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Dermatologic Manifestations of Mycetoma Follow-up

  • Author: Oliverio Welsh, MD(DrSc); Chief Editor: Dirk M Elston, MD  more...
Updated: Jul 26, 2013


Actinomycetomas generally respond well to trimethoprim-sulfamethoxazole/amikacin (see Medication) in 90% of cases. In those cases in which bacteria have become resistant to this treatment, antibiotic susceptibility testing should be performed to select the best antimicrobial agent or agents to be used.

Eumycetoma tends to be a more chronic disease, and success with medical therapy is observed in only about 40% of cases. If the response is partial or negative to medical treatment, surgery of the affected area should be performed, and antifungal drugs continued until complete remission of the disease.

Contributor Information and Disclosures

Oliverio Welsh, MD(DrSc) Former Chair, Active Emeritus Professor, Department of Dermatology, Universidad Autónoma De Nuevo León, Mexico

Oliverio Welsh, MD(DrSc) is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.


Lucio Vera-Cabrera, PhD Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario, UANL, Mexico

Lucio Vera-Cabrera, PhD is a member of the following medical societies: American Society for Microbiology

Disclosure: Nothing to disclose.

Mario C Salinas-Carmona, MD, PhD Chair, Department of Immunology, Universidad Autónoma De Nuevo León, Mexico

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Susan M Swetter, MD Director, Pigmented Lesion and Melanoma Program, Professor, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Veterans Affairs Palo Alto Health Care System

Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, American Society of Clinical Oncology, Society for Melanoma Research, Eastern Cooperative Oncology Group, American Medical Association, Pacific Dermatologic Association, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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Actinomycetoma of the foot (left) and arm (center) caused by Nocardia brasiliensis. Multiple nodules and fistulae are present. Microscopic examination of the pus (right). Granules are observed, which are multilobulated and surrounded by abundant clubs.
Eumycetoma. Mycetoma of the hand (left). Microscopic features of a Madurella mycetomatis grain are observed (center). Notice the presence of brownish hyphae and intercellular cement (hematoxylin and eosin stain). Macrocolony of another eumycotic agent, Scedosporium apiospermum (Pseudallescheria boydii) (right).
Table 1. Fungi Causing Mycetoma
White grainBlack grain
Acremonium falciformeExophiala jeanselmei
Acremonium kilienseMadurella grisea
Acremonium recifeiM mycetomatis
Cylindrocarpon destructansM pseudomycetomatis
Fusarium moniliformeLeptosphaeria tomkinsii
Fusarium solaniLeptosphaeria senegalensis
Neotestudina rosatiiPyrenochaeta mackinnonii
Pseudallescheria boydiiPyrenochaeta romeroi
----------------Phlenodomus avramii
Table 2. Microorganisms Causing Actinomycetomas in Humans
Etiologic agentGrain
A maduraeWhite, large, 1-5 mm in diameter
A pelletieriRed, hard, 1 mm in diameter
N brasiliensisWhite to yellow, multilobed, soft, < 0.5 mm in diameter
N asteroidesUncommon, white, soft, < 0.5 mm in diameter
Nocardia otitidiscaviarumWhite to yellow, lobed, < 0.5 mm in diameter
Nocardia transvalensisWhite to yellow, < 0.5 mm in diameter
Nocardia veterana[11] --
Nocardia mexicana[12] --
N harenae--
N takedensis--
Nocardiopsis dassonvilleiWhite to yellow, < 0.5 mm in diameter
S somaliensisYellow, hard, 2 mm in diameter
Streptomyces sudanensisYellow, hard, 2 mm in diameter
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