Mycetoma : Clinical
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Mycetoma is a chronic infection of the skin and subcutaneous tissues with multiple draining sinuses and characterized by the presence of granules (masses of infecting organisms) in the exudate. It is seen mostly in the impoverished populations of the tropical belt extending from 15 degrees South to 30 degrees North.
It usually occurs in 20 to 50-year age group with a male predominance. Infections usually involve the extremities and the most common location is the foot. The causative agents can be bacteria (vast majority of cases) or fungi (less than 5% of cases). Lesions caused by fungi (eumycetoma) are more superficial and less inflammatory than bacterial lesions (actinomycetoma) which can be deeply invasive.
Repeated minor trauma related to occupation inoculates the causative agents into the tissues. The lesion begins as a papule which enlarges to become a tumor-like discharging nodule. Multiple non-healing sinus tracks develop through which granules composed of matted masses of the causative microorganisms are discharged. There is considerable tissue destruction caused by inflammation and erosion and the involved area becomes firm to hard by fibrosis.
Case History: The patient was a young farmer who presented with a slowly enlarging swelling on the plantar aspect of his foot of 1-yr duration. He gave history of multiple small wounds with discharge from the openings. Examination showed an 8 x 6 cm raised firm nodule on the plantar aspect of his foot. Multiple sinus tracts were present with dark-colored discharge. Tissue biopsy showed thin beaded filamentous and branching bacteria that were identified as Actinomyces israelii on morphologic and biochemical characteristics. A culture of the biopsy was found to be sensitive to penicillin.
Case courtesy of Dr. Sanjay D. Deshmukh, Professor of Pathology, Dr. Vithalrao Vikhe Patil Foundation Medical College & Hospitals, Ahmednagar, India.
It usually occurs in 20 to 50-year age group with a male predominance. Infections usually involve the extremities and the most common location is the foot. The causative agents can be bacteria (vast majority of cases) or fungi (less than 5% of cases). Lesions caused by fungi (eumycetoma) are more superficial and less inflammatory than bacterial lesions (actinomycetoma) which can be deeply invasive.
Repeated minor trauma related to occupation inoculates the causative agents into the tissues. The lesion begins as a papule which enlarges to become a tumor-like discharging nodule. Multiple non-healing sinus tracks develop through which granules composed of matted masses of the causative microorganisms are discharged. There is considerable tissue destruction caused by inflammation and erosion and the involved area becomes firm to hard by fibrosis.
Case History: The patient was a young farmer who presented with a slowly enlarging swelling on the plantar aspect of his foot of 1-yr duration. He gave history of multiple small wounds with discharge from the openings. Examination showed an 8 x 6 cm raised firm nodule on the plantar aspect of his foot. Multiple sinus tracts were present with dark-colored discharge. Tissue biopsy showed thin beaded filamentous and branching bacteria that were identified as Actinomyces israelii on morphologic and biochemical characteristics. A culture of the biopsy was found to be sensitive to penicillin.
Case courtesy of Dr. Sanjay D. Deshmukh, Professor of Pathology, Dr. Vithalrao Vikhe Patil Foundation Medical College & Hospitals, Ahmednagar, India.