Eumycetoma - Revision history

Rossdonaldson1: /* Background */

2024-12-11T16:24:08Z

Background

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	==Background==		==Background==
			{{Skin anatomy background images}}
	*Also known as “mycotic mycetoma” and "Madura foot"		*Also known as “mycotic mycetoma” and "Madura foot"
	*Chronic subcutaneous fungal skin and soft tissue infection		*Chronic subcutaneous fungal skin and soft tissue infection

Rossdonaldson1: /* References */

2021-01-12T16:20:19Z

References

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	==References==		==References==
	<references/>		<references/>

			[[Category:Dermatology]]
			[[Category:ID]]

Rossdonaldson1: /* Disposition */

2021-01-12T16:19:18Z

Disposition

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	*Providers should consider possibility of secondary bacterial infection		*Providers should consider possibility of secondary bacterial infection

			==External Links==

			==See Also==

	==References==		==References==
	<references/>		<references/>

Rossdonaldson1 at 16:18, 12 January 2021

2021-01-12T16:18:14Z

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	*Also known as “mycotic mycetoma” and "Madura foot"		*Also known as “mycotic mycetoma” and "Madura foot"
	*Chronic subcutaneous fungal skin and soft tissue infection		*Chronic subcutaneous fungal skin and soft tissue infection
	*Most often affects lower extremities (typically a single foot) <ref> Zijlstra EE, van de Sande WWJ, Welsh O, Mahgoub ES, Goodfellow M, Fahal AH. Mycetoma: a unique neglected tropical disease. Lancet Infect Dis. 2016;16(1):100-112. doi:10.1016/S1473-3099(15)00359-X </ref>

	*Caused by many different types of molds		*Caused by many different types of molds
	*Infection occurs following inoculation of conidia into skin or subcutaneous tissue		*Infection occurs following inoculation of conidia into skin or subcutaneous tissue
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	[[File:Madura foot..jpg\|thumb\|Madura foot.]]		[[File:Madura foot..jpg\|thumb\|Madura foot.]]
	*Located in uncovered areas that have been traumatized (mostly feet, legs, and hands)		*Located in uncovered areas that have been traumatized (mostly feet, legs, and hands)
			*Most often affects lower extremities (typically a single foot) <ref> Zijlstra EE, van de Sande WWJ, Welsh O, Mahgoub ES, Goodfellow M, Fahal AH. Mycetoma: a unique neglected tropical disease. Lancet Infect Dis. 2016;16(1):100-112. doi:10.1016/S1473-3099(15)00359-X </ref>
	*Characteristic triad is tumor, sinus tracts, and macroscopic grains		*Characteristic triad is tumor, sinus tracts, and macroscopic grains
	*Progression		*Progression

Rossdonaldson1: /* Evaluation */

2021-01-12T16:17:25Z

Evaluation

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	==Evaluation==		==Evaluation==
			[[File:Madura foot x-ray.jpg\|thumb\|Plain x-ray of Madura foot.]]
	*Physical exam looking for characteristic triad (tumor, sinus tract, and macroscopic grains)		*Physical exam looking for characteristic triad (tumor, sinus tract, and macroscopic grains)
	*Microscopy of grains using 20% potassium hydroxide solution		*Microscopy of grains using 20% potassium hydroxide solution

Rossdonaldson1: /* Clinical Features */

2021-01-12T16:16:18Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
			[[File:Madura foot..jpg\|thumb\|Madura foot.]]
	*Located in uncovered areas that have been traumatized (mostly feet, legs, and hands)		*Located in uncovered areas that have been traumatized (mostly feet, legs, and hands)
	*Characteristic triad is tumor, sinus tracts, and macroscopic grains		*Characteristic triad is tumor, sinus tracts, and macroscopic grains

Rossdonaldson1: /* Background */

2021-01-12T16:13:54Z

Background

← Revisión anterior		Revisión del 16:13 12 ene 2021
Línea 1:		Línea 1:
	==Background==		==Background==
	*Also known as “mycotic mycetoma”		*Also known as “mycotic mycetoma” and "Madura foot"
	*Chronic subcutaneous fungal skin and soft tissue infection		*Chronic subcutaneous fungal skin and soft tissue infection
	*Most often affects lower extremities (typically a single foot) <ref> Zijlstra EE, van de Sande WWJ, Welsh O, Mahgoub ES, Goodfellow M, Fahal AH. Mycetoma: a unique neglected tropical disease. Lancet Infect Dis. 2016;16(1):100-112. doi:10.1016/S1473-3099(15)00359-X </ref>		*Most often affects lower extremities (typically a single foot) <ref> Zijlstra EE, van de Sande WWJ, Welsh O, Mahgoub ES, Goodfellow M, Fahal AH. Mycetoma: a unique neglected tropical disease. Lancet Infect Dis. 2016;16(1):100-112. doi:10.1016/S1473-3099(15)00359-X </ref>

SeanDenny: /* Differential Diagnosis */

2020-12-14T01:11:36Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Actinomycosis]]		*[[Actinomycosis]]
	*Botryomycosis		*[[Botryomycosis]]
	*[[Nocardiosis]]		*[[Nocardiosis]]
	*Foreign body granuloma		*Foreign body granuloma

SeanDenny: Created page with "==Background== Also known as “mycotic mycetoma” Chronic subcutaneous fungal skin and soft tissue infection *Most often affects lower extremities (typically a single foo..."

