The Madura Foot

Abstract

"Mycetoma" means a fungal tumor. Mycetoma is a chronic, granulomatous, subcutaneous tissue infection caused by both bacteria (actinomycetoma) and fungi (eumycetoma). This chronic infection was termed Madura foot and eventually mycetoma, owing to its etiology. Inoculation commonly follows minor trauma, predominantly to the foot and hence is seen more among the barefoot-walking populations, common among adult males aged 20 to 50 years. The hallmark triad of the disease includes tumefaction, fistulization of the abscess, and extrusion of colored grains. The color of these extruded grains in the active phase of the disease offers a clue to diagnosis. Radiology, ultrasonology, cytology, histology, immunodiagnosis, and culture are tools used in diagnosis. Recently, DNA sequencing has also been used successfully. Though both infections manifest with similar clinical findings, Actinomycetoma has a rapid course and can lead to amputation or death secondary to systemic spread. However, actinomycetomas are more responsive to antibiotics, whereas eumycetomas require surgical excision in addition to antifungals. Complications include secondary bacterial infections that can progress to full-blown bacteremia or septicemia, resulting in death. With extremely disfiguring sequelae, following the breakdown of the nodules and formation of discharging sinuses, it poses a therapeutic challenge.

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“…Mycetoma is a tropical infection that follows puncture wounds and is typically encountered in patients aged 20-50 years, especially those who walk barefooted 5 . The causative organisms of mycetoma have geographical variations and can be bacterial (actinomycetoma) or fungal (eumycetoma) in origin 6 .…”

“…Fungal stains can also be done through microscopy of any visible discharge. Cytology, histology 11 , enzyme-linked immunosorbent assay, immunohistochemistry and DNA sequencing have also been successfully used 5 . The treatment of choice is surgical excision with wide margins; antifungal or antibiotic treatment following surgical excision is debatable as the results are variable 3 .…”

A 48-Year-Old Male Immigrant with a Painful Foot Mass

“…Contrary to the therapeutic approach in actinomycetoma, which is treated primarily with antibiotics while surgery is reserved to drain abscesses and debride necrotic tissue, an early surgical intervention followed by antifungal therapy is the standard in the treatment of eumycetoma (13). Commonly used antifungal medications include azoles and terbinafine (14).…”

Detection of <i>β</i>-Glucuronidase Activity within <i>Actinomadura madurae</i> Grains of Human Actinomycetoma

“…Actinomycetoma is a suppurative infection which usually affects the lower extremities, but it can occur in almost any region of the body. Actinomycetoma evolution is very slow and therefore the inability condition is lately achieved (months or years) [2] [3].…”

“…Histopathological observation of tissue samples stained with hematoxylin-eosine shows multilobular grains with irregular or uneven edges and with a blue peripheral band intensely stained, while the center is often devoid of color [1]- [3].…”