A mycetoma or madura mycosis is a soft tissue infection caused by fungi or fungal bacteria. The infection occurs mainly in the dry areas of the tropics. The infection occurs via small injuries to the skin, through which the pathogens penetrate into the organism.
What is a mycetoma?
Madura mycosis was first described in the Indian province of Madura, hence the name of the infection. Since the infection usually occurs on the foot – the pathogen typically penetrates the organism via small cracks that occur when walking barefoot – the infection is also known under the name “Madura foot”. See sciencedict for Introduction to Rabbit Hunger.
Madura mycosis occurs in two different forms. True mycetoma (Eumycetoma) is caused by yeast or mold, actinomycetoma (Actinomycetoma) by various genera of bacteria (Streptomyces, Actinomadura, Nocardia).
Overall, madura mycosis occurs very frequently worldwide, with geographical focal points. While in Asia and Africa maduramycosis usually occurs in the form of eumycetoma, actinomycetoma is widespread in Mexico.
The cause of madura mycosis is infection with a fungus or bacterium.
Infection usually occurs through wood splinters that have entered the foot or through the penetration of fungi or bacteria through small injuries to the foot. The following fungi are possible pathogens for eumycetoma: All fungi of the genus Madurella, the genus Acremonium, Phialophora verrucosa and Aspergillus flavus.
Various bacteria can be identified as the source of an actinomycetoma, namely various species of the bacterial genus Nocardia (especially Nocardia brasiliensis), various species of the genus Streptomyces (especially Streptomyces madurae) and Actinomadura.
In about 40% of all cases fungi are responsible for an infection, 60% of all infections are due to contamination with bacteria.
Symptoms, Ailments & Signs
After an incubation period of a few weeks to several months, so-called granulomas develop on the infected soft tissue sites. These are painless nodules that contain the pathogen in question in the form of granular material. At the site of the nodules, there is also massive swelling of the affected part of the body. The purulent granules are transported to the outside via fistula ducts.
Various fungi or bacteria that enter the body through small skin injuries are possible pathogens. The feet are often infected because walking barefoot in various population groups causes the pathogens to get into a wound on the foot via wood splinters. Rarely, the mycetoma is observed on the back, knees or hands.
Despite different pathogens, the symptoms of the disease are similar, so that the term mycetoma can be understood as a collective term. However, depending on the two groups of pathogens, there are also differences in the symptoms in addition to the similarities. In a true mycetoma (fungal infection), for example, the nodules are not clearly demarcated. In addition, there are many fistulas.
Furthermore, in this form of infection, the bones are often involved very early on. It is therefore often necessary to surgically remove the affected tissue areas in addition to drug treatment. In the case of infection caused by bacteria (actinomycetoma), the granules are encapsulated from one another, with only a few fistulas developing. Bone involvement is rarer here. Therefore, in the case of an actinomycetoma, the surgical removal of affected tissue parts is rarely necessary.
Diagnosis & History
An initial diagnosis of madura mycosis can usually be made based on the clear symptoms. Painless small nodules to massive swelling of the infected area form. Grainy secretion is emptied from the nodules or swellings – often without external influence.
The doctor clearly recognizes an infection after a microscopic examination. The discharged secretion is examined. If it is a fungal infection, the secretion has a granular, thread-like, white to slightly yellowish structure.
After a clear diagnosis, the doctor has a selection of different medications that can be used for therapy. If drug therapy is applied in good time, the course of the infection is quite harmless and, most importantly, painless.
If madura mycosis, especially eumycetoma caused by fungi, is not treated, the infection becomes chronic. Symptoms such as purulent growths do not heal by themselves. In addition, an attack on other body regions is almost inevitable. In the worst case, affected body regions have to be amputated.
Infection with the fungi of the mycetoma can lead to an additional bacterial superinfection. This means that another disease caused by bacteria is promoted. This can also occur when medical treatment has been undertaken.
In most cases, however, complications from a mycetoma are more likely to result from a lack of medical treatment, since the tumor then has the opportunity to infiltrate the inside of the body and continue to grow inside. This can lead to bone destruction, which means that bone tissue is destroyed. Muscle tissue can also be affected. Adenopathy is also possible.
This is a disease of hormone-producing glands. Tumors caused by proliferating granulation tissue can form cerebral and visceral metastases. This refers to offshoots in the brain and internal organs.
If the mycetomas are allowed to grow for too long, they can severely limit the ability to walk, as they are particularly common on the feet. Deformations of the ankles can lead to additional movement disorders. If joints, bones and muscles have been damaged too much, an amputation must be carried out, which leads to further disabilities.
When should you go to the doctor?
