simple ppt

2.  Mycetoma is a chronic subcutaneous infection
caused by actinomycetes or fungi. This infection
results in a granulomatous inflammatory response
in the deep dermis and subcutaneous tissue, which
can extend to the underlying bone

3.  Mycetoma was described in the modern literature
in 1694 but was first reported in the mid-19th
century in the Indian town of Madura, and hence
was initially called Madura foot.

4.  Mycetoma commonly affects young adults,
particularly males aged between 20 and 40 years,
mostly in developing countries.

5.  Mycetoma caused by microaerophilic
actinomycetes is termed as actinomycetoma,
 Mycetoma caused by true fungi is called
eumycetoma.

6.  Actinomycetoma may be due to
 Actinomadura madurae,
 Actinomadura pelletieri,
 Streptomyces somaliensis,
 Nocardia spp.
 Eumycetoma is often due to
 Pseudallescheria boydii (Scedosporium
apiospermum),
 Madurella mycetomatis.

7.  The feet are the most common site for infection
 Other sites include the
 Lower legs,
 Hands,
 Head,
 Neck,
 Chest,
 Shoulder
 Arms.

8.  Mycetoma typically presents in agricultural
workers (hands, shoulders and back - from
carrying contaminated vegetation and other
burdens), or in individuals who walk barefoot in
dry, dusty conditions.
 Minor trauma allows pathogens from the soil to
enter the skin.

9.  Transmission occurs when the causative organism
enters the body through minor trauma or a
penetrating injury, commonly thorn pricks. There
is a clear relationship between mycetoma and
individuals who walk barefooted and are manual
workers.

10.  Mycetoma is characterized by a triad of
 Painless subcutaneous mass,
 Multiple sinuses
 Discharge containing grains.
 It usually spreads to involve the skin, deep structures
and bone resulting in destruction, deformity and loss of
function, which may be fatal.
 Mycetoma commonly involves the extremities, back
and gluteal region.
 Secondary bacterial infection is common, and lesions
may cause increased pain and disability and fatal
septicaemia (severe infections involving the entire
human system) if untreated.

11.  The causative organisms can be detected by
examining surgical tissue biopsy as well the lesion
sinuses discharge.
 Grains microscopy is helpful in detecting the
characteristic grains, it is important to culture them
to identify the causative organism properly.
 DNA sequencing and many imaging techniques

12.  Chronic bacterial osteomyelitis,
 Tuberculosis,
 Buruli ulcer.
 Other deep fungal infections such as blastomycosis
or coccidiomycosis.
 Leishmaniasis, yaws and syphilis should be
considered.

13.  Actinomycetoma.
 Surgical debridement, followed by prolonged
appropriate antibiotic therapy for several months is
required for actinomycetoma.
 Combination therapy with trimethoprim-
sulfamethoxazole, dapsone and streptomycin has
been used.
 Rifampin has been used in resistant cases.

14.  Eumycetoma
 Eumycetomas are only partially responsive to
antifungal therapy but can be treated by surgery,
due to their normally well circumscribed nature.
 Surgery in combination with azole treatment is the
recommended regime for small eumycetoma
lesions in the extremities.
 Madurella mycetomatis may respond
to ketoconazole, P. boydii (S. apiospermum) may
respond to itraconazole.
 Other agents of eumycetoma may respond
intermittently to itraconazole or amphotericin B.

15.  People living in or travelling to endemic areas
should be advised not to walk barefooted.