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Fakultas Kedokteran Universitas Tarumanagara
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Mycetoma/Madura Footchronic infection
bacteria (Actinomycetoma) or fungi
(Eumycetoma)
Caseclinical features & response of
treatment.
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- Chronic granulamatous infection of dermal skin,
subcutaneous tissuesextend to the underlying bone.
- Caused by : traumatic inoculation of a fungus
(Eumycetoma) / bacterium (Actinomycetoma).
- tropic/subtropic areas
- Farmersfoot, lower legs, hand.
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Formation of grains containing aggregates of
the causative organismmay be discharged
onto skin surface through multiple sinuses.
Bacteria-induced mycetomaantibacterial
Fungi-induced mycetomaantifungal
Infection extend to the adjacent bonesurgery
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Case Report
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60 y.oFarmer
Thanh Hoaprovince
National Hospital of Dermato-Venereology
Trauma inhis foot leg
9 y.ago
A singlepapule
Successive nodules( intermitten
discharge seen hardwhite grains)
Dorsum&sole surfaceof the left foot
Antibioticpartiallyrelieved lession
-Severe pain &swelling of lesion,
hardened withmultiple
discharging sinus- No enlargementof regional lymph
node
7 y.ago 1 mo.ago Now to hospital
-swell mass
-dischargingsinus
-no pain
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X-rayosteitis (left foot)
Histopathology(HE)
unspesific dermatitis. Culturebacterium(-), fungus(-)past
antibiotic therapy
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Upon characteristics as epidemiology+color
of grains
actynomycetoma Osteitis curettagewelsh regimen.
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Mycetoma(1842) = madura foot (Madurai-India)
Microaerophilic actinomycetesactynomycetoma
True fungi
eumycetoma Young adults ( males 20 -40 y.o) in developing
countries, low socioeconomic status, manual workers
( agricultural workers, laborers, herdsmen) Foottraumatic inoculation of fungi/bacteria into
subcutaneus tissue)
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Lesion : subcutaneus swellingnodules
sinus containing grains
osteolisis. Triad :
- painless
-subcutaneus mass,multiple,sinuss
-discharge containing grains.
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Actinomycetoma Eumycetoma
Areas where the average rainfall isscarce ( 600mm)
Grains can be picked out by naked eyes
red/white
Microscopeblack/white
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-Hispathology
Granulamatous inflammation
Abscess formation
Fibrosis
-Smears of the discharge / Tissue biopsy
-Grains colour,size,PAS,Ziehn-Neelsen,inflamation cells composition.
-organism culturesdepends on : a paucity of grains within sampling error,
contamination of other bacterial organism, fibrosis.
-ELISAIgM antibodies
-PCRidentification of species.
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Eumycetomaantifungalsurgery
Actinomycetomas
Welsh regimen ivamikacin + oral cotrimoxazole
(trimethoprim+sulfamethoxazol) + osteitis
curettage + nodules drainage.
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Culture in mycetoma can be negative
because of many reason Clinical manifestations are very important
treat earlyavoiding complication ( osteitis
& amputation )
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