Mycetoma

Mycetoma is a chronic infection in the skin caused by either bacteria (actinomycetoma) or fungi (eumycetoma), typically resulting in a triad of painless firm skin lumps, the formation of weeping sinuses, and a discharge that contains grains.^[1] 80% occur in feet.^[1]

Most eumycetoma is caused by M. mycetomatis, whereas most actinomycetoma is caused by N. brasiliensis, S. somaliensis, A. madurae and Actinomadura pelletieri.^[1] People who develop mycetoma likely have a weakened immune system.^[1] It can take between 3 months to 50 years from time of infection to first seeking healthcare advice.^[1]

Diagnosis requires ultrasound and fine needle aspiration.^[1]

While most cases of mycetoma occur in Sudan, Venezuela, Mexico, and India, its true prevalence and incidence are not well-known.^[2][3] It appears most frequently in people living in rural areas, particularly in farmers and shepherds, who are often men between 20 and 40 years earning the primary incomes for their families.^[1] It has been reported since 1840.^[4] Noteworthy, the diagnosis of mycetoma in non-endemic or low endemic areas as Europe and North Africa is challenging.^[5][6] Physicians in these areas are usually unfamiliar with the disease-specific manifestations and need to exercise extra vigilance regarding those patients who are at high risk of contracting mycetoma infections.^[7] Recent evidence suggests that Egypt, which borders sub-Saharan Africa, is a low-endemic country.^[5] Additionally, recent evidence suggests that Pakistan, which borders India, is a moderate-endemic country.^[8] Unlike bacterial acute hematogenous osteomyelitis and septic arthritis, misdiagnosed or delayed diagnosis of mycetoma osteomyelitis can result in amputation or radical resection.^[5] The disease is listed by the World Health Organization (WHO) as a neglected tropical disease.^[3]