Mycetoma: Development of Diagnosis and Treatment

Abstract

Mycetoma describes a heterogeneous group of cutaneous and subcutaneous infections caused by either fungi (eumycetomas) or bacteria (actinomycetomas). It is characterized by a triad of clinical symptoms: painless subcutaneous tumor-like swelling, multiple sinuses and fistulas, and discharged grains in pus. This predominantly affects the feet in more than 70% of patients. It is endemic in the “mycetoma belt” regions, including Africa, South America, and South Asia. Autochthonous mycetoma is rare in the United States of America (USA). We recently reported a Latin American immigrant with eumycetoma in the State of Maryland, USA. With millions of immigrants from endemic regions, the true number of mycetomas in the USA is most likely higher than currently recognized. With the aim to raise the awareness of clinicians about mycetoma, especially dermatologists and podiatrists, we update the development of the epidemiology, etiology, clinical presentations, pathogenesis, diagnosis, differential diagnosis, and treatment of mycetoma.

Clinical Manifestations of Human Exposure to Fungi

“…The most common etiological agents of eumycetoma include Madurella mycetomatis (>70% of the cases), Microsporum grisea , Pseudallescheria boydii , Leptosphaeria senegalensis , C. lunata , Scedosporium apiospermum , Neotestudina rosatii , Acremonium spp., and Fusarium spp. [ 192 ].…”

“…The risk factors include age (20–40 years), gender (male), underlying medical conditions (e.g., secondary immunodeficiencies), and environmental exposure [ 192 ].…”

“…Transmission occurs when fungal spores in soil and water enter the body through wounds or other minor skin injuries caused by thorn pricks, wood splinters, or accidental cuts. No person-to-person transmission has been reported [ 192 ].…”

“…Abscesses drain with the extrusion of granules or grains. The infected limb is deformed in untreated or poorly treated cases, and the underlying bone and muscular tissues are destroyed ( Figure 2 I–L) [ 192 ].…”

“…Diagnosis relies on medical and travel history, symptom records, physical examinations, lab tests (direct microscopic examination, histopathological examination, culture growth, molecular profiling, and serodiagnosis test), and imaging tests (X-rays, ultrasound, and MRI) [ 192 ].…”