Mycetoma
{{Short description|Chronic skin infection of bacteria or fungi}}
{{Infobox medical condition
|name = Mycetoma
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|specialty = Infectious diseases
|symptoms = Triad: painless firm skin lump, multiple weeping sinuses, grainy discharge
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|types = *Actinomycetoma (bacterial){{cite journal |last1=Zijlstra |first1=Eduard E. |last2=Sande |first2=Wendy W. J. van de |last3=Welsh |first3=Oliverio |last4=Mahgoub |first4=El Sheikh |last5=Goodfellow |first5=Michael |last6=Fahal |first6=Ahmed H. |title=Mycetoma: a unique neglected tropical disease |journal=The Lancet Infectious Diseases |date=1 January 2016 |volume=16 |issue=1 |pages=100–112 |doi=10.1016/S1473-3099(15)00359-X |pmid=26738840 |url=https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00359-X/fulltext |language=English |issn=1473-3099|url-access=subscription}}
- Eumycetoma (fungal)
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|diagnosis = Ultrasound, fine needle aspiration
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Mycetoma is a chronic infection in the skin caused by either bacteria (actinomycetoma) or fungi (eumycetoma), typically resulting in a triad of painless firm skin lumps, the formation of weeping sinuses, and a discharge that contains grains. 80% occur in feet.
Most eumycetoma is caused by M. mycetomatis, whereas most actinomycetoma is caused by N. brasiliensis, S. somaliensis, A. madurae, and Actinomadura pelletieri. People who develop mycetoma likely have a weakened immune system. It can take between 3 months to 50 years from the time of infection to first seeking healthcare advice.
Diagnosis requires ultrasound and fine needle aspiration.
While most cases of mycetoma occur in Sudan, Venezuela, Mexico, and India, its true prevalence and incidence are not well-known.{{cite journal | vauthors = Welsh O, Al-Abdely HM, Salinas-Carmona MC, Fahal AH | title = Mycetoma medical therapy | journal = PLOS Neglected Tropical Diseases | volume = 8 | issue = 10 | pages = e3218 | date = October 2014 | pmid = 25330342 | pmc = 4199551 | doi = 10.1371/journal.pntd.0003218 | doi-access = free }}{{cite journal |vauthors=van de Sande WW, Maghoub El S, Fahal AH, Goodfellow M, Welsh O, Zijlstra E | title = The mycetoma knowledge gap: identification of research priorities | journal = PLOS Neglected Tropical Diseases | volume = 8 | issue = 3 | pages = e2667 | date = March 2014 | pmid = 24675533 | pmc = 3967943 | doi = 10.1371/journal.pntd.0002667 | doi-access = free }} It appears most frequently in rural areas, particularly in farmers and shepherds, who are often men between 20 and 40 years old earning the primary income for their families. It has been reported since 1840. Noteworthy, the diagnosis of mycetoma in non-endemic or low endemic areas as Europe and North Africa is challenging.{{cite journal |last1=Ahmed |first1=SA |last2=El-Sobky |first2=TA |last3=de Hoog |first3=S |last4=Zaki |first4=SM |last5=Taha |first5=M |title=A scoping review of mycetoma profile in Egypt: revisiting the global endemicity map. |journal=Transactions of the Royal Society of Tropical Medicine and Hygiene |date=9 September 2022 |volume=117 |issue=1 |pages=1–11 |doi=10.1093/trstmh/trac085 |pmid=36084235|pmc=9808524 }}{{cite journal |last1=Buonfrate |first1=D |last2=Gobbi |first2=F |last3=Angheben |first3=A |last4=Marocco |first4=S |last5=Farina |first5=C |last6=Van Den Ende |first6=J |last7=Bisoffi |first7=Z |title=Autochthonous cases of mycetoma in Europe: report of two cases and review of literature. |journal=PLOS ONE |date=2014 |volume=9 |issue=6 |pages=e100590 |doi=10.1371/journal.pone.0100590 |pmid=24963778|pmc=4070928 |bibcode=2014PLoSO...9j0590B |doi-access=free }} Physicians in these areas are usually unfamiliar with the disease-specific manifestations and need to exercise extra vigilance regarding those patients who are at high risk of contracting mycetoma infections.