Mycetoma / Madura foot / maduromycosis

  • Epidemiologia
    • Dry tropics
    • Streptomyces somaliensis from semi-desert areas
    • Found in plant material eg. wood or thorns and soil (Nocardia spp)
  • Apresentação clínica
    • Months or years
    • First lesion: nodule
    • Draining sinuses containing grains
    • Local edema
    • Aspeto verrucoso
    • It can erode bones. Bones of the foot. The scalp.
  • 3 subtipos
    • Implications: bacteria are more easy to treat, fungus are more difficult
    • Actinomycotic (filamentous organisms or bacteria)
      • Color of grain
        • White/yellow: actinomadura madurae, streptomyces, streptomyces somaliensis
        • Red
        • Microscopic
    • Eumycotic (true fungi)
      • Color of grain
        • Dark brown: madurella mycetomatis, m fahalii, trematosphaeria frisea, nigrograna mackinnonii, plenodomus senegalensis, medicopsis romeroi. Dark is from melanin in fungus
        • White/yellow - scedosporium apiospermum, acremonium or fusarium spp, aspergillus nidulans
    • Botryomycosis (true bacteria)
  • Direct inoculation from soil
  • Foot > hand > trunk > scalp
  • Diagnosis
    • Open sinus with sterile needle. Place grains on glass slide. Wash. Histology and culture
    • Deep surgical biopsy. Not punch. The infection is in the deep dermis.
    • Ultrasound guided fine needle aspiration
  • Tratamento
    • Actinomycetomas
      • Cotrimoxazole pls rifampicin (or dapsone plus spretomycin)
      • Alternatives: fusidic acid, clarythromucin, amikacin, imipenem, moxifloxacin
    • Eumycetomas
      • Antifungals eg. itraconazol, voriconazole, fosracuvonazole + surgery
      • Radical surgery