Aspergillus causes fungus balls in nasal antrum of immunocompetent patients with minimal inflammatory response, microabscesses or multinucleated giant cells. Jan 09, 2017 mycetoma is a chronic subcutaneous infection caused by actinomycetes or fungi. In this retrospective study, the experience of the mrc on the common in use diagnostic tests in. Since the treatment of these two etiologies is entirely different, a definite diagnosis after histopathological and microbiological examination is mandatory. Case report open access mycetoma in a nonendemic area. Penicillium, aspergillus, or madurella, or actinomycetes such as nocardia. Introduction mycetoma is a chronic granulomatous disease. It can be introduced for routine diagnosis of mycetoma and for epidemioloical surveys and for sample collection for culture. Page 2 of 3 ao siddig ee fahal ah 217 histopathological approach in iagnosis of ycetoma causative agents. Histopathology of actinomycetoma wikimedia commons. The major advantages of histopathology are speed, low cost and the ability to provide a presumptive identification of the infecting fungus as well as demonstrating the tissue reaction.
We used key words madura foot, mycetoma eumycetoma. Pdf cytodiagnosis of primary actinomycotic mycetoma of the. Pdf eumycetoma on histopathology presenting at unusual. Maduromycosis, also known as mycetoma, is a progressive granulomatous infection involving the skin and subcutaneous tissues with potential to invade muscle and bone.
Actinomycotic mycetoma eumycotic mycetoma delicate, branched, grampositive and sometime beaded or fragmented bacterial filaments foot or mycetoma is a chronic granulomatous disease characterized by chronic infection of skin and subcutaneous tissues, caused by true fungi eumycetoma or by filamentous bacteria actinomycetoma. Mycetoma typically presents in agricultural workers who handle contaminated vegetation or in individuals who walk barefoot in dry, dusty conditions fig 1. Lytic lesions, foot, mycetoma, histopathology, infection introduction although a large number of bones are present in the foot the lesions in them are infrequently reported in the literature1. Pdf mycetoma is a unique neglected tropical disease which distributed worldwide and endemic in tropical and subtropical regions. Case report an unusual case of mixed mycetoma by actinomycete. The cytological features of mycetoma correlates well with the histologic one. The incidence is more common in agricultural workers walking in bare foot. For this reasonand because the first medical reports were from doctors in madura 1, india 2an alternate name for the disease is madura foot. Siddig ee, research assistant, mycetoma research center, department of histopathology and cytology, faculty of medical laboratory. Oct 19, 2017 eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi.
Mycetoma is a chronic, slowly progressive infection of diverse etiology that starts in subcutaneous tissue and spreads across tissue planes to contiguous structures. Materials and methods six patients with foot mycetoma were evaluated with plain x. The centre staff has continually explored new patients management approaches through clinical and basic research. The dotincircle sign a characteristic mri finding in mycetoma foot. The disease is endemic in certain tropical and subtropical areas of the world but can be found elsewhere posing sometimes a diagnostic challenge for clinicians. Case report an approach to histologybased diagnosis and.
Rural workers1645 yrs old, rarely in nonmanual workers. However, partial surgical resection without subsequent use of appropriate antimicrobial or antifungal agents is prone to failure. Mycetoma can be caused by bacteria actinomycetoma or fungi eumycetoma and typically affects poor communities in remote areas. Mycetoma is a granulomatous infection affecting mainly the feet and lower extremities. Mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. An mri, microbiology and histopathology reported a rare infectious agent actinomyces spp, otherwise referred to as madura foot. A 65year old man presented with a right foot swelling evolving for 25 years. A case of eumycotic mycetoma in a young agricultural worker from rural part of northern india who had swelling, induration and minimal discharge from sinuses over the foot is presented herewith.
Mycetoma is an uncommon chronic infective disease of the skin and subcutaneous tissues characterized by the triad of tumefaction, draining sinuses and presence of colonial grains in the exudates. The causative microorganisms probably enter the body by a thorn prick. Mycetoma definition mycetoma, or maduromycosis, is a slowgrowing bacterial or fungal infection focused in one area of the body, usually the foot. It is caused by true mycetes named eumycetoma and filamentous bacteria belonging to group actinomycetes. Other less commonly affected sites includes hand, knee. The disease mycetoma has been known since ancient times in india, where it was described in the religious book atharva veda as padaval mika, which means foot anthill. Eumycetoma is caused by at least 41 hyaline and pigmented species of molds. Mycetoma is a term for a chronic subcutaneous infection caused by aerobic actinomycetic bacteria actinomycetoma or fungi eumycetoma. Medical treatment of mycetoma depends on its fungal or bacterial etiology. Mycetoma, an uncommon chronic infection of skin and subcutaneous tissues. It appears most frequently in people living in rural areas, particularly farmers and shepherds. Conventional culture confirmation of tissue biopsies often fail to identify any pathogen as, first of all. Mycetoma is a unique neglected disease, endemic in many tropical and subtropical regions, characterized by devastating deformities, disability, high morbidity and serious negative socioeconomic.
