II. Definitions
- Mycetoma (Maduramycosis)
- Actinomycetoma
- Chronic subcutaneous, Granulomatous lesions due to Actinomycetes, non-acid fast Bacteria
- Actinomycetes include soil-based Bacteria, Actinomadura, Nocardia, Streptomyces
- Growth is more aggressive than Eumycetoma
- Eumycetoma
- Chronic subcutaneous, Granulomatous lesions due to fungal infection
III. Epidemiology
- Actinomycetoma
- Most cases found in Mexico and Venezuela (sporadic cases in United States and Europe)
- Eumycetoma
- Most cases found in Sudan, Senegal, Nigeria, Somalia, Mauritania, and India
IV. Findings
- Subcutaneous Lesions
- Nodules
- Skin Abscesses
- Skin fistulae
- Localized swelling
- Distribution
- Typically on legs
- May involve hands
V. Labs: Histology
- Mycetoma
- Suppurative Granulomas
- Neutrophil infiltrates
- Palisaded histiocytes
- Actinomycetoma
- Thin filaments (0.5 to 1 um) on Gram Stain or methenamine silver stain
- Eumycetoma
- Thick fungal hyphae
VI. Differential Diagnosis
- See Subcutaneous Nodule (e.g. Rheumatoid Nodule)
- Nodular Lymphangitis
- Cellulitis with ascending lymphangitis
VII. Management
- Surgical debulking may be attempted but high recurrence rate
- Actinomycetoma
- Dapsone
- Streptomycin
- Trimethoprim-Sulfamethoxazole
- Amikacin
- Rifampin
- Amoxicillin-clavulanic acid
- Eumycetoma
- Systemic Antifungals specific to organism
VIII. Complications
- Local disfiguring lesions
- Osteomyelitis or ankylosis (if untreated)
- Systemic spread to Pelvis, lungs, spinal cord (rare, high mortality)