Summary
Mycetomas are subcutaneous inflammatory pseudotumors containing fungal or actinomycetic (bacteria with branched filaments) granules or grains. Annual incidence is unknown. The agents causing mycetoma are very common saprophytes that are found in the soil and on thorny shrubs in semi-desert climates. Humans are infected as the result of localized skin trauma (implantation of a needle or wood splinter) or through a pre-existing wound. The condition is endemic in the northern tropical zone and was first described by McGill in the area of Madura (hence the term 'Madura foot') during the last century. The typical characteristic of fungal mycetomas is a painless tumefaction slowly forming on the foot with fistulae that release grains. Actinomycetic mycetomas are more frequent in Latin America and are more likely to cause inflammatory and painful tumefactions with many fistulae and grains. In both cases, the underlying bone is often affected. Diagnosis is made by microscopic examination of the grains and by analysis of cultures. Differential diagnoses include tumefactions of other origins. Medical treatment with sulfones can cure actinomycetic mycetomas, whereas surgery is the main treatment for fungal mycetomas. Prophylaxis consists of disinfecting wounds and wearing shoes. The prognosis is poor for fungal mycetomas. *Author: Dr A. Datry (October 2008)*.