Mri findings that are specific to the diagnosis of this condition would aid in the early diagnosis of this chronic infection and differentiate it from such conditions. All structured data from the file and property namespaces is available under the creative commons cc0 license. Diagnosis and management of fungal neglected tropical. Mycetoma, an uncommon chronic infection of skin and subcutaneous tissues commonly seen in tropical and subtropical countries. Gms or pas stain the hyphae in mycetoma and highlight fungal morphology of eumycetoma figures 2, 3. Histopathology alone failed to discriminate between and f. The recurrence rate for the disease if treated inadequately is very high.
Histopathology is useful to confirm the clinical diagnosis and distinguish. Postobstructive change may be observed if the mycetoma obstructs the sinus drainage pathway leading to partial or complete sinus opacification 2. The infection is endemic in africa, india and south americas and madurella mycetomatis is the most prevalent cause of mycotic mycetoma worldwide. Pdf madura foot is a deep mycosis commonly seen in tropical and subtropical. Mycetoma pedis mycetoma of the foot, the most common form of mycetoma, is known widely as the madura foot. Mycetoma is a chronic granulomatous infectious disease caused by filamentous bacteria or by fungi. Pdf mycetoma at a tertiary care hospital in saudi arabia. Oct 16, 2014 medical treatment of mycetoma depends on its fungal or bacterial etiology. Mycetoma is a chronic progressive granulomatous exogenous. Mycetoma or madura foot is a chronic granulomatous infection of the skin and subcutaneous tissue, which can be either eumycetoma fungal or actinomycetoma bacterial table 1. Bones are frequently involved in advanced mycetoma of the soft tissue. Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue. Most cases are found in tropical and subtropical regions.
It is a chronic, tumorous, fungal infection of deep soft tissues and bones of foot madura foot. The lesion is usually on the foot but all parts of the body can be affected. Approximately 40% of mycetomas worldwide are eumycotic as opposed to actinomycotic ie, caused by bacterial actinomycetes. Massive mycetoma foot with dilated tortuous veins at and proximal to the mycetoma site. Mri, microbiology and histopathology reported a rare infectious agentactinomyces spp, otherwise referred to as madura foot. To establish the diagnosis of mycetoma in the foot by imaging and identify the principal radiological signs. Madura foot, also called maduromycosis, or mycetoma, fungus infection, usually localized in the foot but occurring occasionally elsewhere on the body, apparently resulting from inoculation into a scratch or abrasion of any of a number of fungi. The patients presenting with radiographic picture of multiple lytic lesions of the foot raise myriad clinical suspicions. The accuracy of histopathological and cytopathological. The staff members are of medical, health and science backgrounds who are interested in all facets related to mycetoma. Pdf eumycetoma on histopathology presenting at unusual site. This has been very rarely described in the literature. Another pitfall in histopathology diagnosis of mycetoma were seen.
Davis jd, stone pa, mcgarry jj 1999 recurrent mycetoma of the foot. It is a disorder of subcutaneous tissue, skin and bones, mainly of feet, characterized by a triad of localized swelling, underlying sinus tracts, and production of grains or granules. An approach to histologybased diagnosis and treatment of madura foot. Also causes invasive aspergillosis, regardless of immune status, with extension into retroorbital region, cranium or parapharyngeal space.
The disease has been included in the world health organizations list of neglected diseases. May 28, 2018 mycetoma or madura foot is a chronic granulomatous infection of the skin and subcutaneous tissue, which can be either eumycetoma fungal or actinomycetoma bacterial table 1. According to the patient, the swelling had gradually increased in size over a few years, but it was painless and thus had not restricted him from continuing to farm until the lesion started to affect mobility. Clinically all were diagnosed as mycetoma foot or madura foot, and were. Rare case of mycetoma foot without any discharging sinuses. Surgical reduction of large lesions can improve the patients response to medical treatment. Madura foot or mycetoma pedis is a chronic suppurative infection caused by true fungi eumycetoma in 40%, or filamentous bacteria actinomycetoma in 60% of patients 1. Mri findings that are specific to the diagnosis of this condition would aid in the early diagnosis of this. Infection is most probably acquired by traumatic inoculation of certain fungi or. Bacterial mycetoma accounts for 60% of cases worldwide, while the rest are fungal.
