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Mycetoma in Adult
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Mycetoma in Adult

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Contributors: Edith Lederman MD, Noah Craft MD, PhD
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Synopsis

A mycetoma is a chronic, slowly progressive, tumor-like infection of the skin and subcutaneous tissue obtained after trauma and subsequent contamination with soil and/or vegetation. It may also be referred to as Madura foot, eumycetoma, actinomycetoma, or exogenous actinomycosis of the lower extremities. See endogenous actinomycosis.

Mycetomas may be caused by a number of different genera of soil-dwelling bacterial and fungal organisms including Nocardia, Pseudoallescheria, Madurella, Actinomyces, Actinomadura, and Streptomyces.

When the cause is fungal, the lesion is referred to as eumycotic, and it carries a worse prognosis for cure. When the cause is bacterial, it is referred to as actinomycotic. These infections are localized, and although they may cause intense local destruction, they rarely cause constitutional symptoms or spread systemically. Painful lesions occur in only 15% of patients.

Risk factors include skin exposure to soil (occupational, traumatic – road rash / motor vehicle accident, shrapnel, carrying crops) and male sex (partly secondary to occupational exposures; male to female ratio is 5:1).

Although infections leading to mycetomas can be contracted anywhere in the world, they are diagnosed most commonly in tropical and sub-tropical regions of the developing world.

Mycetomas develop first as a papule or nodule and slowly evolve in width and depth (actinomycetomas evolve faster than eumycetomas). Eventually, fistulae form, which intermittently exude purulent material of varying hues and consistencies known as granules or sclerotia. This process is indolent and may progress for over a half a century in some patients. Poorer prognosis may be associated with head lesions because they may extend intracranially.

Codes

ICD10CM:
B47.9 – Mycetoma, unspecified

SNOMEDCT:
410039003 – Mycetoma

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Last Updated: 06/08/2016
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Mycetoma in Adult
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Mycetoma : Developed chronically lasting months to years, Edema, Skin ulcer
Clinical image of Mycetoma
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