mycetoma (fungus ball, Madera foot)
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Introduction
A chronic infectious lesion involving skin, subcutaneous tissue, & bone
Etiology
- actinomycetoma
- Actinomyces
- Streptomyces
- Actinomadurae
- Nocardia
- eumycetoma (true fungi)
- Madurella
- Exophialla
- Pseudallescheria
- Curvularia
- Neotestudina
- Pyrencaeta
- Aspergillus
- Leptosphaeria
- Plemodomus
- Polycytella
- Fusarium
- Phialophora
- Corynespora
- Cylindrocarpon
- Pseudochaetosphaeronema
- Bipolaris
- Acremonium
Pathology
- localized lesions
- multiple draining sinus tracts
- exudate contains granules or varying color
- 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]
More general terms
More specific terms
References
- ↑ Pathology, 2nd ed. Rubin & Farber (eds), JB Lippincott, Philadelphia, 1994, pg 385
- ↑ 2.0 2.1 2.2 2.3 2.4 Viguier M, Lafaurie M Actinomycetoma N Engl J Med 2015; 372:264. January 15, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25587950 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1316013