MYCETOMA (MADUROMYCOSIS)
	ORGANISM Mycetoma is caused by several fungi Many different species causing different color grains in the lesion Black grain - Madurella mycetomatis White grain -Pseudallescheria boydii Yellow grains - Nocardia asteroides Distributed worldwide, but especially in tropics. Found in soil and plant material in tropical regions Mycetoma may be due to several fungi
	ENTRY INTO THE BODY The organism is inoculated into the skin by minor injury e.g. a cut with a thorn when walking barefoot.
	CLINICAL FEATURES Chronic infection of skin (usually foot), subcutaneous tissues, bones Fungus destroys subcutaneous tissue causing serious deformities Characterised by grains, the colour of which depend on the organism Starts as a single painless lesion on the foot which may persist for years The middle of the lesion become pus filled and contains grains. Grows slowly, spreading to underlying skin and muscle and bone No discomfort but may be itching or burning Secondary bacterial infection is common Often confused with other fungal infections such as chromoblastomycosis
	INCIDENCE AND GLOBAL DISTRIBUTION Particularly common in the tropics Disease more common in men than women especially those 20-50
	DIAGNOSIS Identification of grains obtained from a soft part of the lesion or by collecting pus. Occasionally a skin biopsy is necessary. Microscopy using potassium hydroxide confirms diagnosis and type
	TREATMENT Does not resolve without appropriate treatment with antibiotics (months-years of treatment) . Itraconazole Ketoconazole Deformity may persist. Surgery to remove the affected tissue completely. Amputation necessary if bone is involved.
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