maduromikosis

Maduromycosis
a destructive chronic disease usually
restricted to the feet, marked by swelling
and deformity resulting from the formation
of granulomatous nodules drained by
sinuses connecting with the exterior, and
caused by various actinomycetes (as of
the genus Nocardia) and fungi (as of the
genus Madurella)called also mycetoma
Geographic distribution: Seen in
tropical region e.g. Asia, Africa, central
and south America.
Etiologi
caused by various fungi
(e.g. madurella mycetomi) or
actinomycetes (e.g. nocardia brasiliensis)
which usually affects the feet.
Mode of infection:
Organisms are normally present in
environment (soil & dust).
Infection occurs in bare-footed persons after
minor penetrating skin injury inoculating soil
organisms, occurring preferentially in rural
areas, usually among labourers who work
barefoot.

Gambaran Klinis
Initially a nodule, or abscess over months to years
progresses to a chronic infection
Lesions contain multiple sinus tracts that usually
discharge serosanguinous fluid and, at times, grossly
visible granules of various colours, sized, and degrees of
hardness depending on the agent involved.
Superimposed bacterial infection may result in larger
open ulcers.
These changes eventually lead to deformity.
The changes on imaging are remarkable with the bones
being destroyed and remodeled.

Histopatologi
Histologically, lapisan dermis dan subkutan mengandung
abses yg terlokalisasi, terdapat satu atau lebih granule di
bagian tengahnya.
Eosinophilic, sel Splendore-Hoeppli material sebagai
batas granula nya.
Between abscesses, there is extensive formation of
granulation tissue, resulting in tumefaction and deformity
that is often so severe as to be mistaken clinically for a
neoplasm.
Infection often involve contiguous bone, resulting in
destructive osteomyelitis.
Lymphatic or hematogenous dissemination from the
primary subcutaneous lesion rarely occurs.

Histologic section of mycetoma caused
by Nocardiabrasiliensis demonstrating
granulomatous inflammation and mixed
cellular infiltrate.
Histologic section of mycetoma caused by
Nocardia brasiliensis, high magnification.
Note the cellular infiltrate largely composed
of lymphocytes and neutrophils, with scant
eosinophils.
DD
otentially similarly presenting conditions,
including :
actinomycosis,
blastomycosis,
coccidioidomycosis,
leishmaniasis,
yaws, syphilis and
chronic osteomyelitis.
Treatment
Eumycetomas should ideally be surgically removed prior
to onset of bony involvement.
Eumycetomas are frequently encapsulated, and care
should be taken not to rupture the capsule, as this
may lead to organism spread and mycetoma
recurrence.
Surgery may be curative, or may be followed by or
performed in conjunction with systemic antifungal
therapy.

Antifungal options include itraconazole, posaconazole,
fluconazole, ketoconazole and terbinafine, often given
for a period of years.
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