| 词条 | Eumycetoma |
| 释义 |
| name = Mycetoma | synonyms = | image = Madura foot..JPG | caption = Madura Foot | pronounce = | field = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }}Eumycetoma is a chronic granulomatous[1] fungal disease[2] of humans, affecting mainly the limbs, and sometimes the abdominal and chest walls or the head.[3] Mycetoma pedis (mycetoma of the foot), the most common form of mycetoma, is known widely as the Madura foot. The infection is endemic in Africa, India and Central and South America.[4] Signs and symptomsThe initial lesion is a small subcutaneous swelling following minor trauma. Later, sinuses that discharge purulent and seropurulent exudates containing grains which are fungal colonies are formed.[3][6] Destruction of deeper tissues, and deformity and loss of function in the affected limbs may occur in later stages. CausesMycetoma may be caused by bacteria from the phylum Actinomycetes, or by fungi (Eumycetes) where it is called eumycetoma.[3][5] Bacterial and fungal species that can cause mycetoma are listed below under their characteristic colours of discharge from infected wounds: Red discharge
Some species of the bacterial genus Nocardia (including Nocardia asteroides and Nocardia brasiliensis) which can cause mycetoma produce a yellow discharge, and those of the bacterial genus Streptomyces (including Streptomyces somaliensis) produce a yellow or red discharge. PathogenesisThe disease is usually seen in field workers like farmers, and generally affects men between 20 and 40 years. The disease is acquired by inoculation of grains of fungal spores from the soil through a breach in the skin produced by minor trauma like a thorn prick. The disease then spreads to deeper tissues and also forms sinus tracts leading to skin surface.[5] Mature lesions are characterised by a grainy discharge from these sinuses. These discharges contain fungal colonies and are infective. Spread of infection internally through blood or lymph is uncommon. Infections that produce a black discharge mainly spread subcutaneously. In the red and yellow varieties deep spread occurs early, infiltrating muscles and bones but sparing nerves and tendons, which are highly resistant to the invasion.[4] Botryomycosis, also known as bacterial pseudomycosis, produces a similar clinical picture and is caused usually by Staphylococcus aureus.[11] Other bacteria may also cause botryomycosis.[12]DiagnosisDiagnosis of mycetoma is usually established clinically in endemic areas. X rays and ultrasonography may be employed in evaluating the extent of the disease. X rays findings are extremely variable. The disease is most often observed at an advanced stage that exhibits extensive destruction of all bones of the foot. Rarely, a single lesion may be seen in the tibia where the picture is identical with chronic osteomyelitis. Cytology of fine needle aspirate or pus from the lesion, and tissue biopsy may be undertaken sometimes.[3] Some publications have claimed a "dot in a circle sign" as a characteristic MRI feature for this condition (this feature has also been described on ultrasound). Differential diagnosisThe following clinical conditions may be considered before diagnosing a patient with mycetoma:
PreventionNo vaccine is available. Simple hygienic precautions like wearing shoes or sandals while working in fields, and washing hands and feet at regular intervals may help prevent the disease. TreatmentDrugs like ketoconazole,[13] voriconazole,[14] and itraconazole[3] are generally employed in treating the infection. ActinomyceteEpidemiologyThe disease is endemic in tropical and subtropical regions.[3][5] The exact incidence and geographical distribution of mycetoma throughout the world is not known as the disease is usually painless, slowly progressive and presented to health centres only in late stages by majority of patients. Mycetoma has an uneven worldwide distribution. HistoryMadura foot or maduromycosis or maduramycosis[15] is described in ancient writings of India as Padavalmika, which, translated means Foot anthill.[5] The first modern description of Madura foot was made in 1842 from Madurai (the city after which the disease was named Madura mycosis) in India, by Gill.[5] The fungal cause of the disease was established in 1860 by Carter.