By Disease Name > Mycetoma

Mycetoma

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a clinical entity but not an etiologic one
= a tumor-like lesion produced by fungus
caused by exogenous organisms that produce filamentous grains
eumycetoma produced by true fungi
actinomycetoma produced  by actinomycetes (e.g. Nocardia asteroides, Actinomyces Israelii)
if the infection is caused by non-filaurenous bacteria, it is called botryomycosis (e.g. staph aureus)
histology:  all three above are characterized by similar tissue response
pseudocarcinomatous hyperplasia or ulceration
grains (deeply basophilic granules) may be present
Splenori-Hoeppli phenomenon may be present on the periphery of the granule
neutrophils and macrophages form a granuloma
organisms (i.e. filaments or bacteria) are rarely seen on H&E and require special stains

clinical:

foot is most common site (Madura foot)
a chronic, localized, slowly progressive, and often painless disease
triad of signs: tumefaction, sinuses, and granules
underlying fascia and bone usually involved

 

diagnosis:  

clinical triad
often history of localized minor trauma or walking bare foot in soil
culture of tissue and special stains for organisms
x-ray to rule-out osteomyelitis

 

treatment:

eumycetoma frequently amputation
A. israelli high dose PCN
Nocardia spp. sulfonamides