II. Definitions

  1. Mycetoma (Maduramycosis)
    1. Chronic progressive subcutaneous, Granulomatous infection
    2. Caused by non-acid fast Bacteria (Actinomycetoma) and fungi (Eumycetoma)
  2. Actinomycetoma
    1. Chronic subcutaneous, Granulomatous lesions due to Actinomycetes, non-acid fast Bacteria
    2. Actinomycetes include soil-based Bacteria, Actinomadura, Nocardia, Streptomyces
    3. Growth is more aggressive than Eumycetoma
  3. Eumycetoma
    1. Chronic subcutaneous, Granulomatous lesions due to fungal infection

III. Epidemiology

  1. Actinomycetoma
    1. Most cases found in Mexico and Venezuela (sporadic cases in United States and Europe)
  2. Eumycetoma
    1. Most cases found in Sudan, Senegal, Nigeria, Somalia, Mauritania, and India

IV. Findings

  1. Subcutaneous Lesions
    1. Nodules
    2. Skin Abscesses
    3. Skin fistulae
    4. Localized swelling
  2. Distribution
    1. Typically on legs
    2. May involve hands

V. Labs: Histology

  1. Mycetoma
    1. Suppurative Granulomas
    2. Neutrophil infiltrates
    3. Palisaded histiocytes
  2. Actinomycetoma
    1. Thin filaments (0.5 to 1 um) on Gram Stain or methenamine silver stain
  3. Eumycetoma
    1. Thick fungal hyphae

VI. Differential Diagnosis

  1. See Subcutaneous Nodule (e.g. Rheumatoid Nodule)
  2. Nodular Lymphangitis
  3. Cellulitis with ascending lymphangitis

VII. Management

  1. Surgical debulking may be attempted but high recurrence rate
  2. Actinomycetoma
    1. Dapsone
    2. Streptomycin
    3. Trimethoprim-Sulfamethoxazole
    4. Amikacin
    5. Rifampin
    6. Amoxicillin-clavulanic acid
  3. Eumycetoma
    1. Systemic Antifungals specific to organism

VIII. Complications

  1. Local disfiguring lesions
  2. Osteomyelitis or ankylosis (if untreated)
  3. Systemic spread to Pelvis, lungs, spinal cord (rare, high mortality)

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Related Studies

Ontology: Mycetoma (C0024449)

Definition (MSH) A chronic progressive subcutaneous infection caused by species of fungi (eumycetoma), or actinomycetes (actinomycetoma). It is characterized by tumefaction, abscesses, and tumor-like granules representing microcolonies of pathogens, such as MADURELLA fungi and bacteria ACTINOMYCETES, with different grain colors.
Definition (NCI) A chronic granulomatous inflammation involving the deep dermis and the subcutaneous tissues. It is caused by fungi and actinomycetes.
Concepts Disease or Syndrome (T047)
MSH D008271
ICD10 B47 , B47.9
SnomedCT 187497002, 410039003
English Mycetomas, Mycetoma, unspecified, [X]Mycetoma, unspecified, mycetoma (diagnosis), mycetoma, Mycetoma, Mycetoma NOS, Mycetoma [Disease/Finding], madura foot, fungal mycetoma, maduramycosis, mycetomas, maduromycosis, [X]Mycetoma, unspecified (disorder), Mycetoma (disorder), Mycetomata
Dutch mycetoom NAO, Mycetoom, niet gespecificeerd, Mycetoom
French Mycétome SAI, Mycétome
German Myzetom NNB, Myzetom, nicht naeher bezeichnet, Myzetom, Mycetom
Italian Micetoma non specificato, Micetoma
Portuguese Micetoma NE, Micetoma
Spanish Micetoma NEOM, Micetoma, [X]micetoma, no especificado (trastorno), [X]micetoma, no especificado, micetoma, micetoma (trastorno)
Japanese 足菌腫NOS, アシキンシュNOS, ソクキンシュNOS, 菌腫, マズラミコーシス, マズラ菌症, マズラ足, 真菌性マズラ菌症, 足菌腫, 足菌腫症, マズラ足(マズラアシ)
Swedish Madurafot
Finnish Maduromykoosi
Czech Mycetom NOS, mycetom
Korean 상세불명의 균종, 균종
Croatian MICETOM
Polish Stopa madurska, Mycetoma, Aktynomycetoma, Maduromikoza, Grzybica madurska, Stopa madurska grzybicza
Hungarian Mycetoma k.m.n.
Norwegian Mycetom

