Eumycetoma (Fungal Mycetoma) Treatment & Management

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

Medical Care

Treatment of eumycetoma remains problematic. Historically, the treatment of eumycetoma has included surgical treatment, medical treatment, or both. Combined surgical and medical treatment appears to be the management option of choice.

Antifungal therapy has variable results. Note the following:

  • The sensitivity of organisms to antifungal drugs in vitro is not necessarily correlated with the in vivo response.
  • Amphotericin B has minimal or no effect on eumycetoma organisms.
  • Anecdotal reports of successful treatment with griseofulvin and dapsone exist.
  • In one study, a case of eumycetoma due to M grisea initially responded to fluconazole 400 mg/d but worsened after the patient stopped the treatment. In the same report, 2 other cases due to M mycetomatis and P boydii had either slight improvement or only transient clinical improvement with fluconazole 200-400 mg/d for 3 months. These cases were classified as nonresponsive.
  • Azole antifungal agents such as ketoconazole have some effectiveness. Mahgoub and Gumaa demonstrated that ketoconazole is effective in the treatment of eumycetoma caused by M mycetomatis.[12] They treated 13 patients with oral ketoconazole 200-400 mg/d; 5 patients were cured, and 4 patients improved. The median treatment duration was 12.9 months, with a treatment range of 3-36 months. Cures were noted with the higher dosages of ketoconazole.
  • Itraconazole is variably effective in the treatment of eumycetoma due to various organisms.[13, 14] One case of eumycetoma due to M mycetomatis without bony involvement was successfully treated with oral voriconazole at 600 mg/d, with a 4-year disease free follow-up.[15]
  • A study by N'Diaye et al showed that high-dose terbinafine (500 mg bid) for 24-48 weeks was generally well tolerated. In the investigators' overall opinion at the end of the study, of 20 eumycetoma patients who completed the study, 5 patients were clinically cured and 11 were clinically improved.[16]
Next

Surgical Care

Treatment in the past has included amputation of the affected limb or other radical surgery. Although surgical treatment alone results in recurrence rates as high as 80%, surgical resection with a wide surgical margin of uninfected tissue may be useful in early, small lesions without bony involvement. Surgical debulking together with oral antifungal treatment may be necessary with chronic extensive lesions.

Previous
Proceed to Medication
 
 
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

  1. Carter HV. On a new and striking form of fungus disease principally affecting the foot and prevailing endemically in many parts of India. Transactions of the Medical and Physical Society of Bombay. 1860;6:104-42.

  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].

  4. Abbott P. Mycetoma in the Sudan. Trans R Soc Trop Med Hyg. Jan 1956;50(1):11-24; discussion, 24-30. [Medline].

  5. Werlinger KD, Yen Moore A. Eumycotic mycetoma caused by Cladophialophora bantiana in a patient with systemic lupus erythematosus. J Am Acad Dermatol. May 2005;52(5 Suppl 1):S114-7. [Medline].

  6. Turiansky GW, Benson PM, Sperling LC, Sau P, Salkin IF, McGinnis MR, et al. Phialophora verrucosa: a new cause of mycetoma. J Am Acad Dermatol. Feb 1995;32(2 Pt 2):311-5. [Medline].

  7. Mathuram Thiyagarajan U, Bagul A, Nicholson ML. A nodulo-cystic eumycetoma caused by Pyrenochaeta romeroi in a renal transplant recipient: A case report. J Med Case Reports. Sep 14 2011;5(1):460. [Medline]. [Full Text].

  8. Ahmed AO, Desplaces N, Leonard P, Goldstein F, De Hoog S, Verbrugh H, et al. Molecular detection and identification of agents of eumycetoma: detailed report of two cases. J Clin Microbiol. Dec 2003;41(12):5813-6. [Medline].

  9. Hemalata M, Prasad S, Venkatesh K, Niveditha SR, Kumar SA. Cytological diagnosis of actinomycosis and eumycetoma: a report of two cases. Diagn Cytopathol. Dec 2010;38(12):918-20. [Medline].

  10. Gabhane SK, Gangane N, Anshu. Cytodiagnosis of eumycotic mycetoma: a case report. Acta Cytol. May-Jun 2008;52(3):354-6. [Medline].

  11. Ahmed M, Sureka J, Chacko G, Eapen A. MRI findings in cranial eumycetoma. Indian J Radiol Imaging. Oct 2011;21(4):261-3. [Medline].

  12. Mahgoub ES, Gumaa SA. Ketoconazole in the treatment of eumycetoma due to Madurella mycetomii. Trans R Soc Trop Med Hyg. 1984;78(3):376-9. [Medline].

  13. Degavre B, Joujoux JM, Dandurand M, Guillot B. First report of mycetoma caused by Arthrographis kalrae: successful treatment with itraconazole. J Am Acad Dermatol. Aug 1997;37(2 Pt 2):318-20. [Medline].

  14. Lee MW, Kim JC, Choi JS, Kim KH, Greer DL. Mycetoma caused by Acremonium falciforme: successful treatment with itraconazole. J Am Acad Dermatol. May 1995;32(5 Pt 2):897-900. [Medline].

  15. Lacroix C, de Kerviler E, Morel P, Derouin F, Feuilhade de Chavin M. Madurella mycetomatis mycetoma treated successfully with oral voriconazole. Br J Dermatol. May 2005;152(5):1067-8. [Medline].

  16. N'diaye B, Dieng MT, Perez A, Stockmeyer M, Bakshi R. Clinical efficacy and safety of oral terbinafine in fungal mycetoma. Int J Dermatol. Feb 2006;45(2):154-7. [Medline].

  17. Diaz M, Negroni R, Montero-Gei F, Castro LG, Sampaio SA, Borelli D, et al. A Pan-American 5-year study of fluconazole therapy for deep mycoses in the immunocompetent host. Pan-American Study Group. Clin Infect Dis. Mar 1992;14 Suppl 1:S68-76. [Medline].

  18. Hay RJ, Mackenzie DW. Mycetoma (madura foot) in the United Kingdom--a survey of forty-four cases. Clin Exp Dermatol. Sep 1983;8(5):553-62. [Medline].

  19. Hay RJ, Mahgoub ES, Leon G, al-Sogair S, Welsh O. Mycetoma. J Med Vet Mycol. 1992;30 Suppl 1:41-9. [Medline].

  20. Mahgoub ES. Mycetoma. Semin Dermatol. 1985;4:230-9.

  21. Mahgoub ES, Murray IG. Mycetoma. London, England: William Heinemann Medical Books; 1973:1-5, 47-53.

  22. Mariat F, Destombes P, Segretain G. The mycetomas: clinical features, pathology, etiology and epidemiology. Contrib Microbiol Immunol. 1977;4:1-39. [Medline].

  23. McGinnis MR. Mycetoma. Dermatol Clin. Jan 1996;14(1):97-104. [Medline].

  24. Murray PR, ed. Manual of Clinical Microbiology. 7th ed. Washington, DC: Amercian Society for Microbiology; 1999:1318-26.

  25. Rippon JW. Medical mycology: the pathogenic fungi and the pathogenic actinomycetes. Philadelphia, Pa: WB Saunders; 1988:80-118.

  26. Welsh O. Mycetoma. Current concepts in treatment. Int J Dermatol. Jun 1991;30(6):387-98. [Medline].

  27. Zaias N, Taplin D, Rebell G. Mycetoma. Arch Dermatol. Feb 1969;99(2):215-25. [Medline].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.