A mycetoma or maduramycosis is a soft tissue infection caused by fungi or fungal bacteria. The infection occurs mainly in the dry areas of the tropics. The infection is caused by small injuries of the skin through which the pathogens invade the organism.

What is a mycetoma?

Maduramycosis was first described in the Indian province of Madura, hence the name of the infection. Since the infection usually occurs at the foot - through small cracks, which are caused by walking barefoot, the pathogen typically penetrates into the organism - the infection is also known under the name "Madura foot".

Maduramycosis occurs in two different forms. The true mycetomas (Eumyzetoma) is caused by yeast or mold fungi, the actinomycetomas (actinomycetoma) by various bacterial genera (Streptomyces, Actinomadura, Nocardia).

Overall, Maduramycosis occurs very frequently worldwide, with geographical focus. While maduramycosis usually occurs in Asia and Africa in the form of eumycetomas, actinomycetoma is widespread in Mexico.

causes

The cause of maduramycosis is the infection with a fungus or a bacterium.

An infection usually occurs in the foot occurred Holzspreisel or on the penetration of the fungi or bacteria on small injuries to the foot. As exciters for a Eumyzetom the following fungi come into question: All fungi of the genus Madurella, the genus Acremonium, Phialophora verrucosa and Aspergillus flavus.

As a source of actinomycetoma, various bacteria can be identified, namely various species of the bacterial genus Nocardia (especially Nocardia brasiliensis), various species of the genus Streptomyces (especially Streptomyces madurae) and Actinomadura.

In about 40% of all cases, fungi are responsible for an infection, 60% of all infections are due to bacterial infection.

Symptoms, complaints & signs

After an incubation period of a few weeks to several months, so-called granulomas develop at the infected soft tissue sites. These are painless nodules that contain the respective pathogen in the form of granular material. At the site of the nodules, it also leads to massive swelling of the affected body part. Via fistula tracts the purulent granules are transported to the outside.

Possible pathogens are various fungi or bacteria that enter the body via small skin injuries. Thus, the feet are often infected, because by walking barefoot in different groups of the population, the pathogens, for example about occurred wood splinters get into a wound on the foot. Less often, the mycetoma is observed on the back, knees or hands.

Despite various pathogens, the symptoms of the disease are similar, so that the term mycetoma can be understood as a collective term. However, depending on the two groups of pathogens, there are differences in the symptoms in addition to the similarities. So in a true mycetoma (fungal infection), the nodules are not clearly separated from each other. In addition, many fistulas are present.

Furthermore, the bones are often involved very early in this form of infection. Therefore, it often becomes necessary to surgically remove the affected tissue areas besides the drug treatment. In bacteria-induced infection (actinomycetoma), the granules are isolated from each other, leaving only a few fistulas. A bone involvement is rarer here. Therefore, in an actinomycetoma surgical removal of infested tissue is rarely necessary.

Diagnosis & History

An initial diagnosis of maduramycosis can usually be made due to the clear symptoms. It forms painless small nodules to massive swelling of the infected area. From the nodules or swellings emptied - often without external influence - granular secretions.

The doctor clearly recognizes an infection after a microscopic examination. Examined here is the leaked secretion. If it is a fungal infection, the secretion has a grainy, thread-like, white to slightly yellowish structure.

After a clear diagnosis, the doctor has a selection of different drugs that can be used for therapy. If the drug therapy is applied in time, the course of the infection is quite harmless and above all painless.

If a Maduramycosis, but especially the fungus-induced Eumyzetoma, not treated, the infection is chronic. Symptoms such as purulent ulcers do not heal on their own. In addition, an attack on other parts of the body is almost inevitable. In the worst case, affected body regions have to be amputated.

complications

An infection with the fungi of the mycetome may lead to an additional bacterial superinfection. This means that another bacterial disease is favored. This can also occur if medical treatment has been done.

Mostly complications of a mycetoma but rather by a lack of medical treatment, since the tumor then has the ability to infiltrate the inside of the body and continue to grow inside. This can lead to bone destruction, that is, bone tissue is destroyed. The muscle tissue can also be affected. Adenopathy is also possible.

This refers to a disease of hormones producing glands. Tumors formed by proliferating granulation tissue can form cerebral and visceral metastases. This refers to offshoots in the brain and internal organs.

Letting the mycetomas grow too long can often cause them to severely limit their ability to walk because they are common on the feet. Deformation of the ankles can lead to additional movement disorders. If joints, bones and muscles have been attacked too much, an amputation must be performed, resulting in further disability.

When should you go to the doctor?

