Mycetoma

Mycetoma is a chronic, granulomatous infection of the skin and subcutaneous tissue that may affect underlying organs. It can be caused by true fungi (eumycetoma) or by aerobic filamentous bacteria (actinomycetoma). It is predominantly found in tropical or subtropical regions but sporadic cases have been reported worldwide. Clinically, it presents as a painless, subcutaneous mass with presence of nodules, sinuses, and fistulae that drain a seropurulent discharge with grains of the etiological agent. Diagnosis is performed by direct mycological examination, biopsy, fungal and bacterial cultures, and imaging methods. Treatment depends on the etiology. Eumycetoma therapy consists of surgery and antifungals. Actinomycetoma treatment is based on antibiotic combinations usually trimethoprim/sulfamethoxazole and amikacin.