Eumycetoma

Synonym(s)

Madura foot; maduromycosis; fungal myce-toma; eumycotic mycetoma; melanoid myc-etoma; ochroid mycetoma

Definition

Chronic cutaneous and subcutaneous infection caused by various genera of fungi and characterized by progressive destruction of soft tissue

Pathogen,esis

Infectious agents primarily saprophytic microorganisms found in the soil and on plant matter; inoculation occurrs as a result of traumatic implantation of thorns, splinters, and other plant matter; Pseudallesche-ria boydii most common etiologic agent of eumycetoma in the United States; Madurella mycetomatis most common causative organism worldwide

Clinical manifestation

Disease presents as a painless swelling or thickening of the skin and subcutaneous tissue, usually over the distal lower extremity; with progression over months or years; lesion enlarges and eventually becomes tumorous; overlying skin sometimes smooth, dyspigmented, or shiny; abscesses and sinus tracts develops and sometimes contains a serosanguinous or seropurulent discharge, with white-to-yellow or black granules; predisposing factors: walking barefoot, agricultural work; poor personal hygiene; poor nutrition, and wounds or skin infections

Differential diagnosis

Tuberculosis; leprosy; leishmaniasis; squa-mous cell carcinoma; yaws; syphilis; actino-mycetoma; botryomycosis; chromoblasto-mycosis; sporotrichosis; blastomycosis; coc-cidioidomycosis; elephantiasis

Therapy

Ketoconazole; itraconazole; surgical excision

References

Restrepo A (1994) Treatment of tropical mycoses. Journal of the American Academy of Dermatology 31(3 Pt 2):S91-102

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