2020-12-14T01:10:38Z

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==Background==
*Also known as “mycotic mycetoma”
*Chronic subcutaneous fungal skin and soft tissue infection
*Most often affects lower extremities (typically a single foot) <ref> Zijlstra EE, van de Sande WWJ, Welsh O, Mahgoub ES, Goodfellow M, Fahal AH. Mycetoma: a unique neglected tropical disease. Lancet Infect Dis. 2016;16(1):100-112. doi:10.1016/S1473-3099(15)00359-X </ref>

*Caused by many different types of molds
*Infection occurs following inoculation of conidia into skin or subcutaneous tissue
*Usually confined to subcutaneous tissue but can spread to fascia, bone, and lymph nodes via continguous dissemination <ref> el Hassan AM, Mahgoub ES. Lymph node involvement in mycetoma. Trans R Soc Trop Med Hyg. 1972;66(1):165-169. doi:10.1016/0035-9203(72)90065-x </ref>

===Microbiology===
*There are at least 41 organisms capable of causing eumycetoma
*Most frequent pathogens include
**Madurella mycetomatis
**Nigrograna mackinnonii
**Trematosphaeria grisea
**Falciformispora senegalensis
**Scedosporium apiospermum

==Clinical Features==

*Located in uncovered areas that have been traumatized (mostly feet, legs, and hands)
*Characteristic triad is tumor, sinus tracts, and macroscopic grains
*Progression
**Initial lesions are painless, often begin as slowly growing indurated subcutaneous nodules
**Extension occurs due to nodule swelling and coalescence, resulting in large tumors that can evolve into necrotic abscesses with sinus tracts
**May progress over months to many years
**Can extend from skin and subcutaneous tissue to muscle, bone, and lymphatic vessels
*Pain is usually associated with secondary bacterial infection

===Complications===
*Fibrosis
*Ankylosis
*Lymphedema
*Joint destruction

==Differential Diagnosis==
*[[Actinomycosis]]
*Botryomycosis
*[[Nocardiosis]]
*Foreign body granuloma
*Soft tissue tumor
*Cyst
*[[Folliculitis]]
*[[Sporotrichosis]]
*[[Chromoblastomycosis]]
*Cutaneous [[leishmaniasis]]
*Cutaneous [[tuberculosis]]
*[[Elephantiasis]]
*[[Podoconiosis]]

==Evaluation==
*Physical exam looking for characteristic triad (tumor, sinus tract, and macroscopic grains)
*Microscopy of grains using 20% potassium hydroxide solution
*Gram stain can be considered to evaluate for alternative diagnoses
*Deep biopsy with culture
*Imaging: CT or MRI (although MRI more sensitive) to determine bony involvement and extent of soft tissue involvement
*PCR can be done to evaluate for specific causative pathogens

==Management==
*Extended antifungal therapy, depending on causative agent, generally at least 12 months (3 months after clinical and radiographic resolution)
**Possibilities include itraconazole, voriconazole, posaconazole
*Surgery is not first line as relapse rates are high (109),if performed it should be done in conjunction with antifungal therapy

==Disposition==
*Disposition will depend on severity of lesion and overall clinical status of patient
*Providers should consider possibility of secondary bacterial infection

==References==
<references/>

Eumycetoma - Revision history

Rossdonaldson1: /* Background */

Rossdonaldson1: /* References */

Rossdonaldson1: /* Disposition */

Rossdonaldson1 at 16:18, 12 January 2021

Rossdonaldson1: /* Evaluation */

Rossdonaldson1: /* Clinical Features */

Rossdonaldson1: /* Background */

SeanDenny: /* Differential Diagnosis */

SeanDenny: Created page with "==Background== *Also known as “mycotic mycetoma” *Chronic subcutaneous fungal skin and soft tissue infection *Most often affects lower extremities (typically a single foo..."

SeanDenny: Created page with "==Background== Also known as “mycotic mycetoma” Chronic subcutaneous fungal skin and soft tissue infection *Most often affects lower extremities (typically a single foo..."