University:
University of Cambridge
Course:
MBBS | Bachelor of Medicine Bachelor of Surgery
Academic year:

2021
Views:

49

Pages:

4
Author:

Nicole W.

MYCETOMA Chronic, slowly progressive granulomatous infection of the skin and subcutaneous tissues • Triad: Swelling, discharging sinuses and presence of granules in the discharge • Also known as Maduramycosis or Madura foot, as it was first described in Madurai, South India, by John Gill (1842) TYPES OF MYCETOMA AND CAUSATIVE AGENTS It may caused by True fungi/eumycetes - EUMYCETOMA Higher bacteria / microaerophilic actinomycetes--- ACTINOMYCETOMA Botryomycosis - mycetoma like condition caused by some bacteria like staphylococcus aureus Common causative organism is Actinomadura madurae MYCETOMA Chronic, slowly progressive granulomatous infection of the skin and subcutaneous tissues • Triad: Swelling, discharging sinuses and presence of granules in the discharge • Also known as Maduramycosis or Madura foot, as it was first described in Madurai, South India, by John Gill (1842) TYPES OF MYCETOMA AND CAUSATIVE AGENTS It may caused by True fungi/eumycetes - EUMYCETOMA Higher bacteria / microaerophilic actinomycetes--- ACTINOMYCETOMA Botryomycosis - mycetoma like condition caused by some bacteria like staphylococcus aureus Common causative organism is Actinomadura madurae eumycetoma and actinomycetoma vary clinically: Table 58.6: Clinical manifestations of eumycetoma and actinomycetoma CiRica manifestacions Tumor Single, well-defined margins Sinuses Appear late, few in number Discharge Serous Grains Black/white Sone Osteosclerotic lesions Grains contain Fungal hyphae 2 um) As themty snoond Multiple tumor masses with ill-defined margins Appear early, numerous with raised inflamed opening Purulent White/red Osteolytic lesions Filamentous bacteria (<2 um) LABORATORY DIAGNOSIS Selection of specimen 1. Pus is collected with granules 2. Swabs from deeper parts of the infection 3. The scrapings of the deeper parts [superficial parts may be contaminated with bacteria] 4. Biopsy material 5. Dressings which contain drained pus. Specimen collection Direct examination • Specimen Collection • Grains collected on sterile gauze by pressing the sinuses from periphery or by using a loop • Direct Examination • Granules washed in sterile saline; crushed between the slides and examined • Macroscopic appearance of granules color, size, shape, texture • Stispected Eumycetoma: -KOH mount-hyphae of 2-6 µm width along with chlamydospores at margin • Süspected Actinomycetoma: - Gram staining filamentous gram positive bacilli (0.5-1 µm wide) - Modified acid fast stain - Nocardia is weekly acid fast HISTOPATHOLOGICAL STAINING OF GRANULES • Eumycetoma: granulomatous reaction with palisade arrangement of hyphae in the cement substance (A) • Actinomycetoma: granulomatous reaction with filamentous bacteria at the margin (B) Culture Best culture-granules obtained from deep biopsies Both fungal SDA and bacteriological media such lowenstein jensen media should be included TREATMENT • Surgical removal of the lesion followed by: • Antifungal agents for eumycetona (itraconazole or amphotericin B for 8-24 months) • Antibiotics for actinomycetoma such as Welsh regimen (amikacin plus cotrimoxazole)

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