A chronic case of Madurella mycetoma involving left foot
Keywords:Diabetes, Eumycetoma, Sinuses, Surgery
Mycetoma is a localized chronic, suppurative, and deforming granulomatous disorder of subcutaneous tissue, skin and bones. Mycetoma is endemic in tropical and subtropical areas, where it is a real public health issue. It is a rare and neglected disease in our country. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is completely different, a definite diagnosis after microbiological and histopathological examination, though difficult, is important. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Authors report a case of eumycetoma in a 38 year-old male from Bihar, with history of thorn prick 30 yrs back. Madurella mycetomatis was isolated from the granular discharge from sinuses and itraconazole was given followed by surgical debridement of the lesion. The patient recovered well and is still on follow up.
Zijlstra EE, Van De Sande WW, Welsh O, Goodfellow M, Fahal AH. Mycetoma: a unique neglected tropical disease. Lancet Infect Dis. 2016 Jan 1;16(1):100-12.
Bonifaz A, Tirado-Sánchez A, Calderón L, Saúl A, Araiza J, Hernández M, et al. Mycetoma: experience of 482 cases in a single center in Mexico. PLoS Neglected Trop Dis. 2014 Aug 21;8(8):e3102.
van de Sande WW. Global burden of human mycetoma: a systematic review and meta-analysis. PLoS Neglected Trop Dis. 2013 Nov 7;7(11):e2550.
Nenoff P, Van de Sande WW, Fahal AH, Reinel D, Schöfer H. Eumycetoma and actinomycetoma-an update on causative agents, epidemiology, pathogenesis, diagnostics and therapy. J European Acad Dermatol Venereol. 2015 Oct;29(10):1873-83.
van de Sande WW, Fahal AH, Goodfellow M, Welsh O, Zijlstra EE. Merits and pitfalls of currently used diagnostic tools in mycetoma. PLoS Neglected Trop Dis. 2014 Jul 3;8(7):e2918.
Venkatswami S, Sankarasubramanian A, Subramanyam S. The madura foot: looking deep. Internat J Lower Extrem Wounds. 2012 Mar;11(1):31-42.
Welsh O, Al-Abdely HM, Salinas-Carmona MC, Fahal AH. Mycetoma medical therapy. PLoS Neglec Tropi Dis. 2014 Oct 16;8(10):e3218.
Maiti PK, Ray A, Bandyopadhyay S. Epidemiological aspects of mycetoma from a retrospective study of 264 cases in West Bengal. Tropi Med Internat Health. 2002 Sep;7(9):788-92.
Chander J. Mycetoma. In: Textbook of Medical Mycology, 4th Ed. New Delhi: Jaypee Publishers; 2018: 203-228
Ahmed AO, van Leeuwen W, Fahal A, van de Sande W, Verbrugh H, van Belkum A. Mycetoma caused by Madurella mycetomatis: a neglected infectious burden. Lancet Infect Dis. 2004 Sep 1;4(9):566-74.
Welsh, O, Vera-Cabrera, L, Salinas-Carmora, MC. Mycetoma. Clin Dermatol. 2007;25(2):195-202.
Elmaataoui A, Elmoustachi A, Aoufi S, Lyagoubi M. Eumycetoma due to Madurella mycetomatis from two cases of black grain mycetoma in Morocco. J Mycol Méd. 2011 Dec 1;21(4):281-4.
Gumaa SA. Ketoconazole in the treatment of eumycetoma due to Madurella mycetomii. Transactions Royal Society Trop Med Hygiene. 1984 Jan 1;78(3):376-9.
Estrada R, Chávez-López G, Estrada-Chávez G, López-Martínez R, Welsh O. Eumycetoma. Clin Dermatol. 2012 Jul-Aug;30(4):389-96.
Fahal AH, Rahman IA, El-Hassan AM, Rahman MA, Zijlstra EE. The safety and efficacy of itraconazole for the treatment of patients with eumycetoma due to Madurella mycetomatis. Transactions Royal Society Trop Med Hygiene. 2011 Mar 1;105(3):127-32.
Smith EL, Kutbi S. Improvement of eumycetoma with itraconazole. J Am Acad Dermatol. 1997 Feb;36(2 Pt 1):279-80.