Eumycetoma (Fungal Mycetoma) 

  • Author: George Turiansky, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 30, 2012
 

Background

Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi. Approximately 40% of mycetomas worldwide are eumycotic as opposed to actinomycotic (ie, caused by bacterial actinomycetes). The disease is marked by progressive destruction of soft tissue and nearby anatomic structures.

Gill, who worked at a dispensary in the southern Indian province of Madura, first recognized mycetomas as a disease entity in 1842. Godfrey first documented a case of mycetoma in Madras, India. Native peoples of the province of Madura commonly called the disease Madura foot. In 1860, Carter, who established the fungal etiology of this disorder, first proposed the term mycetoma.[1] In 1872, Carter further proposed the terms melanoid and ochroid in an attempt to classify the disease into 2 varieties on the basis of the black or pale-colored granules (ie, grains, sclerotia) produced by the etiologic agents.[2]

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Pathophysiology

The foot is the most common site of infection, and 70% of all mycetomas affect the foot. Other reported sites of involvement include the upper extremities, trunk, buttocks, eyelids, lacrimal glands, paranasal sinuses, mandible, scalp, neck, perineum, and testes. The disease is initially limited to the skin and subcutaneous tissue but may eventually spread through the fascial planes to contiguous structures such as muscle, bone, blood and lymphatic vessels, and nerves. Rarely, the disease may spread to the regional lymph nodes or viscera.

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Epidemiology

Frequency

United States

Sporadic cases have been reported in North America. In the United States, epidemiologic data from 1896-1964 include only 30 cases of eumycetoma, with the highest incidence in the Southwest.[3] Mycetoma is common in Mexico; in the United States, physicians in Texas and other border states are most likely to encounter patients with mycetoma.

International

Eumycetoma is mainly a disease of the tropical and subtropical zones especially between the Tropic of Cancer and the Tropic of Capricorn, that is, between the latitudes 15° S and 30° N. Eumycetoma is endemic in India, parts of Africa (eg, Sudan,[4] Senegal, Somalia, Nigeria, Zaire, Chad), Pakistan, Yemen, Mexico, Central America, South America (eg, Guatemala, Venezuela, Colombia, Brazil), and Indonesia.

Mortality/Morbidity

Eumycetoma can be associated with significant morbidity in terms of gradual enlargement and deformity of the infected site. Severe involvement of the lower extremity may impair ambulation.

Sex

The disease incidence is higher in males than females, with a ratio of 4-5:1.

Age

The disease incidence is highest in persons aged 10-40 years.

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Contributor Information and Disclosures
Author

George Turiansky, MD  Professor, Department of Dermatology, Uniformed Services University of the Health Sciences; Deputy Director, National Capital Consortium, Graduate Medical Education, Uniformed Services University of the Health Sciences

George Turiansky, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Association of Professors of Dermatology, and Ukrainian Medical Association of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Carter HV. On mycetoma or the fungus disease of India. London, England: J & A Churchill; 1874.

  3. Green WO Jr, Adams TE. Mycetoma in the United States; a review and report of seven additional cases. Am J Clin Pathol. Jul 1964;42:75-91. [Medline].

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Eumycetoma of the leg with tumefaction, deformity, and multiple sinus tracts in a patient from Costa Rica. Courtesy of Mervyn L. Elgart, MD, Washington, DC.
Eumycetoma of the foot with tumefaction, deformity, and multiple sinus tracts. Courtesy of Mervyn L. Elgart, MD, Washington, DC.
 
 
 
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