OVERVIEW:
 

Mycetoma is a local chronic and progressive infection of the skin, subcutaneous tissues and bone. It is characterized by swelling that is often grotesque and disfiguring and by multiple sinus tracts that drain granule-containing pus.
 

ETIOLOGY:

Mycetoma is caused by at least 20 species of actinomycetes and fungi. The most common infecting agents are Nocardia spp and Madurella mycetomi.
 

PATHOLOGY AND CLINICAL SYMPTOMS:

The disease is acquired by traumatic implantation in the skin. The microorganisms grow through the subcutaneous tissue into the bone. As this occurs, there is hyperplasia of the tissues, formation of pus containing granules (which are actually colonies of microorganisms), expression of pus to the surface of the skin and granuloma formation at the periphery of the infected area. The classical triad of symptoms is:
 

Gross deformity of the infected area

Draining sinuses

Granules in the pus
 

DIAGNOSIS AND TREATMENT:
 

Diagnosis is made by the presence of the classical triad of symptoms and by culture of the pus draining from the wound. Treatment is initially with trimethoprim-sulfamethoxazole for Nocardia or Amphotericin B for fungi. If the fungal infection does not respond to amphotericin B then amputation is required.