Fact-sheet: Mycetoma - Madura foot
  • Madura foot


Updated on 10/06/2021 at 9:44 AM

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Definition

Inflammatory pseudotumors of the following origin: - 40% eumycetoma: fungal - 60% actinomycetoma: filamentous bacteria of the actinomycete class These pathogens live in soil and thorny vegetation of hot, humid, or semi-desert climates.

Clinical features

Primarily affects rural adults, following trauma. Foot involvement constitutes Madura foot (India). Chronic, painless, multifistulized swelling discharging grains. Contiguous bone involvement in 50% of cases.

Radiography

Contiguous bone involvement: - cortical erosions, lucencies - bony sclerosis - periosteal reactions - lace-like bone pattern in advanced stages

Ultrasound

Visualization of numerous small cavities containing multiple hyperechoic foci corresponding to mycetoma grains

CT

More sensitive than radiographs for detecting early erosions. Mycetoma: shows spontaneous density close to that of muscle, sometimes with hyperdense nodular areas. Moderate, heterogeneous enhancement after contrast injection

MRI

Infiltrative mass with T1 hyposignal; composed of multiple nodules with T2 hypersignal, sometimes showing a central focus of T2 hyposignal (mycelial aggregate). Gadolinium: marked enhancement of the granulomas, pathognomonic Dot-In-Circle appearance

Management

Definitive diagnosis: direct examination, bacteriological culture, and histology