Mycetoma: a tropical disease uncommon

Abstract

Mycetoma is a chronic and progressive infectious disease (produced by bacteria or fungi) of the skin, which can include subcutaneous tissue and bone. Among the causal agents, there are 27 species of true fungi and 10 actinomycetes, the latter being the most common, specifically Nocardia brasiliensis. Mycetoma is an endemic disease of tropical and subtropical regions, in people between 30 and 40 years of age are affected in a ratio of up to 4:1 men/women. The habitat of the causal agent is the soil and it is inoculated by skin traumas; it mainly affects farmers and individuals who carry out outdoor activities, populations with low economic resources and rural areas, who do not use closed shoes or footwear. The clinical manifestation of mycetoma is characterized by the presence of confluent erythematous and/or violaceous nodules that can be associated with fistulas that produces blood-purulent secretions. The classic mycetoma triad consists of a painless subcutaneous mass, multiple fistulas with discharge, and grains of varying size, consistency, and color. The etiologic diagnosis of this disease is made by histology, fine-needle puncture and PCR. In most patients, the clinical manifestation is asymptomatic or mild; however, complications such as bacterial superinfection or extension to underlying structures can occur, producing periostitis and osteomyelitis. Cachexia and anemia can be seen in cases of late mycetoma, appear in conjunction with malnutrition, sepsis and depression. The effective treatment of mycetoma is based on an accurate and early diagnosis of the causative organisms of this pathology. Treatment options will depend on the causative agent.