{{cite journal |last1=Barış |first1=Ayşe |last2=Öncül |first2=Ahsen |last3=Öztürk |first3=Kahraman |last4=Barış |first4=Alican |last5=Aykut |first5=Serkan |last6=Aktaş |first6=Elif |title=Mikolojik Tanının Önemi: 20 Yıl İhmal Edilen Bir Scedosporium apiospermum Kompleks Miçetoma Olgusu |journal=Mikrobiyoloji Bulteni |date=19 April 2021 |volume=55 |issue=2 |pages=256–264 |doi=10.5578/mb.20219911 |pmid=33882656|s2cid=241887330 |doi-access=free }} Recent evidence suggests that Egypt, which borders sub-Saharan Africa, is a low-endemic country. Additionally, recent evidence suggests that Pakistan, which borders India, is a moderate-endemic country.{{cite journal |last1=Zeeshan |first1=Mohammad |last2=Fatima |first2=Saira |last3=Farooqi |first3=Joveria |last4=Jabeen |first4=Kauser |last5=Ahmed |first5=Arsalan |last6=Haq |first6=Afreen |last7=Arif |first7=Muhammad Omer |last8=Zafar |first8=Afia |title=Reporting of mycetoma cases from skin and soft tissue biopsies over a period of ten years: A single center report and literature review from Pakistan |journal=PLOS Neglected Tropical Diseases |date=29 July 2022 |volume=16 |issue=7 |pages=e0010607 |doi=10.1371/journal.pntd.0010607 |pmid=35905141|pmc=9365187 |doi-access=free }} Unlike bacterial acute hematogenous osteomyelitis and septic arthritis, misdiagnosed or delayed diagnosis of mycetoma osteomyelitis can result in amputation or radical resection. The disease is listed by the World Health Organization (WHO) as a neglected tropical disease.
Risk
Pathogenesis
Mycetoma is caused by common saprotrophs found in the soil and on thorny shrubs in semi-desert climates.{{Cite web|url=http://www.orpha.net/consor/cgi-bin/Disease_Search.php?lng=EN&data_id=3539&Disease_Disease_Search_diseaseGroup=mycetoma&Disease_Disease_Search_diseaseType=Pat&Disease(s)/group%20of%20diseases=Mycetoma&title=Mycetoma&search=Disease_Search_Simple|title=Orphanet: Mycetoma|last=RESERVED|first=INSERM US14 -- ALL RIGHTS|website=www.orpha.net|language=en|access-date=2018-04-17}} Some common causative agents are:{{Cite journal |last1=Verma |first1=P. |last2=Jha |first2=A. |date=March 2019 |title=Mycetoma: reviewing a neglected disease |url=https://onlinelibrary.wiley.com/doi/10.1111/ced.13642 |journal=Clinical and Experimental Dermatology |language=en |volume=44 |issue=2 |pages=123–129 |doi=10.1111/ced.13642|pmid=29808607 |s2cid=44123860 }}
- Madurella mycetomatis (fungus)
- Nocardia brasiliensis (bacteria)
- Actinomadure madura (bacteria)
- Streptomyces somaliensis (bacteria)
- Actinomadura pelletieri (bacteria)
Infection is caused as a result of localized skin trauma, such as stepping on a needle or wood splinter, or through a pre-existing wound.
The first visible symptom of mycetoma is a typically painless swelling beneath the skin; over several years, this will grow to a nodule (lump).{{Cite web |url=https://rarediseases.info.nih.gov/diseases/3862/mycetoma |title=Mycetoma |website=Genetic and Rare Diseases Information Center (GARD) |publisher=National Institutes of Health |language=en |access-date=2018-04-17}} Affected people will experience massive swelling and hardening of the area, in addition to skin rupture and the formation of sinus tracts that discharge pus and grains filled with organisms. In many instances, the underlying bone is affected.{{cite journal |last1=El-Sobky |first1=TA |last2=Haleem |first2=JF |last3=Samir |first3=S |title=Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy. |journal=Case Reports in Pathology |date=2015 |volume=2015 |pages=129020 |doi=10.1155/2015/129020 |pmid=26483983|pmc=4592886 |doi-access=free }} Some people with mycetoma will not experience pain or discomfort, while others will report itching and/or pain.
