| • | 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:
| • | 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 |
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