Eumycetoma
Eumycetoma, also known as Madura foot, is a persistent fungal infection of the skin and the tissues just under the skin, affecting most commonly the feet, although it can occur in hands and other body parts. It starts as a painless wet nodule, which may be present for years before ulceration, swelling, grainy discharge and weeping from sinuses and fistulae, followed by bone deformity.
| Eumycetoma | |
|---|---|
| Other names | Madura foot |
| An infected foot | |
| Specialty | Infectious disease |
| Symptoms | Swelling, weeping pus filled sinuses, deformity. |
| Complications | Amputation |
| Causes | Madurella spp., Falciformispora senegalensis, Curvularia lunata, Pseudallescheria spp., Neotestudina spp., Acremonium spp., Scedosporium spp. and Fusarium spp. |
| Diagnostic method | Microscopy, biopsy, culture, medical imaging, ELISA, immunodiffusion, DNA sequencing |
| Differential diagnosis | Actinomycosis (Actinomycetoma) |
| Treatment | Surgical debridement, antifungal medicines |
| Medication | Itraconazole, posaconazole, voriconazole |
| Prognosis | Recurrence is common |
| Frequency | Endemic in Africa, India and South America |
Several fungi can cause eumycetoma, including: Madurella mycetomatis, Madurella grisea, Curvularia lunata, Scedosporium species, Acremonium and Fusarium species. Diagnosis is by biopsy, visualising the fungi under the microscope and culture. Medical imaging may reveal extent of bone involvement. Other tests include ELISA, immunodiffusion, and DNA Barcoding.
Treatment includes surgical removal of affected tissue and antifungal medicines. After treatment, recurrence is common. Sometimes amputation is required.
The infection occurs generally in the tropics, and is endemic in Sub-Saharan Africa, especially Sudan, India, parts of South America and Mexico. Few cases have been reported across North Africa. Mycetoma is probably low-endemic to Egypt with predilection for eumycetoma. In 2016, the World Health Organization recognised eumycetoma as a neglected tropical disease.