Diagnosis
There are currently no rapid diagnostic tools for mycetoma. Mycetoma is diagnosed through microscopic examination of the grains in the nodule and by analysis of cultures. Since the bacterial form and the fungal form of mycetoma infection of the foot share similar clinical and radiological features, diagnosis can be a challenge. Magnetic resonance imaging is a valuable diagnostic tool. However, its results should be closely correlated with the clinical, laboratory, and pathological findings.{{cite journal |last1=Karrakchou |first1=B |last2=Boubnane |first2=I |last3=Senouci |first3=K |last4=Hassam |first4=B |title=Madurella mycetomatis infection of the foot: a case report of a neglected tropical disease in a non-endemic region. |journal=BMC Dermatology |date=10 January 2020 |volume=20 |issue=1 |pages=1 |doi=10.1186/s12895-019-0097-1 |pmid=31918687|pmc=6953183 |doi-access=free }}
Treatment
Currently, itraconazole is used to treat mycetoma. Recent research found that fosravuconazole can also treat the disease.{{cite news |last1=Johnson |first1=Sarah |title=Cheap over-the-counter nail drug found to work on crippling flesh-eating disease |url=https://www.theguardian.com/global-development/2023/nov/23/fungal-nail-drug-fosravuconazole-breakthrough-treating-neglected-flesheating-disease-mycetoma |access-date=24 November 2023 |work=The Guardian |date=23 November 2023}}
While treatment will vary depending on the cause of the condition, it may include antibiotics or antifungal medication. Actinomycetoma, the bacterial form, can be cured with antibiotics. Eumycetoma, the fungal form, is treated with antifungals. Surgery in the form of bone resection may be necessary in late-presenting cases or to enhance the effects of medical treatment. In the more extensive cases amputation is another surgical treatment option.{{Cite journal|last1=Efared|first1=Boubacar|last2=Tahiri|first2=Layla|last3=Boubacar|first3=Marou Soumana|last4=Atsam-Ebang|first4=Gabrielle|last5=Hammas|first5=Nawal|last6=Hinde|first6=El Fatemi|last7=Chbani|first7=Laila|date=December 2017|title=Mycetoma in a non-endemic area: a diagnostic challenge|journal=BMC Clinical Pathology|language=en|volume=17|issue=1|pages=1|doi=10.1186/s12907-017-0040-5|issn=1472-6890|pmc=5288886|pmid=28167862 |doi-access=free }} For both forms, extended treatment is necessary.
Epidemiology
File:Human Mycetoma in India in 2013.png
Mycetoma is endemic in some regions of the tropics and subtropics. India, sub-Saharan Africa (e.g., Sudan), and Mexico are most affected.{{cite journal |last1=Oladele |first1=RO |last2=Ly |first2=F |last3=Sow |first3=D |last4=Akinkugbe |first4=AO |last5=Ocansey |first5=BK |last6=Fahal |first6=AH |last7=van de Sande |first7=WWJ |title=Mycetoma in West Africa. |journal=Transactions of the Royal Society of Tropical Medicine and Hygiene |date=14 April 2021 |volume=115 |issue=4 |pages=328–336 |doi=10.1093/trstmh/trab032 |pmid=33728466}} Pakistan is probably a moderate-endemic country. Sporadic cases have been reported across some North African countries.{{cite journal |last1=Elgallali |first1=N |last2=El Euch |first2=D |last3=Cheikhrouhou |first3=R |last4=Belhadj |first4=S |last5=Chelly |first5=I |last6=Chaker |first6=E |last7=Ben Osman |first7=A |title=[Mycetoma in Tunisia: a 15-case series]. |journal=Médecine Tropicale |date=June 2010 |volume=70 |issue=3 |pages=269–73 |pmid=20734597}} Egypt is probably a low-endemic country.
Other animals
In cats, mycetoma can be treated with complete surgical removal. Antifungal drugs are rarely effective.{{Cite book|title=Cat Owner's Home Veterinary Handbook|last1=Eldredge|first1=Debra M.|last2=Carlson|first2=Delbert G.|last3=Carlson|first3=Liisa D.|last4=Giffin|first4=James M.|publisher=Howell Book House|year=2008|pages=160}}
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References
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External links
- [https://dermnetnz.org/topics/mycetoma DermNet NZ]: an online resource about skin diseases from the New Zealand Dermatological Society Incorporated.
- [http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=2583 Orphanet]: a reference portal from Europe that provides information on rare diseases and orphan drugs.
- [https://www.clinicaltrials.gov/ct2/results?cond=%22Mycetoma%22 ClinicalTrials.gov]: a list of clinical trials related to mycetoma.