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Madura Foot

Case: Madura Foot - Mycetoma

Reported by Dr.C.N.Kulkarni, Balaji Plots, Amaravati, M.S. India

A 37 yr old, male, suffering from painful swelling of left foot for last 7 yrs. He has multiple discharging sinuses on the foot. The discharge is of reddish fluid, yellow puslike fluid & tiny yellowish stones. Our clinical diagnosis is Madura mycosis. Such cases are rare in our part of the world (India). I would like to know about treatment for this condition. He is nondiabetic.

Comments

FROM: Myles Clough

I did a search on Medline using the search term "Madura mycosis" This yeilded 74 citations most of which were on the subject. One of the most recent was published in Acta Belgica Orthopaedica in 1998 and was typical of the abstracts I read, stressing the need for a mycological diagnosis and aggressive antibiotic treatment.

Acta Orthop Belg 1998 Jun;64(2):242-8
The Madura foot: an "innocent foot mycosis"?
Ten Broeke R, Walenkamp G
Department of Orthopedic Surgery, University Hospital Maastricht, TheNetherlands.

With the increased movement of the world population, acquaintance with the clinical picture of the Madura foot is of growing importance beyond its original endemic areas. The characteristic triad of symptoms consists of indurated swelling, multiple sinus tracts with purulent discharge filled with grains and localization at the foot. An increasing number of new etiologic agents are recognized today. For a better choice of therapy an adequate diagnostic procedure is essential ; a deep biopsy for histology appears to give a more substantial contribution to identification of the causal organism than culture. The treatment which should be started early, is at first essentially a drug treatment. However, in spite of high expectations with regard to new antimycotic drugs, amputation or disarticulation is often inevitable even today, particularly when the lesion is caused by Eumycetes. The first two documented patients with this disease in the Netherlands are described. They developed serious deformities of the lower extremity despite long-term use of antimycotic and antibiotic medication.

Myles Clough
Orthopaedic Surgeon, Kamloops, BC, Canada


FROM: Dr. T.M. Sunil

Maduramycosis is indeed rare everywhere. Treatment is controversial as pharmacotherapy doesn't seem to have much effect. Dapsone & Tetracyclines are two recommended drugs. However, the foot lesion is very recalcitrant and most often ends up in a Syme's amputation.
The danger of inadequate local clearance - just in case you were planning a curettage - is that there may be a systemic spread especially the inguinal nodes and intestines.

All the best,
Dr. T.M. Sunil, M.B.,B.S.(B.M.C.), M.S. ORTH (MADRAS), D.N.B. ORTH
Assistant Professor
Department of Orthopaedics, M.S. Ramaiah Medical College
Bangalore, India

Bibliography

Rigopoulos D, Mavridou M, Nicolaidou E, Christofidou E, Antoniou C, Stratigos A, Katsambas A. Mycetoma due to actinomycetes: a rare entity in Europe. Int J Dermatol. 2000 Jul;39(7):557-8.

Lucas RE, Armstrong PK. Two cases of mycetoma due to Nocardia brasiliensis in central Australia. Med J Aust. 2000 Feb 21;172(4):167-9.

Hay RJ. Therapeutic potential of terbinafine in subcutaneous and systemic mycoses. Br J Dermatol. 1999 Nov;141 Suppl 56:36-40. Review.

Young BA, Fee MJ, Giacopelli JA, Granoff DP, Kobayashi W.Mycetoma. J Am Podiatr Med Assoc. 2000 Feb;90(2):81-4. Review.

Ganguli SN, Hershkop M. Bone scintigraphy of Madura foot. Clin Nucl Med. 1999 Apr;24(4):284-5.

Lexier R, Walmsley SL. Successful treatment of Madura foot caused by Pseudallescheria boydii with Escherichia coli superinfection: a case report. Can J Surg. 1999 Aug;42(4):307-9. No abstract available.

Janaki C, Sentamilselvi G, Janaki VR, Devesh S, Ajithados K.Case report. Eumycetoma due to Curvularia lunata. Mycoses. 1999;42(4):345-6.

Severo LC, Vetoratto G, Oliveira F de M, Londero AT.Eumycetoma by Madurella grisea. Report of the first case observed in the southern Brazilian region. Rev Inst Med Trop Sao Paulo. 1999 Mar-Apr;41(2):139-42. Review.

Yamamoto Y.  Mycetoma pedis. Ryoikibetsu Shokogun Shirizu. 1999;(25 Pt 3):247-8. Review. Japanese.

Davis JD, Stone PA, McGarry JJ. Recurrent mycetoma of the foot. J Foot Ankle Surg. 1999 Jan-Feb;38(1):55-60.

Boiron P, Locci R, Goodfellow M, Gumaa SA, Isik K, Kim B, McNeil MM, Salinas-Carmona MC, Shojaei H. Nocardia, nocardiosis and mycetoma. Med Mycol. 1998;36 Suppl 1:26-37. Review.

