2. • It is a chronic granulomatous condition of foot causibg multiple
discharging sinus
• 3 distinct features are
Soft tissue swelling
Multiple discharging sinus
Macroscopic grains
3. • First identified in Madurai,tamil nadu by Gill in 1842
• Then carter in 1860 established its fungal (Mycotic) origin,
• Hence the name madura mycetoma was established.
4. Causative organisms
• Nocardia madurae
• Nocardia Brasiliensis
• Nocardia asteroids
• Actinomyces israelii
• MCC of madura foot / mycetoma in world– Actinomycetoma
• MCC of mycetoma in India Actinomycetoma (actinomadura
madurae)
• MCC of Eumycetoma in India Madurella mycetomatis
7. Clinical features
• Painless diffuse swelling in foot for long duration
• mutiple discharging sinuses develop on skin
• Secondary bacterial infections are common and cause worsening of
the condition
• Later discharging granules are
black – infection is mainly subcutaneous
Red and yellow types – infection burrows into deeper planes including
bones i.e. osteomyelitis
8. diagnosis
• Lab studies
-discharge study wil show branching filamentous appearance of
organism
--culture in sabouroud’s agar medim
--gram stain for actinomycosis will show sun ray appearance with gram
positive centre and gram negative clubs.
---Immunodiffusion tests eumycotic mycetoma infections.
9. • -- X ray of the foot to look for osteomyelitis.
• Cortical thinning is due to compression from the outside by the
mycetoma.
• Multiple lytic lesions or cavities may be large and few in
number with well-defined margins.
• MRI FOR better assessment of the degree of bone and soft
tissue involvement
10. Treatment
• Medical
• Actinomycetomas usually respond better to medical treatment
than eumycetomas
• Therapy is suggested for 1-2 years (or greater) for complete
eradication
• The current treatment of actinomycetoma is trimethoprim-
sulfamethoxazole 7.5-40mg/kg daily in 3 oral doses for several
months or years.
11. Eumycetoma
• Ketoconazole 400mg daily
• Itraconazole 300mg daily
• Amphotericin B 50 mg daily
• Terbinafin • External beam radiotherapy in doses ranging from
3.5-14 Gy has been considered successful treatment in a few
selected cases
12. • Surgical
• Excision of the affected tissues
• Localized mycetoma lesions that can be excised completely
without residual disability.
• Disease process more extensive than suggested by superficial
lesion- so apparently healthy tissue removed to avoid
recurrence
• Surgical reduction of large lesions can improve the patient’s
response to medical treatment.
• In severe cases amputation is required.
