Mycetoma (Madura Foot) is a localized destructive infection of the skin and subcutaneous tissues which slowly progresses to involve contiguous muscle, fascia, and bone. Lesions are usually painless. Infections are initiated where organisms present in soil or plant debris are inoculated into skin and may involve any area subject to local trauma by contaminated objects. Feet or hands are most commonly affected, but carriage of contaminated sacks or other objects may lead to infections involving, the shoulders, back, chest wall, head, or neck, and the buttocks may be inoculated during sitting. A localized papular or nodular swelling containing suppurative granulomas develops, with progressive extension and formation of multiple sinus tracts which exude characteristic grains or granules representing colonies of causative organisms. Grains are 0.2 to 30 mm in diameter and may be colored black, white, yellow, pink, or red depending on the causative organism. Extensive tissue swelling, induration, and destruction develop. Extensive chronic lesions typically contain healed, scarred, sometimes closed sinus tracts with new open suppurative tracts in other adjacent areas. Over a period of months to years, invasion of bone cortex results in replacement of osseous tissues and marrow by masses of grains, manifested on x-rays by cavitary osteolytic lesions and periosteal new bone formation. There may be some regional lymphadenopathy but hematogenous spread does not occur. Systemic signs or symptoms such as fever typically do not develop unless there is secondary bacterial infection.
KeywordsTuberculin Skin Test Causative Organism Aspergillus Nidulans Osseous Tissue Secondary Bacterial Infection
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