Changes in skin texture, discoloration or lump formation should be presented to a doctor. If the symptoms spread or if the intensity increases, there is a health impairment that must be examined and treated. In the case of swelling, itching or open wounds, the cause should be clarified. If mobility is restricted or there is a decrease in mobility as a result of the disorders, a doctor must be consulted. If the symptoms increase rapidly within a few hours, you need to see a doctor as soon as possible.
The pathogens spread quickly and the body’s own defense system is not strong enough to defend itself against it to the necessary extent. A decrease in physical capacity, internal weakness or general malaise indicate irregularities that should be presented to a doctor. If the affected person suffers from the optical changes in the skin or the blemish, surgical removal of the unwanted tissue is necessary.
If the skin becomes inflamed, an existing wound becomes enlarged or there is a gangrene, a doctor must be consulted immediately. In severe cases there is a risk of sepsis and thus a potential danger to life. Irritability, behavioral problems or withdrawal from usual social activities are further indications of an existing illness.
Treatment & Therapy
A mycetoma is treated by means of medication. In order to choose the right remedy in the right dosage, an accurate diagnosis is necessary. If a fungal infection is present, various antifungal drugs are used to treat it.
Since many of the fungal cultures are now very resistant or resistant to the antifungal agents, it is essential to monitor the effect accordingly while taking the medication. The funds are usually taken over a very long period of time, usually several years.
In addition to administering medication, it is advisable to surgically remove affected swollen or purulent areas in order to reduce the associated discomfort for the patient.
If the mycetoma is caused by bacteria, the patient is given an antibiotic. Even with a bacterial infection, it can happen that the swelling in the affected body regions does not heal. Even then, surgical intervention would be indicated.
Outlook & Forecast
A mycetoma is nowadays easily treatable and offers a positive prognosis. The condition must be treated with surgery or medication to prevent the fungus from spreading. If left untreated, madura mycosis can develop into a chronic disease that is associated with numerous restrictions in the professional and private life of the sufferer.
As the disease progresses, amputations may be necessary, which significantly reduce the patient’s quality of life. Mental illnesses can also develop as a result of an amputation. For example, after losing a body part, some patients develop depression or anxiety that requires treatment. Physical complaints such as circulatory disorders or phantom pains also occur after an amputation and influence the assessment of the course.
Nevertheless, the prognosis is good, since a whole range of therapeutic methods are available today and the fungal disease is usually not fatal. The course of the disease is assessed by the responsible dermatologist or internist, who takes into account the severity of the disease, the constitution of the patient and social factors such as the financial situation of the person concerned. If necessary, the prognosis must be adjusted, especially in the case of unforeseen complications, which occur primarily in the case of serious illnesses.
A mycetoma is very easy to prevent. In the areas where the mycetoma is widespread, walking barefoot should be consistently avoided. However, should small injuries occur in the area of the foot, the wounds must be disinfected immediately and sustainably. When traveling to such areas, disinfectants or alcohol swabs should therefore not be missing from the first-aid kit.
Follow-up care for a mycetoma depends on the type of treatment and the success of the treatment. If the fungal infestation can be treated with medication, medical follow-up care is usually no longer necessary. If the infestation is not serious and treated early, consequential damage can almost always be prevented.
In more severe cases, however, surgical interventions can be considered. It is aimed at removing infected tissue. In some cases, little tissue is removed, which means that good wound care is important afterwards. Depending on the case and indication, preventive antibiotic therapy can be useful.
Follow-up examinations of the tissue for remaining pathogens are also important. The follow-up care must be communicated by the specialist and depends on the severity of the procedure. With good wound care, wound healing can be achieved within a few weeks. Further aftercare measures are not necessary after complete healing.
If, on the other hand, an amputation is carried out because too much tissue is affected, follow-up care is more difficult. The stump needs to be taken care of. If necessary, further therapies are added for follow-up care. This is the case, for example, when the person concerned feels phantom pain. Learning how to move despite the amputated body part is also part of the aftercare. The follow-up measures mentioned apply to fungal eumycetomas as well as to bacterial actinomycetomas.
You can do that yourself
A mycetoma is usually treated with medication. Which measures the affected person can take to relieve the symptoms and promote the healing process depends on the type and severity of the disease.
Basically rest and bed rest apply. Especially in the first days of the disease, care should be taken to ensure that the bed is warm enough to avoid spreading the pathogen. In addition, swollen or purulent areas should be carefully cared for and, if necessary, treated with gentle care products. The use of appropriate preparations should first be discussed with the responsible doctor. If the symptoms are severe, surgical intervention is required. After an operation, the skin is usually very irritated and must not be exposed to harmful influences such as dirt or allergens. The person concerned should strictly follow the doctor’s instructions and inform the doctor of any unusual symptoms.
A mycetoma usually heals well if treated early and a doctor monitors its progress. In order to avoid reinfection, the causes of the first fungal infection must be determined. For this purpose, a complaints diary can be created in which possible triggers and other abnormalities are noted.