Mycetoma and Its Clinical Features

<p>Multiple abscesses and cavitary lesions. (A)</p> Signup and view all the answers

<p>Smaller and more abundant cavities. (C)</p> Signup and view all the answers

<p>Formation of sinuses and fistulas. (D)</p> Signup and view all the answers

<p>Immunocompromised patients. (B)</p> Signup and view all the answers

<p>3 months to 30 years. (A)</p> Signup and view all the answers

<p>Dietary habits of the host (B)</p> Signup and view all the answers

<p>Localized with well-defined margins (D)</p> Signup and view all the answers

<p>It may cause neurological symptoms due to pressure on the brain. (D)</p> Signup and view all the answers

<p>Rhabdomyosarcoma (C)</p> Signup and view all the answers

<p>Bone destruction in absence of sinuses (B)</p> Signup and view all the answers

<p>Streptomycin and Cotrimoxazole (A)</p> Signup and view all the answers

<p>Ketoconazole (B)</p> Signup and view all the answers

<p>Every month (B)</p> Signup and view all the answers

<p>Amputation (B)</p> Signup and view all the answers

<p>To prevent local spread of organisms (C)</p> Signup and view all the answers

<p>25 – 50% (C)</p> Signup and view all the answers

<p>Due to ill-defined borders of the lesion (D)</p> Signup and view all the answers

<p>It ranges between 20% and 90% (A)</p> Signup and view all the answers

<p>It causes destructive granulomatous responses. (A)</p> Signup and view all the answers

<p>It is common in areas with savanna vegetation. (B)</p> Signup and view all the answers

<p>Madurella mycetomatis (D)</p> Signup and view all the answers

<p>Small hard yellow grains (B)</p> Signup and view all the answers

<p>15° – 30° N (B)</p> Signup and view all the answers

<p>5:1 (B)</p> Signup and view all the answers

<p>It can affect any age group, but is common in ages 15 – 45 years. (C)</p> Signup and view all the answers

<p>By direct penetration of a thorn contaminated with the organism. (A)</p> Signup and view all the answers

<p>Chronic osteomyelitis (C), Osteoclastoma (D)</p> Signup and view all the answers

<p>Shape and size (A)</p> Signup and view all the answers

<p>Firm, rounded, and potentially soft (B)</p> Signup and view all the answers

<p>Eumycetoma shows abundant small cavities (B)</p> Signup and view all the answers

<p>LJ media containing eggs (B)</p> Signup and view all the answers

<p>Incorporating medical treatment (C)</p> Signup and view all the answers

<p>Type of occupation and history of similar conditions (C)</p> Signup and view all the answers

<p>Approximately 400 (C)</p> Signup and view all the answers

Combined therapy using Streptomycin and Cotrimoxazole is the standard approach. Streptomycin is administered at a dosage of 14mg/kg/day for the first month, followed by alternate-day dosing. Cotrimoxazole is given twice daily at 14mg/kg. If no response is observed, alternative medications like Dapsone, Rifambicin, or Fansidar can be combined with Streptomycin.

In cases where the standard treatment fails, amikacin can be used alone or in combination with cotrimoxazole. This regimen is reserved for situations where the initial therapy has proven ineffective. Amikacin is administered at 15 mg/kg/day in two divided doses for one week. Cotrimoxazole is continued for an additional five weeks. This therapy is cyclical and should not be used if patients have liver, ear, or kidney problems.

Ketoconazole is the drug of choice for Eumycetoma. The standard dose is 200mg twice daily. Liver function tests must be performed monthly during treatment to monitor for potential side effects.

Procaine penicillin is another option for treating Eumycetoma. The recommended dosage is 600,000 – 800,000 U/day administered intramuscularly.

Surgical intervention for mycetoma ranges from localized excision to mass reduction and, in advanced cases, amputation. Surgery also serves as a diagnostic tool.

