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