Hazra B, Bandyopadhyay S, Saha SK, Banerjee DP, Dutta G.A study of mycetoma in eastern India. J Commun Dis. 1998 Mar;30(1):7-11.

Ten Broeke R, Walenkamp G. The Madura foot: an "innocent foot mycosis"? Acta Orthop Belg. 1998 Jun;64(2):242-8.

Ahmed AO, Abugroun ES. Unexpected high prevalence of secondary bacterial infection in patients with mycetoma. J Clin Microbiol. 1998 Mar;36(3):850-1.

Paugam A, Tourte-Schaefer C, Keita A, Chemla N, Chevrot A.Clinical cure of fungal madura foot with oral itraconazole.
Cutis. 1997 Oct;60(4):191-3.

Corr P. Clinics in diagnostic imaging (26). Madura foot (or mycetoma). Singapore Med J. 1997 Jun;38(6):268-9.

Locken JA, Strong B, Martin TP. Mycetoma of the calf. Skeletal Radiol. 1997 May;26(5):319-22. 

Fahal AH, Sheik HE, Homeida MM, Arabi YE, Mahgoub ES.Ultrasonographic imaging of mycetoma.Br J Surg. 1997 Aug;84(8):1120-2.

EL Hag IA, Fahal AH, Gasim ET. Fine needle aspiration cytology of mycetoma. Acta Cytol. 1996 May-Jun;40(3):461-4.

Perez-Blanco M, Hernandez-Valles R, Fernandez-Zeppenfeldt G, Yegres F.  Mycetoma: report of 3 cases in Falcon State, Venezuela. Invest Clin. 1996 Mar;37(1):61-73. Review. Spanish.

Warren NG. Actinomycosis, nocardiosis, and actinomycetoma. Dermatol Clin. 1996 Jan;14(1):85-95. Review.

McGinnis MR. Mycetoma.
Dermatol Clin. 1996 Jan;14(1):97-104. Review.

Mahe A, Develoux M, Lienhardt C, Keita S, Bobin P. Mycetomas in Mali: causative agents and geographic distribution. Am J Trop Med Hyg. 1996 Jan;54(1):77-9.

Gugnani HC, Ezeanolue BC, Khalil M, Amoah CD, Ajuiu EU, Oyewo EA. Fluconazole in the therapy of tropical deep mycoses. Mycoses. 1995 Nov-Dec;38(11-12):485-8.

Resnik BI, Burdick AE. Improvement of eumycetoma with itraconazole. J Am Acad Dermatol. 1995 Nov;33(5 Pt 2):917-9.

Develoux M, Ndiaye B, Dieng MT. Mycetomas in Africa. Sante. 1995 Jul-Aug;5(4):211-7. Review. French.

Subrahmanyam M. Intra-arterial chemotherapy for mycetoma of the foot. Br J Surg. 1995 May;82(5):643.

Turiansky GW, Benson PM, Sperling LC, Sau P, Salkin IF, McGinnis MR, James WD. Phialophora verrucosa: a new cause of mycetoma. J Am Acad Dermatol. 1995 Feb;32(2 Pt 2):311-5.

Olivero JJ, Alfaro FG. Case in point. Madura foot (mycetoma). Hosp Pract (Off Ed). 1995 Jan 15;30(1):29.

Restrepo A. Treatment of tropical mycoses. J Am Acad Dermatol. 1994 Sep;31(3 Pt 2):S91-102. Review. (Colombia)

Rios-Fabra A, Moreno AR, Isturiz RE. Fungal infection in Latin American countries. Infect Dis Clin North Am. 1994 Mar;8(1):129-54. Review.

Ndiaye B, Develoux M, Langlade MA, Kane A.  Actinomycotic mycetoma. Apropos of 27 cases in Dakar; medical treatment with cotrimoxazole. Ann Dermatol Venereol. 1994;121(2):161-5. French.

Welsh O. Mycetoma.
Semin Dermatol. 1993 Dec;12(4):290-5. Review.

Braga FJ, Araujo EB, Camargo EE, Rivitti MC, Cuce LC. Scintigraphic evaluation of mycetoma. Nucl Med Commun. 1993 Sep;14(9):814-8.

Buiting AG, Visser LG, Barge RM, van 't Wout JW. Mycetoma of the foot; a disease from the tropics. Ned Tijdschr Geneeskd. 1993 Jul 24;137(30):1513-5. Dutch.

Sharma AK, Wakhlu A, Chaturvedi V, Agarwal LD. Primary mycetoma of the calcaneum. Trop Doct. 1993 Jul;23(3):135-6.

Tendolkar UM, Deodhar LP, Jerajani H, Khatri M, Joshi M. Microbiological study of mycetoma patients from Bombay with special reference to actinomyces immunofluorescence. Indian J Pathol Microbiol. 1993 Jul;36(3):245-52.

Yu AM, Zhao S, Nie LY. Mycetomas in northern Yemen: identification of causative organisms and epidemiologic considerations. Am J Trop Med Hyg. 1993 Jun;48(6):812-7.

Corresponding Author

Dr C N Kulkarni
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