Appendix
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Dermatology/Infectious Diseases

Eumycetoma

Mycetoma is characterized by a progressive and chronic granulomatous infection affecting the skin and subcutaneous tissue. Mycetoma can be classified as "eumycetoma" when it is caused by fungi or "actinomycetoma" when caused by bacteria in the order Actinomycetes. Therefore, eumycetoma is a deep fungal infection of the skin and subcutaneous tissue commonly caused by the filamentous fungi Madurella mycetomatis . Eumycetoma is characterized by a deep granulomatous inflammation, resulting in the fo

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  • Neglected infections may lead to severe tissue destruction
  • If left untreated, the infection can spread along fascial planes and affect muscle and bone, resulting in complications such as osteomyelitis or extension into deeper structures, which can render the organism more resistant to treatment
  • Screen individuals in endemic regions for signs and symptoms of eumycetoma, especially those with a history of barefoot walking and soil exposure.
  • Clinical evaluation may be sufficient for diagnosis, especially in low-resource settings, based on the triad of diagnostic findings (tumor, sinus tracts, and discharge with grains).
  • The most specific test for diagnosing eumycetoma involves examining grains or granules from discharge, both visually and microscopically.
  • However, a deep punch biopsy can be a diagnostic tool if drainage material cannot be expressed or examined.
  • H&E staining of tissue sections and fungal staining techniques such as PAS provides detailed visualization of fungal grains.
  • Imaging may be necessary to determine the disease burden, utilizing techniques such as x-ray, ultrasonography, computed tomography (CT) scans, and magnetic resonance imaging (MRI).
  • MRI may be employed when there are concerns regarding soft tissue or bone involvement, with a characteristic finding known as the "dot-in-circle" sign.
  • Surgical biopsy, histopathological examination, and fungal tissue cultures are crucial in identifying the organism.
  • Managing eumycetoma poses significant challenges and necessitates a prolonged treatment regimen that often combines systemic antifungal therapy for an extended duration with surgical interventions.
  • treatment involves a combination of antifungal therapies and surgical procedures.
  • Initially, preoperative antifungal therapy is administered for a duration of 6 months, followed by surgical procedures aimed at debulking and reducing the disease burden, succeeded by an additional 6 months of antifungal therapy.
  • Azole antifungals are considered the "gold standard" for treatment, with itraconazole being the most commonly used.
  • Amphotericin B : The toxicity and requirement for hospitalization have significantly restricted the utilization of amphotericin B.
  • Although liposomal amphotericin B has been used in certain cases in endemic regions, its efficacy has been inadequate, and the severe adverse effect of nephrotoxicity limits its application.
  • Intralesional administration of amphotericin B has demonstrated favorable outcomes in select cases with a solitary lesion; however, it is not an efficacious treatment option for multilobulated lesions due to uneven drug diffusion and the risk of dissemination.
  • Relapse of eumycetoma is common, especially among individuals with a disease duration exceeding 10 years and those with involvement outside of the feet.
  • If left untreated, the infection can spread along fascial planes and affect muscle and bone, resulting in complications such as osteomyelitis or extension into deeper structures, which can render the organism more resistant to treatment
  • Moreover, the condition may cause significant deformities with associated psychosocial consequences.
  • The outcomes of eumycetoma rely on prompt diagnosis and timely management of the condition; hence, early consultation with interprofessional healthcare specialists is highly recommended.
  • review
    Eumycetoma. StatPearls [Internet] — Sujitha Yadlapati, Nishad C. Sathe, Soham P. Chaudhari — StatPearls Publishing, 2024

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov