Mycetoma: Treatment, Procedure, Cost and Side Effects

Initially called Madura foot.

Mycetoma is a condition where a chronic infection occurs of skin and the subcutaneous layer of cells. The condition may be caused by fungi, where it is called eumycetoma or mycotic mycetoma, or by the actinomyces group of bactereia, where it is called actinomycetoma or actnomycotic mycetoma. Commonly affected regions are the feet and hands, although head, chest, back, and neck infections may also occur. Infection occurs through minor trauma like cuts on the skin or pricking through thorns, fishbones, etc. Infected soil is the main culprit.

The condition is characterized by an inflammatory response at the site of infection accompanied by formation of granules. This causes a progressive swelling and formation of lesions in the cutaneous and subcutaneous region which may spread to the underlying bones. These lesions burst and discharge their contents in the form of tiny granules onto the skin through multiple sinuses. The colour of these granules can identify the specific causative agent.

Mycetoma causes disfiguration, but is usually not fatal, except in patients with compromised immune system or where the skull becomes involved in the infection. The lesions are progressive, but painless, although painful secondary infections may occur. Treatment is more effective the earlier the condition is diagnosed.

Treatment for mycetoma is usually a combination of medications and surgical removal of the abscesses. Antibiotics, followed by surgery are prescribed for actinomycetes infection, while the surgical removal is usually done first in a fungal infection, followed by antifungal treatment. Antibiotic treatment is usually sufficient for mycetoma caused by bacterial infection, especially if the treatment is started early. However, medical treatment is lengthy, usually extending for years. Few cases have been treated with beam radiotherapy.

Symptoms of mycetoma are same for both actinomycotic and eumycotic mycetoma. These include progressive swelling accompanied by inflammation at the site of infection and around it on the skin and subcutaneous cells. The swelling may be accompanied by abscesses or lesions containing characteristic granular formations. These lesions may burst and release these granules on the skin through multiple sinuses. The inflammation and swelling may spread into the surrounding bones which may cause disfiguration. Secondary infections may occur. These symptoms are eligible for treatment.

If the inflammation is not chronic and progressive then treatment for mycetoma is not required. The lesions formed and granules discharged are characteristic of the condition and the causing organism. Treatment for mycetoma is not required if the symptoms are not of mycetoma.

Antibiotic treatment is usually accompanied by some side effects, and prolonged treatment with antibiotics carries a risk of developing resistance to it.

There are no specific post treatment guidelines after treatment for mycetoma. Some guidelines may be prescribed by the healthcare professional.

Medical treatment for mycetoma is long term, extending for months or even years. Surgical procedures are performed together with medical treatment which significantly reduces time for recovery.

Cost of treatment for mycetoma including medicines and surgical costs usually stay between Rs. 1,000 and Rs. 10,000. Additional procedures may increase the cost.

The results after completion of the treatment and successful elimination of the causative agent by medications or surgery are permanent as long as the infection does not happen again.