Ontology: Actinomycetoma (C1261283)

Definition (NCI) A chronic granulomatous inflammation involving the deep dermis and the subcutaneous tissues. It is caused by Actinomycetes bacteria.
Concepts Disease or Syndrome (T047)
MSH D008271
ICD10 B47.1
SnomedCT 186397005, 37431000, 82684004, 187089001
Dutch actinomycetomen, actinomycose; mycetoom, actinomycotisch; mycetoom, infectie; mycetoom, actinomycotisch, mycetoom; actinomycose, mycetoom; actinomycotisch, mycetoom; infectie, actinomycotisch, mycetoom; voet, actinomycotisch, voet; mycetoom, actinomycotisch, Actinomycetoom
German Aktinomycetome, Aktinomyzetom, Aktinomyzetoma
Italian Actinomicetomi, Actinomicetoma
Portuguese Actinomicetomas
Spanish Actinomicetomas, micetoma actinomicótico del pie, esquizomicetoma actinomicótico, micetoma actinomicótico, pie de Madura por Actinomadura, pie de Madura actinomicótico (trastorno), pie de Madura actinomicótico, pie de Madura por Actinomadura (trastorno), maduromicosis actinomicótica, actinomicetoma (trastorno), actinomicetoma, maduromicosis - actinomicótico (trastorno), maduromicosis - actinomicótico, pie de Madura por Actinomadura (concepto no activo)
Japanese 放線菌腫, ホウセンキンシュ
English Madura foot - actinomycotic, Actinomycetoma, Actinomycetomas, actinomycetoma (diagnosis), Madura foot due to Actinomadura (disorder), Actinomycotic madura foot (disorder), Actinomycotic schizomycetoma, Actinomycotic maduromycosis, Madura foot due to Actinomadura, Actinomycotic mycetoma, Actinomycotic mycetema, Actinomycotic mycetoma (disorder), Madura foot - actinomycotic (disorder), actinomycetoma, foot; mycetoma, actinomycotic, infection; mycetoma, actinomycotic, actinomycosis; mycetoma, actinomycotic; mycetoma, mycetoma; actinomycosis, mycetoma; actinomycotic, mycetoma; foot, actinomycotic, mycetoma; infection, actinomycotic, Madura foot due to Actinomadura, NOS, Actinomycotic madura foot, Actinomycotic mycetoma of foot
Czech Actinomycetomy, aktinomycetom
French Actinomycétome
Korean 방선균종
Hungarian actinomycetomák
Norwegian Aktinomycetom

Ontology: Eumycetoma (C2350621)

Concepts Disease or Syndrome (T047)
MSH D008271
ICD9 117.4
ICD10 B47.0
SnomedCT 29761005, 187088009, 410038006
English Madura foot - mycotic, eumycotic mycetoma (diagnosis), eumycotic mycetoma, Eumycetomas, Mycetoma mycotic, Eumycetoma, Madura foot, mycotic, Maduromycosis, Mycotic mycetoma (disorder), eumycetoma, eumycotic; mycetoma, infection; mycetoma, mycotic, mycetoma; eumycotic, mycetoma; infection, mycotic, mycetoma; mycotic, mycotic; mycetoma, Mycotic mycetoma, Eumycotic mycetoma, Fungal mycetoma, Eumycotic mycetoma (disorder), Mycotic mycetomas
Italian Micetoma micotico, Micetomi micotici, Eumicetoma
Dutch mycotische mycetomen, eumycotisch; mycetoom, infectie; mycetoom, mycotisch, mycetoom; eumycotisch, mycetoom; infectie, mycotisch, mycetoom; mycotisch, mycotisch; mycetoom, Eumycetoom, mycetoom mycotisch
French Mycétomes mycosiques, Eumycétome, Mycétome mycotique
German mykotische Myzetome, Eumyzetom, Eumyzetoma, Eumycetom, mykotisches Myzetom
Portuguese Micetomas micóticos, Micetoma micótico
Spanish Micetomas micóticos, micetoma micótico, eumicetoma, micetoma micótico (trastorno), Micetoma micótico, micetoma eumicótico, micetoma eumicótico (trastorno)
Japanese 真菌性足菌腫, シンキンセイソクキンシュ
Czech Mykotický mycetom, Mykotické mycetomy, eumycetom
Korean 진균종
Hungarian Mycoticus mycetomák, mycotikus mycetoma
Norwegian Eumycetom