Mycetoma

Mycetoma is a focal, chronic, slowly progressive, often painless, destructive disease that begins in the subcutaneous tissue and spreads to other parts of the body.

What are the causes?

The term actinomycetoma is derived from the disease-causing microorganism actinomycetomas – bacteria that form a branching mycelium. When the causative agents are fungi, this pathological process is called eumycetoma.

The pathogens causing the fungal form of the disease are Pseudoallescheria boydii, Madurella mycetomatis, Madurella griea, etc. The causative agents of actinomycetoma are the following aerobic actinomycetomas – Actinomadura madurae, Actinomadura pelletierii, Streptomyces somaliensis, etc.

Microorganisms causing mycetoma differ in their geographical distribution, in color, possible differences in the clinical manifestations of the pathological processes caused by them.

Risk factors – injury to the lower limbs when walking barefoot or in shoes that do not protect the skin.

What are the symptoms?

Mycetoma is most common in men between the ages of 20 and 40. However, it should be noted that in endemic regions the disease also occurs in children and the elderly.

The ratio of affected males to females is 5 to 1, and according to other data 3.7 to 1. It is most often found in farmers and other workers in the agricultural region, who often injure their skin with thorns and debris.< /p>

The most common site of infection is the feet, and usually their rear part /79%/. For unknown reasons, the left leg is most often affected. Painless mass-like tumors form on the feet.

Complaints are usually rare, and body temperature may rise in cases where a secondary bacterial infection occurs.

Cases have been described of infection not only of the feet, but also of other parts of the legs, the torso, all parts of the arms, the head, the neck and the buttocks. When the scalp is involved in the infection, it usually starts in the neck or neck area.

Early manifestations are small painless papules and nodules on the bottom or back of the foot that progress in size. The process develops faster in actinomycetomas than in eumycetomas. Skin manifestations are in the form of swellings, abscesses and fistula formation.

When the pathological process spreads, similar foci of infection are formed in the surrounding parts. Initially, the lesions on the skin heal, but new ones appear in other places.

In this way, old long-standing mycetomas are characterized by numerous healed scars and fistulas.

After a very long time, months and even years, the pathology causes degenerative changes in deep tissues such as bones, which manifests itself as a generalized edema, which, however, in most cases remains painless except for 15% of those infected, who because of pain syndrome seek medical help.

The disease progresses as focal tissue formations with the formation of tumors, purulent areas and scars. The infection never spreads hematogenously, however, dissemination through the lymphatics is possible – to the regional lymph nodes with subsequent suppuration.

Treatment of mycetoma

A public awareness program is needed to seek medical attention as early as possible. Surgical treatment, which is still preferred by some doctors, usually leads to immediate relapse, but nevertheless there is also a significant risk to the patient’s life.

Mycetoma in all stages can be treated only with conservative therapy or in combination with local surgical intervention.

The success of therapy depends not only on the difference between actinomycetomas and eumycetomas, but also on the species of the causative agent.