[5] References1. ^{{cite journal |vauthors=Motswaledi HM, Mathekga K, Sein PP, Nemutavhanani DL |title=Paecilomyces lilacinus eumycetoma |journal=Int. J. Dermatol. |volume=48 |issue=8 |pages=858–61 |date=August 2009 |pmid=19659864 |doi=10.1111/j.1365-4632.2008.04047.x |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0011-9059&date=2009&volume=48&issue=8&spage=858|archive-url=https://archive.today/20130105054743/http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0011-9059&date=2009&volume=48&issue=8&spage=858|dead-url=yes|archive-date=2013-01-05}} 2. ^{{cite journal |vauthors=Brownell I, Pomeranz M, Ma L |title=Eumycetoma |journal=Dermatol. Online J. |volume=11 |issue=4 |pages=10 |year=2005 |pmid=16403382 |doi= |url=http://dermatology.cdlib.org/114/NYU/NYUtexts/0419058.html}} 3. ^1 2 3 4 5 {{cite book|title=Davidson's principles and practice of medicine|publisher=Churchill Livingstone Elsevier|isbn=9780443101335|page=373|edition=20th|year=2006}} 4. ^1 2 Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery {{ISBN|0-7506-0625-8}} 5. ^1 2 3 4 5 6 7 8 {{cite book|title=Textbook of Microbiology|publisher=Orient Longman Private Ltd.|isbn=978-8125028086|page=618|edition=7th|vauthors= Ananthanarayan BA, Jayaram CK, Paniker MD |year=2006}} 6. ^{{cite journal |vauthors=Hemashettar BM, Siddaramappa B, Munjunathaswamy BS, etal |title=Phaeoacremonium krajdenii, a cause of white grain eumycetoma |journal=J. Clin. Microbiol. |volume=44 |issue=12 |pages=4619–22 |date=December 2006 |pmid=17005754 |pmc=1698411 |doi=10.1128/JCM.01019-06 |url=http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=17005754}} 7. ^{{cite web |url=http://pathmicro.med.sc.edu/mycology/mycology-5.htm |title=Filamentous Fungi |website= |accessdate=}} 8. ^{{cite journal |vauthors=Severo LC, Oliveira FM, Vettorato G, Londero AT |title=Mycetoma caused by Exophiala jeanselmei. Report of a case successfully treated with itraconazole and review of the literature |journal=Rev Iberoam Micol |volume=16 |issue=1 |pages=57–9 |date=March 1999 |pmid=18473595 |doi= |url=http://www.reviberoammicol.com/pubmed_linkout.php?16p57}} 9. ^{{cite journal |vauthors=Vilela R, Duarte OM, Rosa CA, etal |title=A case of eumycetoma due to Madurella grisea in northern Brazil |journal=Mycopathologia |volume=158 |issue=4 |pages=415–8 |date=November 2004 |pmid=15630550 |doi=10.1007/s11046-004-2844-y |url=http://www.kluweronline.com/art.pdf?issn=0301-486X&volume=158&page=415}} 10. ^{{cite journal |vauthors=Ahmed AO, Desplaces N, Leonard P, etal |title=Molecular detection and identification of agents of eumycetoma: detailed report of two cases |journal=J. Clin. Microbiol. |volume=41 |issue=12 |pages=5813–6 |date=December 2003 |pmid=14662990 |pmc=309011 |doi= 10.1128/JCM.41.12.5813-5816.2003|url=http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=14662990}} 11. ^{{cite web|url=http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/two/000014143.htm|archive-url=https://web.archive.org/web/20080905182716/http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/two/000014143.htm|dead-url=yes|archive-date=5 September 2008|title=Dorlands Medical Dictionary:botryomycosis|author=|date=5 September 2008|accessdate=10 July 2018}} 12. ^{{cite web|title=Skin-nontumor Infectious disorders Botryomycosis|url=http://pathologyoutlines.com/topic/skinnontumorbotryomycosis.html|publisher=PathologyOutlines.com, Inc.}} 13. ^{{cite journal |vauthors=Capoor MR, Khanna G, Nair D, etal |title=Eumycetoma pedis due to Exophiala jeanselmei |journal=Indian J Med Microbiol |volume=25 |issue=2 |pages=155–7 |date=April 2007 |pmid=17582190 |doi= 10.4103/0255-0857.32726|url=http://www.ijmm.org/article.asp?issn=0255-0857;year=2007;volume=25;issue=2;spage=155;epage=157;aulast=Capoor}} 14. ^{{cite journal |vauthors=Loulergue P, Hot A, Dannaoui E, etal |title=Successful treatment of black-grain mycetoma with voriconazole |journal=Am. J. Trop. Med. Hyg. |volume=75 |issue=6 |pages=1106–7 |date=December 2006 |pmid=17172376 |doi= |url=http://www.ajtmh.org/cgi/pmidlookup?view=long&pmid=17172376}} 15. ^{{cite web|title=Infectious Disorders (Specific Agent) Madura foot/Mycetoma/Maduramycosis|url=http://en.diagnosispro.com/differential_diagnosis-for/synonym-maduromycosis/16211-154.html|publisher=MedTech USA, Inc.}} External links{{Medical resources| DiseasesDB = 8472 | ICD10 = {{ICD10|B|47|0|b|35}} | ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = med | eMedicineTopic = 30 | eMedicine_mult = {{eMedicine2|derm|280}} {{eMedicine2|derm|147}} | MeshID = D008271 }}{{Mycoses}} 3 : Neglected diseases|Tropical diseases|Mycosis-related cutaneous conditions |
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