Mycetoma (Madura foot, maduromycosis, Madura’s disease, mycotic tumor, mycetoma actinomycotic, mycetoma pedis; maduromycosis) is a chronic polyetiological fungal disease of soft tissues and bones, which is characterized by a deep lesion of the foot (less often the hand) with tumor-like enlargement, deformation, mycotic tumors), abscesses and fistulas with serous-purulent and hemorrhagic contents containing grains with elements of the pathogen. Mycetoma pedis is a collective term for a characteristic fungal infection of the foot (about 80 species of its pathogens of various systematic groups have been described; among them are nocardia, actinomycetes, and mold fungi). Moreover, some fungi are found in nature as saprophytes. Mycetoma is described in many countries of the world, but its distribution is uneven even in each individual state. It is generally accepted that this mycosis is found in countries with a hot and humid climate. The disease was first discovered in the 19th century in India, in Madura County – hence one of its names – maduromycosis (does not reflect the etiology, distribution, clinical identity). The possibility of mycetoma disease in the inhabitants of all climatic zones of the Earth is shown – from the equator to the Arctic Ocean; so, mycetoma is registered in Alaska, in Magadan, and so on. In Ukraine, the Zaporizhzhya region is considered endemic for mycetoma, where patients who have not left its borders are constantly registered (V.P. Fedotov et al., 1994).
As noted, this deep mycosis is caused by various types of parasitic fungi. Infection occurs with a limb injury, for example, spikes and needles of plants (walking barefoot during operation); soil is considered a source of infection. The incubation period is from 10 days to several years.
Clinically more often one foot is affected. The process makes its debut by the appearance of small, initially solitary, knots soldered to the tissue; In the future, dense, deep infiltrates and tumor-like nodes appear, increasing in size, abscessing and opening with the formation of fistulas. In the detachable fistulas there are characteristic “grains”, black or yellow; inside and outside of them fungal elements are revealed (more often the plexus of the mycelium). Along with scarring, the destructive process continues – muscles, fascia, joints, bones are affected – the foot (or hand) is sharply deformed and increases in size; the skin above it is first red-violet, then brownish in color. Peripheral and regional lymph nodes are often not enlarged. Bone pathology with mycetoma is accompanied by the appearance of single or multiple foci of destruction in the large bones of the limbs, as well as the destruction of small bones (metatarsus, tarsus, metacarpus, wrist). There are phenomena of osteosclerosis, periostitis, marginal usury, narrowing of the joint spaces, extensive osteolysis. Sometimes there is a diffuse lesion of all bones (foot or hand) of the “honeycomb” type. With mycetoma, visceropathy and generalization of the process are usually not observed; at the same time, the disease is often complicated by a secondary infection; cases of amyloidosis of internal organs are described. Mycetoma has a clinical resemblance to tuberculosis, pyoderma, osteomyelitis of a different etiology.
Treatment depends on the type of pathogen. When isolating filamentous and mold fungi (eumitsetoma), amphotericin B, amphoglucamine, orungal are used (200 mg 1 r / day for 2-5 months); in the identification of nocardia, therapy is carried out according to the principles of such with nocardiosis; nizoral with mycetoma is ineffective. When finding actinomycetes (actinomycotic mycetoma), actinolysate is prescribed according to the scheme, semisynthetic tetracyclines, sulfanilamides (including those combined with trimethoprim), clindamycin, natural (benzylpenicillin, fau-penicillin), high-dose synthetic amicillin, ampicillin, ampicillin, ampicillin, ampicillin, ampicillin, ampicillin, ampicillin and ampicillin the treatment complex includes iodides (50% solution of potassium iodide inside), DDS (150 mg / day), purified sulfur, gamma globulin – intramuscularly 2 r / week, for a course of 5 injections; immunocorrectors according to indications, large doses of vitamins; there is a recommendation to prescribe phtivazide, radiotherapy. Fractional plasmapheresis is used to eliminate circulating immune complexes (S. A. Burova et al., 1993). Fistulas are washed with antibiotic solutions, the passages are filled with ointments on PEO and other bases. In severe cases that are not amenable to therapy (including with bone damage), surgical intervention is necessary – amputation of the limb.