Summary about Disease
Mycetoma is a chronic, progressive, destructive inflammatory disease usually of the foot, but any part of the body can be affected. It is characterized by a triad of painless subcutaneous mass, multiple draining sinuses, and grains containing the causative agent. Mycetoma is caused by true fungi (eumycetoma) or aerobic actinomycetes (actinomycetoma). It's primarily found in tropical and subtropical regions, often affecting rural workers. The disease can lead to significant disability and disfigurement if left untreated.
Symptoms
Painless subcutaneous swelling or mass, usually on the foot
Multiple draining sinuses (small holes) that discharge pus and grains
The grains are small granules of the causative organism (fungus or bacteria), which can be different colors depending on the specific organism.
Possible bone involvement and destruction in advanced cases
Deformity of the affected area
Limited range of motion.
Causes
Mycetoma is caused by a variety of fungi (eumycetoma) or bacteria, specifically aerobic actinomycetes (actinomycetoma). The causative organisms are usually found in soil and enter the body through minor trauma, such as a thorn prick or cut.
Eumycetoma (fungal mycetoma): Caused by various fungi, including Madurella mycetomatis, *Trematosphaeria grisea*, *Exophiala jeanselmei*, *Scedosporium apiospermum*.
Actinomycetoma (bacterial mycetoma): Caused by aerobic actinomycetes, including Nocardia brasiliensis, *Actinomadura madurae*, *Streptomyces somaliensis*.
Medicine Used
4. Medicine used Treatment depends on whether the mycetoma is caused by bacteria (actinomycetoma) or fungi (eumycetoma).
Actinomycetoma: Primarily treated with antibiotics for a prolonged period (several months). Common antibiotics include:
Trimethoprim-sulfamethoxazole (TMP-SMX)
Dapsone
Amikacin (often used in combination with other antibiotics)
Streptomycin
Eumycetoma: More difficult to treat.
Antifungal medications, such as itraconazole, voriconazole, or posaconazole. Treatment duration is typically very long (1-2 years or more).
Surgery: Often required in combination with antifungals. Excision of the affected tissue may be necessary.
Amputation: In severe cases, amputation may be necessary to prevent further spread and improve quality of life.
Is Communicable
Mycetoma is not communicable from person to person or from animals to humans. It is acquired through direct inoculation of the causative organisms (fungi or bacteria) into the skin, usually via trauma.
Precautions
Wear protective footwear, especially in agricultural areas and areas known to be endemic for mycetoma.
Avoid walking barefoot in high-risk areas.
Promptly clean and disinfect any wounds or cuts, especially those acquired outdoors.
Seek medical attention for any persistent or unusual skin lesions, particularly those with swelling, draining sinuses, or grains.
Improve hygiene and sanitation.
Wear gloves when handling soil or working in the garden.
How long does an outbreak last?
Mycetoma is not an "outbreak" in the typical sense of a contagious disease. It is a chronic, progressive infection. Without treatment, the infection will continue to worsen indefinitely, leading to extensive tissue damage and disability. With treatment, it can take months or years to resolve the infection.
How is it diagnosed?
Diagnosis involves a combination of clinical evaluation, imaging, and laboratory tests:
Clinical Examination: Examination of the affected area for characteristic signs (swelling, draining sinuses, grains).
Microscopy and Culture: Grains from the draining sinuses are examined under a microscope to identify the causative organism. Culture is performed to confirm the diagnosis and identify the specific species of fungus or bacteria.
Histopathology: Biopsy of the affected tissue to examine under a microscope.
Imaging: X-rays, ultrasound, MRI, or CT scans to assess the extent of the infection, including bone involvement.
Molecular Tests: PCR (Polymerase Chain Reaction) for organism identification.
Serology: Tests for antibodies against specific mycetoma-causing organisms
Timeline of Symptoms
9. Timeline of symptoms The timeline of symptoms can vary, but generally follows this pattern:
Initial Infection: A small, painless bump or swelling appears at the site of inoculation. This may be easily overlooked.
Early Stage: Over weeks to months, the swelling gradually increases. Draining sinuses may begin to develop, discharging pus and grains.
Progressive Stage: Over months to years, the infection spreads deeper into the tissues, potentially involving muscle and bone. The number of draining sinuses increases, and the affected area becomes increasingly deformed. Pain may become more prominent.
Late Stage: Extensive tissue destruction, deformity, and disability. Secondary bacterial infections are common. Amputation may be considered.
Important Considerations
Early diagnosis and treatment are crucial to prevent significant morbidity.
Distinguishing between actinomycetoma and eumycetoma is critical, as the treatment approaches differ significantly.
Treatment is often prolonged and may require a combination of medical and surgical interventions.
Recurrence is possible, even after successful treatment.
Patient compliance with long-term treatment is essential.
Socioeconomic factors can play a role in the development and management of mycetoma, as it often affects people in rural, impoverished areas with limited access to healthcare.
Public health initiatives are needed to raise awareness, promote prevention, and improve access to treatment.