Similarly, the lesion showed marked inflammatory changes in the left foot with cortical erosion, with microabscesses formation. The dotincircle sign a characteristic mri finding in. Histopathological approach in diagnosis of mycetoma. The importance of diagnostic imaging of mycetoma in the foot. While most cases of mycetoma occur in sudan, venezuela, mexico, and india, its true prevalence and incidence are not wellknown. Both forms of mycetoma present as a progressive, cutaneous and subcutaneous swelling, although actinomycetoma has a more rapid course. The infection is usually produced by the introduction of the etiologic agents through minor wounds caused by thorns and wood splinters. Madura foot or mycetoma is a chronic granulomatous disease characterized by chronic infection of skin and subcutaneous tissues, caused by true fungi eumycetoma or by filamentous bacteria actinomycetoma. Files are available under licenses specified on their description page.
The characteristic clinical presentation includes a triad of tumor. This infection results in a granulomatous inflammatory response in the deep dermis and subcutaneous tissue, which can extend to the underlying bone. It can be caused either by aerobic, branched actinomycetes or by eumycetes. Gill in 1842 and colebrook in 1848, as part of their madura dispensary reports were the first investigators to clearly describe the disease. To present the histopathological and clinical correlation of mycetoma among. Jan 01, 2014 maduromycosis, also known as mycetoma, is a progressive granulomatous infection involving the skin and subcutaneous tissues with potential to invade muscle and bone. Mycetoma a tumor produced by fungi was first described in 1842 in the madura district of india, hence the terms madura foot, maduromycosis, and maduromycetoma. The disease mycetoma has been known since ancient times in india, where it was described in the religious book atharva vedaas padaval mika, which means foot anthill.
That had badly affected the patients proper diagnosis and management and thus the late presentation of patients with advanced disease. Mycetoma, also known as madura foot, is a local, chronic, slowly progressive disease with the classic presentation involving tumefaction, multiple draining sinuses, and grainfilled pus. It is endemic in tropical and subtropical regions where it is a real public health issue. In the absence of typical clinical features of discharging sinuses, mycetoma foot may clinically mimic a neoplasm or a chronic bacterial or tuberculous infection. The imaging features of madura foot mycetoma pedis. Clinically, these entities share similar features that can confuse diagnosis, causing a lack of therapeutic response due to inappropriate treatment. Grain histopathology actinomycetoma haematoxylin and eosin 100x. Mycetoma is a localized chronic, suppurative, and deforming granulomatous infection seen in tropical and subtropical areas.
Pdf an approach to histologybased diagnosis and treatment of. It is a disorder of subcutaneous tissue, skin and bones, mainly of feet, characterized by a triad of localized swelling, underlying sinus tracts, and production of. In this retrospective study, the experience of the mrc on the common in use diagnostic tests. They also postulated that this appearance reflects the unique pathological features of mycetoma. Cytodiagnosis of primary actinomycotic mycetoma of the foot mycetoma is chronic suppurative granulomatous disorder of subcutaneous tissue characterized by localized swelling with multiple. In endemic areas, mycetomamadura foot should be considered in the differential diagnosis of chronic subcutaneous lesions, even in the absence of sinuses or discharging grains, as surgical excision of such lesions may result in complete cure. It was first described by sarrisetal 3 in two casesof mycetoma involvingthe soft tissues of the foot.
Pdf cytodiagnosis of primary actinomycotic mycetoma of. Eumycetoma mycotic mycetoma is a chronic subcutaneous fungal infection of the skin and soft tissue, most often affecting the lower extremity typically a single foot. Histopathology remains one of the major tools of diagnosis in mycology20 table 3. They have rich track records in patients management, teaching, research and community development. Kiran alam 1, veena maheshwari 1, shruti bhargava 1, anshu jain 1, uroos fatima 1, ershad ul haq 2 1 department of pathology, jawaharlal nehru medical college, aligarh muslim university, aligarh, india 2 taif, saudi arabia click here for correspondence address. Mycetoma is a chronic, progressively destructive morbid inflammatory disease usually of the foot but any part of the body can be affected. Disseminated infections mycetoma forms a discrete mass or localized masses in the skin and soft tissues with draining sinuses through to the overlying skin. Maduromycosis usually involves feet, and appears as a nodule or abscess, which progresses over months to years to a chronic infection with granulomatous nodules drained by skin sinuses, leading to deformities involving the bones. Pdf histopathological approach in diagnosis of mycetoma. Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi. Full eradication was not possible, and the patient required prolonged.
Delay in diagnosis, lack of expertise and diagnostic facilities in remote areas, poor patient compliance, and resistant nature of almost all the causative organisms contribute towards the difficulty index in the management of mycetoma cases. A clue to the diagnosis includes soft tissue density within the sinus withwithout foci of calcific deposit. It is an infection of subcutaneous tissues resulting in mass and sinus formation and a discharge that contains grains. Paranasal sinus mycetoma radiology reference article. Author summary in mycetoma endemic regions, the medical and health settings are commonly suboptimal, and only a few diagnostic tests and techniques are available.
343 547 519 1019 580 686 1172 255 1436 1514 250 491 678 1488 1549 568 1147 142 247 1394 606 523 675 1172 1113 446 1450 637 561 755 887 803 838