Eumycetoma

Eumycetoma is a chronic granulomatous fungal disease of humans, affecting mainly the limbs, and sometimes the abdominal and chest walls or the head. Mycetoma pedis (mycetoma of the foot), the most common form of mycetoma, is known widely as the Madura foot. The infection is endemic in Africa, India and Central and South America. Eumycetoma is a chronic granulomatous fungal disease of humans, affecting mainly the limbs, and sometimes the abdominal and chest walls or the head. Mycetoma pedis (mycetoma of the foot), the most common form of mycetoma, is known widely as the Madura foot. The infection is endemic in Africa, India and Central and South America. The initial lesion is a small subcutaneous swelling following minor trauma. Later, sinuses that discharge purulent and seropurulent exudates containing grains which are fungal colonies are formed. Destruction of deeper tissues, and deformity and loss of function in the affected limbs may occur in later stages. Mycetoma may be caused by bacteria from the phylum Actinomycetes, or by fungi (Eumycetes) where it is called eumycetoma. Bacterial and fungal species that can cause mycetoma are listed below under their characteristic colours of discharge from infected wounds: Red discharge White or yellow discharge Black discharge Some species of the bacterial genus Nocardia (including Nocardia asteroides and Nocardia brasiliensis) which can cause mycetoma produce a yellow discharge, and those of the bacterial genus Streptomyces (including Streptomyces somaliensis) produce a yellow or red discharge. The disease is usually seen in field workers like farmers, and generally affects men between 20 and 40 years. The disease is acquired by inoculation of grains of fungal spores from the soil through a breach in the skin produced by minor trauma like a thorn prick. The disease then spreads to deeper tissues and also forms sinus tracts leading to skin surface. Mature lesions are characterised by a grainy discharge from these sinuses. These discharges contain fungal colonies and are infective. Spread of infection internally through blood or lymph is uncommon. Infections that produce a black discharge mainly spread subcutaneously. In the red and yellow varieties deep spread occurs early, infiltrating muscles and bones but sparing nerves and tendons, which are highly resistant to the invasion.