Excisional or incisional biopsies can be performed during surgery to obtain tissue samples for histological examination and identification of the fungus causing the infection.

The goal of surgical treatment is to completely remove the mycetoma lesion. This is achievable in the early stages when the granuloma is confined to a specific area.

In cases of extensive lesions, surgical intervention focuses on reducing the mass of the infection. This involves excising involved soft tissues and curetting the affected bone.

The duration of the disease, the specific organism causing it, the affected body part, and the individual's immune response all influence how mycetoma appears.

Eumycetoma has well-defined borders and expands slowly, forming a few large sinuses with rare bone involvement. Actinomycetoma, however, is more aggressive with poorly defined borders, numerous small sinuses actively releasing pus, and early bone involvement.

Mycetoma usually presents as a firm, rounded swelling but can also be soft, bumpy, or rarely, filled with fluid. It typically continues to grow in size.

Mycetoma in the head and neck is particularly challenging to treat and carries a higher risk due to the potential for the infection to compress the brain, resulting in neurological issues and potentially death.

Conditions like Kaposi's sarcoma, neurofibroma, and malignant melanoma can resemble mycetoma, making it crucial to differentiate them.

Mycetoma is a chronic, granulomatous, subcutaneous infection caused by a fungus or bacteria. It is characterized by the presence of small, hard nodules (grains) in the skin and underlying tissues.

Mycetoma typically starts with a small, painless nodule in the skin, often following a minor injury.

The infection spreads slowly, typically involving skin, subcutaneous tissue, muscles, and bones, but not nerves or tendons.

Mycetoma can affect any part of the body, but commonly affects the lower limbs, followed by the upper limbs. It can also affect the head, neck, chest, back, abdomen, and perineum. Internal organs are rarely affected, except in immunocompromised patients.

As the infection progresses, the affected area may develop abscesses, sinuses, and fistulas that discharge pus and granules.

The distinctive radiological appearance of mycetoma is focal bone destruction with cavity formation. These cavities are generally small and numerous in Actinomycetoma, while larger and less numerous in Eumycetoma.

Mycetoma can be caused by different fungi or bacteria, with Actinomycetoma often progressing more rapidly compared to Eumycetoma.

Mycetoma is a painful and debilitating disease, requiring long-term treatment and often significant surgical intervention.

Mycetoma is characterized by destructive granulomatous and suppurative responses, which means the body tries to fight off the infection by forming clumps of immune cells and pus-forming reactions.

The disease was first reported in India about 300 years ago and was initially called 'Madura foot' because the foot was the most frequent site of infection.

The term 'Mycetoma' was introduced in 1861 to distinguish the disease from other tumors.

Mycetoma is more common in regions like Sudan and is caused by various fungi, including Madurella mycetomatis, Curvularia lunata, and Aspergillus nidulans, each leading to the formation of different types of grains.

Actinomycetoma is a bacterial disease caused by various bacteria, like Streptomyces somaliensis, Actinomadura madurae, Actinomadura Pelletieri, and Nocardia braziliensis, each producing different types of grains.

Mycetoma is prevalent in tropical and subtropical regions, particularly in areas with savanna vegetation, where acacia plants with thorns harbor the causative organisms.

The prevalence of mycetoma depends on factors like temperature, rainfall, and soil type.

A firm, rounded swelling that may be soft, lobulated, rarely cystic, and mobile.

The process of examining the skin's attachment to the underlying tissue. This helps determine the extent of the infection.

The number and activity of sinuses or openings in the skin that are associated with mycetoma.

A medical imaging technique used to reveal cavities or spaces within the bone. Helps diagnose mycetoma.

The appearance, size, and color of the causative organisms (grains) from the mycetoma.

Directly examining the mycetoma grains under a microscope to identify the fungus.

Growing the fungus from mycetoma in a lab to identify the specific organism.

Analyzing blood samples for the presence of antibodies against mycetoma, which can help confirm the diagnosis.