Mysetoma Balado Dr Linda

8/11/2019 Mysetoma Balado Dr Linda

1/15

Fakultas Kedokteran Universitas Tarumanagara


2/15

Mycetoma/Madura Footchronic infection

bacteria (Actinomycetoma) or fungi

(Eumycetoma)

Caseclinical features & response of

treatment.


3/15

- Chronic granulamatous infection of dermal skin,

subcutaneous tissuesextend to the underlying bone.

- Caused by : traumatic inoculation of a fungus

(Eumycetoma) / bacterium (Actinomycetoma).

- tropic/subtropic areas

- Farmersfoot, lower legs, hand.


4/15

Formation of grains containing aggregates of

the causative organismmay be discharged

onto skin surface through multiple sinuses.

Bacteria-induced mycetomaantibacterial

Fungi-induced mycetomaantifungal

Infection extend to the adjacent bonesurgery


5/15

Case Report


6/15

60 y.oFarmer

Thanh Hoaprovince

National Hospital of Dermato-Venereology

Trauma inhis foot leg

9 y.ago

A singlepapule

Successive nodules( intermitten

discharge seen hardwhite grains)

Dorsum&sole surfaceof the left foot

Antibioticpartiallyrelieved lession

-Severe pain &swelling of lesion,

hardened withmultiple

discharging sinus- No enlargementof regional lymph

node

7 y.ago 1 mo.ago Now to hospital

-swell mass

-dischargingsinus

-no pain


7/15

X-rayosteitis (left foot)

Histopathology(HE)

unspesific dermatitis. Culturebacterium(-), fungus(-)past

antibiotic therapy


8/15

Upon characteristics as epidemiology+color

of grains

actynomycetoma Osteitis curettagewelsh regimen.


9/15

Mycetoma(1842) = madura foot (Madurai-India)

Microaerophilic actinomycetesactynomycetoma

True fungi

eumycetoma Young adults ( males 20 -40 y.o) in developing

countries, low socioeconomic status, manual workers

( agricultural workers, laborers, herdsmen) Foottraumatic inoculation of fungi/bacteria into

subcutaneus tissue)


10/15

Lesion : subcutaneus swellingnodules

sinus containing grains

osteolisis. Triad :

- painless

-subcutaneus mass,multiple,sinuss

-discharge containing grains.


11/15

Actinomycetoma Eumycetoma

Areas where the average rainfall isscarce ( 600mm)

Grains can be picked out by naked eyes

red/white

Microscopeblack/white


12/15

-Hispathology

Granulamatous inflammation

Abscess formation

Fibrosis

-Smears of the discharge / Tissue biopsy

-Grains colour,size,PAS,Ziehn-Neelsen,inflamation cells composition.

-organism culturesdepends on : a paucity of grains within sampling error,

contamination of other bacterial organism, fibrosis.

-ELISAIgM antibodies

-PCRidentification of species.


13/15

Eumycetomaantifungalsurgery

Actinomycetomas

Welsh regimen ivamikacin + oral cotrimoxazole

(trimethoprim+sulfamethoxazol) + osteitis

curettage + nodules drainage.


14/15

Culture in mycetoma can be negative

because of many reason Clinical manifestations are very important

treat earlyavoiding complication ( osteitis

& amputation )


15/15

Documents

Mysetoma Balado Dr Linda