Mycetoma

• Chronic progressive granulomatous infection of the skin and subcutaneous tissue, usually affecting a single extremity

Background

Microbiology

• Can be caused either by fungi or filamentous aerobic bacteria
• Fungal species (eumycotic mycetoma):
  • Dark grains:
    • Madurella mycetomatis
    • Leptosphaeria senegalensis
    • Madurella grisea
    • Exophiala jeanselmei and Exophiala oligosperma
  • Pale/white grains:
    • Pseudallescheria boydii (most common) (Scedosporium)
    • Acremonium kiliense
    • Aspergillus flavus, Aspergillus nidulans, Aspergillus hollandicus
• Aerobic bacteria (actinomycotic mycetoma):
  • Nocardia brasiliensis
  • Actinomadura madurae
  • Streptomyces somaliensis
  • Actinomadura pelletieri (grains are red to pink)

Clinical Presentation

• Clinical triad:
  • Localized swelling
  • Underlying sinus tract
  • Grains and granules (“sulfur granules”) within the sinus tracts

Diagnosis

• Send granules in sterile container
• Gram stain a crushed granule for bacteria, then set up cultures for bacterial and fungal cultures