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mycetoma (fungus ball, Madera foot)
A chronic infectious lesion involving skin, subcutaneous tissue, & bone
Etiology:
1) actinomycetoma
a) Actinomyces
b) Streptomyces
c) Actinomadurae
d) Nocardia
2) eumycetoma (true fungi)
a) Madurella
b) Exophialla
c) Pseudallescheria
d) Curvularia
e) Neotestudina
f) Pyrencaeta
g) Aspergillus
h) Leptosphaeria
i) Plemodomus
j) Polycytella
k) Fusarium
l) Phialophora
m) Corynespora
n) Cylindrocarpon
o) Pseudochaetosphaeronema
p) Bipolaris
q) Acremonium
Pathology:
1) localized lesions
2) multiple draining sinus tracts
3) exudate contains granules or varying color
4) inflammatory infiltrate surrounding granules with peripheral "clubs" [2]
Clinical manifestations:
- chronic condition [2]
- soft-tissue swelling
- multiple painless, sometimes ulcerated, skin nodules
- ipsilateral popliteal & inguinal lymphadenopathy (Madera foot)
Laboratory:
- punch biopsy with microscopic examination [2]
- fungus culture may not grow any organisms
Management:
- amikacin for 10 days, plus trimethoprim-sulfamethoxazole
- trimethoprim-sulfamethoxazole (Bactrim DS) BID until resolution
- years of therapy may be required [2]
Specific
Madura foot; mycetoma pedis
General
abnormal morphologic structure (malformation)
mycosis; fungal infection
References
- Pathology, 2nd ed. Rubin & Farber (eds), JB Lippincott,
Philadelphia, 1994, pg 385
- Viguier M, Lafaurie M
Actinomycetoma
N Engl J Med 2015; 372:264. January 15, 2015
PMID: 25587950
http://www.nejm.org/doi/full/10.1056/NEJMicm1316013