Eumycetoma (Fungal Mycetoma) Workup

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

Laboratory Studies

Identification of the etiologic agent of eumycetoma is based on direct microscopic examination of the granules, culture isolation of the agent, colonial features and fungal microscopic morphology.[8, 9]

Eumycetoma granules can be crushed and examined at microscopy with direct wet mounts after treatment with 10-20% potassium hydroxide, lactophenol cotton blue, Albert stain, or physiologic saline solution.

Eumycetoma agents appear as broad, septate, branching hyphae 2-5 µm in diameter or, as in the case of E jeanselmei, as a compact mass of rounded cells.

Fresh granules can be teased from lesional tissue or biopsy specimens. These cells can be washed in saline solution or saline solution containing antibiotics prior to culturing on fungal media such as Sabouraud dextrose agar, blood agar, or a brain-heart infusion containing antibiotics.

Granules from draining sinus tracts may not be optimal for culturing because of bacterial contamination.

Ahmed et al reported 2 cases of leg eumycetoma due to M mycetomatis that were successfully identified by species-specific polymerase chain reaction and DNA sequencing.

Fine-needle aspiration cytology of lesional tissue with the use of special stains may be useful in diagnosis.[10]

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Imaging Studies

Radiographs, CT scans, and MRIs demonstrate the presence and extent of bone or organ involvement.[11] Changes of underlying bony structures may include the following:

  • Osteoporosis
  • Bony destruction
  • Loss of cortical margin with bony erosion
  • Punched-out lytic lesions
  • Osteophyte formation
  • Osteomyelitis
  • Periosteal elevation
  • Marrow infiltration
  • Coarse trabecular pattern
  • Bony expansion
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Histologic Findings

A biopsy specimen should be obtained from a small abscess or from the sinus tract. Hematoxylin-eosin stained sections reveal extensive granulation tissue containing abscesses. Granules of 0.2-5.0 mm in diameter may be found in abscesses or sinuses. Eumycotic granules have positive results with periodic acid–Schiff and Gomori methenamine silver stains. They contain gram-negative septate hyphae that are 2-5 µm in diameter. Eosinophilic material may be seen deposited around the granule; this material represents an immunologic response, the Splendore-Hoeppli reaction.

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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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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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