introduced through trauma, such as a thorn prick or cut, allowing them to enter the subcutaneous tissue.
Medicine Used
Treatment depends on whether the infection is eumycetoma (fungal) or actinomycetoma (bacterial).
Actinomycetoma:
Antibiotics are the primary treatment. Common antibiotics include:
Trimethoprim-sulfamethoxazole (TMP-SMX)
Dapsone
Amikacin
Streptomycin
Combination therapy is often used, and treatment duration can be prolonged (months to years).
Eumycetoma:
Antifungal medications are used, but they are often less effective than antibiotics for actinomycetoma. Common antifungals include:
Itraconazole
Voriconazole
Posaconazole
Terbinafine
Surgery: Surgical excision or amputation may be necessary, especially in advanced cases.
Is Communicable
Madura foot is not communicable from person to person or from animals to humans. It is acquired through direct inoculation of the causative organism into the skin through trauma.
Precautions
Wear protective footwear when walking in areas known to have a high prevalence of the disease (especially agricultural areas).
Avoid walking barefoot in endemic areas.
Promptly clean and disinfect any skin injuries, especially puncture wounds or cuts.
Seek medical attention if you develop any signs of infection, such as swelling or draining sinuses, after a skin injury.
How long does an outbreak last?
Madura foot is a chronic infection. Without treatment, it can persist for many years, progressively worsening and causing significant tissue damage. The "outbreak" refers to the duration of the infection in an individual, not a community outbreak. Untreated, it continues indefinitely. With treatment, duration varies greatly, often spanning months to years, and depends on the type of infection (eumycetoma or actinomycetoma), severity, and response to therapy.
How is it diagnosed?
Clinical Examination: Examination of the affected area for characteristic signs and symptoms.
Microscopy: Direct microscopic examination of granules from the draining sinuses to identify the causative organism. Gram staining, potassium hydroxide (KOH) preparation, and other stains are used.
Culture: Culture of the granules or tissue samples to identify the specific bacteria or fungi causing the infection.
Imaging: X-rays, ultrasound, MRI, or CT scans to assess the extent of the infection and involvement of deeper tissues (bone, muscle).
Histopathology: Biopsy of the affected tissue for histological examination and identification of the organism.
Molecular tests: PCR and other molecular tests can be used to identify the causative organism in some cases.
Serology: Immunodiffusion and ELISA tests can be helpful in some cases.
Timeline of Symptoms
Initial Stage: A small, painless nodule or swelling appears at the site of inoculation.
Progression: The swelling gradually increases in size. Sinus tracts begin to form and discharge pus containing granules.
Advanced Stage: The infection spreads to deeper tissues, including muscle and bone. The affected area becomes deformed and painful. Limitation of movement occurs. Secondary bacterial infections may develop. The disease can persist for many years if left untreated.
Important Considerations
Early diagnosis and treatment are crucial to prevent extensive tissue damage and disability.
Distinguishing between actinomycetoma and eumycetoma is essential, as the treatment approaches differ significantly.
Treatment can be prolonged and may require a combination of medical and surgical interventions.
Even with treatment, recurrence is possible.
Amputation may be necessary in severe or refractory cases.
Access to appropriate diagnostic and treatment facilities can be limited in endemic areas.
Research is ongoing to develop more effective treatments for Madura foot.