Mysterious mycetoma foot – A case series

Abstract

Mycetoma or Madura foot is an unique tropical disease affecting skin, subcutaneous tissue,and bones commonly the foot, characterized by triad of localized swelling, multiple sinus tracts and discharge of grains or granules. The causative microorganism enters the skin through minor abrasions caused by trivial injuries. Mycetoma classified into eumycetoma caused by fungus such as Madurella mycetomatis etc, and actinomycetoma caused by bacteria such as Actinomadura madurae etc. Approximately 75% of mycetoma cases are actinomycetoma in India. Usually Actinomycetoma responds well to antibacterial therapy whereas eumycetoma poorly responds to antifungal therapy with frequent recurrences. Three cases of actinomycetoma foot were reported at Aarupadai Veedu Medical College and Hospital. These cases were males of low socioeconomic status, residing at villages (rural areas) around Chidambaram town and farmers by occupation. These cases were provisionally diagnosed as actinomycetoma foot clinically and with laboratory investigation such as KOH, Gram stain. Confirmation was done by Fungal culture and Biopsy. No bony involvement was confirmed by radiologically. These three cases were treated with Welsch regimen of 3 cycles of injection amikacin IV for 21 days thrice at the interval of 15 days combined with oral Cotrimaxole for 6 months showed satisfying response. Out of three cases one case showed recurrence due to irregular treatment undergone by the patient. The recurrence was confirmed by repeat biopsy which showed the evidence of sinus tracts lined by inflammatory vascular granulation tissue. This case was presented mainly to establish the prolonged disease course and often diagnosed at the later stage.Therefore the diagnostic and therapeutic challenges along with epidemiological data emphasis the need to pay more attention to this unique neglected tropical disease.