Mycetoma (Madura Foot)
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Is a chronic infection of skin and subcutaneous tissue. It can be caused by infection from fungi or bacteria. Once tests have established the etiology, the term Actinomycetoma is used for the bacterial form, while Eumycetoma is used for the fungal form. Clinical presentation depends on the affected site and the disease can last for months to years.
Clinical presentation
- First lesion: nodule
- Localization: feet, legs, arms, buttocks, scalp, trunk
- Discharging sinuses where grains may be visible usually white yellow for Actinomycetoma or black for Eumycetoma
- Pain before rupture of discharging sinus
Investigations
- KOH
- Biopsy
- Local X-ray to rule infiltration of underlying bone
Treatment of Actinomycetoma (bacteria form) Pharmacological Treatment
A: co-trimoxazole (PO) 480mg–960mg 12hourly for 5weeks
AND
S: amikacin 7.5mg/kg 12hourly for 5weeks
Alternatively
A: co-trimoxazole (PO) 480mg–960 mg 12hourly for 5weeks
AND
S: dapsone (PO): adult 100mg 24hourly for 2–4months; Paediatric 25–50mg 24hourly for 5weeks
Treatment of Eumycetoma (Fungi form)
Non-pharmacological Treatment
- Surgery where indicated
- Footwear and protective clothing in at-risk populations e.g. cattle herders
Pharmacological Treatment
D: itraconazole (PO) 200mg 12hourly for 5weeks or longer (up to a year).
Referral to surgeon
- Radical surgery for some cases