Changes in the appearance of the skin, discoloration or knots should be presented to a doctor. If there is a spread of the symptoms or if the intensity increases, there is a health impairment that needs to be investigated and treated. In cases of swelling, itching or open wounds, a clarification of the cause should be made. If mobility restrictions occur due to the disturbances or if there is a decrease in mobility, a doctor should be consulted. If the symptoms rapidly increase within a few hours, a doctor's visit is required as soon as possible.

The pathogens spread quickly and the body's defense system is not strong enough to defend itself against it to the necessary extent. A decrease in physical performance, an internal weakness or a general malaise indicate irregularities that should be presented to a doctor. If the person suffering from the visual changes of the skin or the blemish, an operative removal of the unwanted tissue is needed.

If it comes to inflammation of the skin, enlargement of an existing wound or gangrene, consult a doctor immediately. In severe cases, sepsis threatens and there is a potential threat to life. Irritability, behavioral problems or a withdrawal from familiar social activities are further indications of an existing disease.

Treatment & Therapy

Treatment of mycetoma is by medication. To choose the right remedy in the right dosage requires an accurate diagnosis. If there is a fungal infection, different antifungals are used for the treatment.

Since many of the fungal cultures are now very resistant or resistant to the antifungals, it is essential to control the effect accordingly while taking the medication. The funds are usually taken over a very long period, usually several years.

In addition to drug administration, it is recommended to surgically remove affected swollen or purulent areas to mitigate the associated discomfort to the patient.

If the mycetome is triggered by bacteria, the patient receives an antibiotic. Even with a bacterial infection, it can happen that the swelling in the affected areas of the body does not heal. Even then a surgical intervention would be indicated.

Outlook & Forecast

A mycetoma is now treatable and offers a positive prognosis. The condition must be treated surgically or medically in order to avoid spread of the fungus. If left untreated, maduramycosis can develop into a chronic disease associated with numerous occupational and personal limitations for the sufferer.

During the course of the disease, amputations may be necessary which significantly reduce the patient's quality of life. As a result of an amputation, mental illness can develop. For example, after loss of a body part, some patients develop depression or anxiety disorders that need to be treated. Also, physical complaints such as circulatory disorders or phantom pain occur after an amputation and influence the evaluation of the course.

Nevertheless, the prognosis is good, because today a whole range of therapy procedures are available and the fungal disease is usually not fatal. The assessment of the course of the disease is carried out by the responsible dermatologist or internist, which includes the severity of the disease, the constitution of the patient and social factors such as the financial situation of the person concerned. If necessary, the prognosis must be adjusted, especially in the case of unforeseen complications, such as those that occur especially in severe diseases.

prevention

A mycetome is very easy to prevent. Barefoot walking should be consistently avoided in those areas where mycetoma is common. If minor injuries occur in the area of ​​the foot, the wounds must be disinfected immediately and sustainably. When traveling to appropriate areas disinfectant or alcohol swabs in the first aid kit should not be missed.

aftercare

Aftercare for a mycetome depends on the type of treatment and the success of the treatment. If the fungal infection can be treated by medication, medical follow-up is usually no longer necessary. In the case of non-serious infestation and early treatment, consequential damage can almost always be prevented.

For more severe cases, surgical procedures may be considered. It is aimed to remove infected tissue. This sometimes leads to the removal of less tissue, with good wound care being important thereafter. Depending on the case and indication, a precautionary antibiotic therapy may be useful.

Follow-up of the tissue to remaining pathogens are also important. The aftercare must be reported by the specialist and depends on the severity of the procedure. Wound healing can be achieved within a few weeks with good wound care. Further follow-up measures are not necessary after complete healing.

If, however, amputated because too much tissue is affected, the aftercare is more difficult. The stump must be supplied. If necessary, additional therapies for aftercare may be added. This is the case, for example, if the person feels phantom pain. The learning of movements despite the amputated body part is part of the aftercare. The above-mentioned aftercare measures apply to fungal eumycetomas as well as bacterial actinomycetoms.

You can do that yourself

A mycetoma is usually treated with medication. Which measures the person concerned can take to alleviate the symptoms and promote the healing process depends on the type and severity of the disease.

Basically, protection and bed rest apply. Especially in the first days of the disease should be paid to sufficient warmth of the bed to avoid carryover of the pathogen. In addition, swollen or purulent areas should be carefully cared for and, if necessary, treated with gentle care products. The use of appropriate preparations should first be discussed with the responsible physician. Severe symptoms require surgical intervention. After surgery, the skin is usually very irritated and must not be exposed to harmful influences such as dirt or allergens. The person concerned should strictly adhere to the medical guidelines and inform the doctor about unusual symptoms.

Mycetoma usually heals well, provided that it is treated early and a doctor monitors the course. To avoid re-infection, the causes of the first fungal infection must be determined. For this purpose, a complaint diary can be created in which possible triggers and other abnormalities are noted.

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