What is Mycetoma?
Mycetoma (madur foot, maduromycosis, phycomycetoma) is a focal, chronic, slowly progressive, often painless destructive disease that starts in the subcutaneous tissue and spreads to neighboring parts of the body.
In 1842, Gill described the disease in patients observed in the Indian province of Madura and called the disease “Madura foot” or maduromycetoma, highlighting the pathogen Madurella and Actinomadura. In 1874, Carter gave a full description of the disease in India. Currently, mycetoma is widespread in tropical regions around the world and less common in temperate zones. The most common disease is found in Mexico, Saudi Arabia, Venezuela, Yemen and in the countries located under the Sahara, a sort of “belt” stretching from Senegal to the west coast – through Mali, Niger, Congo and Sudan – to Somalia on the east coast of Africa. The most common causative agents of mycete in North America are Ps. boidii, which is found in the soil of the USA and Canada. M. mycetomatis and S. somaliniensis dominate the tropical regions of Africa and India, and N. brasiliensis and A. madurae are the most frequent pathogens of the mycetomas in Mexico, Central and South America. N. asteroides prevails in Japan. Of the 21 cases described by Kornysheva V.G. (1998) mycetoma diseases in Russia, half were observed in Caucasian people, 6 (29%) were from Azerbaijan and 4 (9%) were from St. Petersburg, a third of patients were from European part of the former USSR, isolated cases were described in Siberian residents , Far East, Central Asia, the Urals and Altai. Rural residents and construction workers accounted for 50% of patients. Described foot mycetoma, due to Ps. voidii in a resident of Grozny and forearm mycetoma in a Tiraspol resident (44 years), due to Strept. somaliniensis, which arose after an open fracture, obtained during the stay of the patient in the Far East.
Causes of Mycetoma
The term actinomycete is derived from their causative agent — the actymcetes — the bacteria forming the branching mycelium. When causative agents are fungi, this process is called eumycetoma. Eumycetomas Actinomycetoma pathogens include the following aerobic actinomycetes: Actinomadura madurae, Actinomadura pelletierii, Streptomyces somaliensis, Nocardia brasiliensis, Nocardia asteroides, Nocardia otitis-caviarum, Nocardia transvalensis and Nocardia diophony, Microorganisms that cause mycetomas are distinguished by geographic distribution, the color of drusen, and there may be differences in the clinical manifestations of pathological processes caused by them.
Risk factors – trauma to the lower limbs when walking barefoot or in a little shoe protecting skin.
Pathogenesis during Mycetoma
Mycetoma occurs after penetration into the wound or abrasion of the soil or other infected substrate (usually decomposing plant residues).
Local lesions with edema and multiple abscesses with fistulas are characteristic.
Inhalation lesions are characterized by lesions of the respiratory tract.
The most frequent lesions of the feet, possibly infecting the wounds of any part of the body.
Occasionally, secondary bone lesions and bacterial superinfections are observed, often ending in death.