Mycetoma

simple ppt

1. MYCETOMA

2. DEFINITION Mycetoma is a chronic subcutaneous infection caused by  actinomycetes  or fungi. This infection results in a granulomatous inflammatory response in the deep dermis and subcutaneous tissue, which can extend to the underlying bone

3. HISTORY Mycetoma was described in the modern literature in 1694 but was first reported in the mid-19th century in the Indian town of Madura, and hence was initially called Madura foot.

4. INCIDENCE Mycetoma commonly affects young adults, particularly males aged between 20 and 40 years, mostly in developing countries.

5. TYPES Mycetoma caused by microaerophilic actinomycetes is termed as actinomycetoma , Mycetoma caused by true fungi is called eumycetoma .

6. CAUSATIVE AGENTS Actinomycetoma may be due to  Actinomadura madurae ,  Actinomadura pelletieri , Streptomyces somaliensis ,  Nocardia  spp. Eumycetoma is often due to  Pseudallescheria boydii  ( Scedosporium apiospermum ), Madurella mycetomatis .

7. SITES The feet are the most common site for infection Other sites include the Lower legs, Hands, Head, Neck, Chest, Shoulder Arms.

8. RISK FACTORS Mycetoma typically presents in agricultural workers (hands, shoulders and back - from carrying contaminated vegetation and other burdens), or in individuals who walk barefoot in dry, dusty conditions. Minor trauma allows pathogens from the soil to enter the skin.

9. TRANSMISSION Transmission occurs when the causative organism enters the body through minor trauma or a penetrating injury, commonly thorn pricks. There is a clear relationship between mycetoma and individuals who walk barefooted and are manual workers.

10. Signs/Symptoms Mycetoma  is characterized by a triad of Painless ‎subcutaneous mass, Multiple sinuses Discharge ‎containing grains. It usually ‎spreads to involve the skin, deep structures and bone resulting in ‎destruction, ‎deformity and loss of function, which may be fatal. ‎ Mycetoma commonly ‎involves the extremities, back and gluteal region.‎ Secondary bacterial infection is common, and lesions may cause increased pain and disability and fatal septicaemia (severe infections involving the entire human system) if untreated.

11. DIAGNOSTIC EVALUATIONS The causative organisms can be detected by examining surgical tissue biopsy as well the lesion sinuses discharge. Grains microscopy is helpful in detecting the characteristic grains, it is important to culture them to identify the causative organism properly. DNA sequencing and many imaging techniques

12. DIFFERENTIAL DIAGNOSIS Chronic bacterial osteomyelitis ,  Tuberculosis, Buruli ulcer. Other deep fungal infections such as blastomycosis or coccidiomycosis . Leishmaniasis , yaws and syphilis should be considered.

13. TREATMENT Actinomycetoma . Surgical debridement, followed by prolonged appropriate antibiotic therapy for several months is required for actinomycetoma . Combination therapy with trimethoprim-sulfamethoxazole ,  dapsone  and streptomycin has been used.  Rifampin  has been used in resistant cases.

14. Eumycetoma Eumycetomas are only partially responsive to antifungal therapy but can be treated by surgery, due to their normally well circumscribed nature. Surgery in combination with azole treatment is the recommended regime for small eumycetoma lesions in the extremities.  Madurella mycetomatis  may respond to  ketoconazole ,  P. boydii  ( S. apiospermum ) may respond to  itraconazole . Other agents of eumycetoma may respond intermittently to itraconazole  or  amphotericin  B.

15. PREVENTION People living in or travelling to endemic areas should be advised not to walk barefooted.