Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India.
Int J Dermatol. 2010 Nov;49(11):1289-96. doi: 10.1111/j.1365-4632.2010.04610.x.
Mycetoma is a chronic suppurative and/or granulomatous inflammatory lesion of skin, subcutaneous tissue, fascia, and tendons caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. The disease is characterized by triad of tumefaction, discharging sinuses, and grains.
Thirteen new cases of biopsy proven mycetomas were analyzed, retrospectively, from January 2000 to October 2009. Clinical parameters, bone involvement, microbiological properties, and histopathological features were evaluated. Categorization into eumycotic or actinomycotic was based upon features on hematoxylin and eosin stained sections with special stains. Therapeutic outcome was presented wherever available.
There were eight actinomycetomas and five eumycetoma cases including 11 men and two women. Foot and lower extremities were the most common site of involvement (9 of 13, 69%). Culture results were available in 8 of 13 cases (61.5%). Madurella mycetomatis, Neoscytalidium dimidiatum, and Aspergillus flavus were the isolates among eumycetomas whereas Acinomadura madurae, Actinomadura pelletieri, and Nocardia species were the isolates among actinomycetomas. Two cases had underlying bone involvement. On follow-up, four of five eumycetoma cases showed partial improvement following surgery and antifungal therapy, one had amputation of the lower leg. Of the actinomycetomas, six of eight had dramatic improvement following sulfamethoxazole-trimethoprim based therapy, one had complete cure, and one was lost to follow-up.
Strong clinical suspicion, exact categorization of lesion into eumycotic or actinomycotic along with culture correlation, is essential for prognosis and effective therapy.
足菌肿是一种由土壤中存在的真菌（外生性真菌）或细菌（放线菌）通过创伤接种引起的皮肤、皮下组织、筋膜和肌腱的慢性化脓性和/或肉芽肿性炎症病变。该疾病的特征是三肿、窦道和颗粒。
回顾性分析了 2000 年 1 月至 2009 年 10 月期间经活检证实的 13 例新足菌肿病例。评估了临床参数、骨受累、微生物特性和组织病理学特征。根据苏木精和伊红染色切片的特征以及特殊染色，将其分为外生性真菌或放线菌。只要有可用的治疗结果，就会呈现出来。
有 8 例放线菌肿和 5 例外生性真菌肿，包括 11 名男性和 2 名女性。足部和下肢是最常见的受累部位（13 例中的 9 例，69%）。在 13 例中有 8 例可获得培养结果（61.5%）。在 5 例外生性真菌肿中，分离出的菌种为Madurella mycetomatis、Neoscytalidium dimidiatum和Aspergillus flavus，而在 8 例放线菌肿中，分离出的菌种为Acinomadura madurae、Actinomadura pelletieri和Nocardia 属。有 2 例有骨受累。在随访中，5 例外生性真菌肿病例中有 4 例在手术后和抗真菌治疗后有部分改善，1 例进行了小腿截肢。在 8 例放线菌肿中，有 6 例在磺胺甲恶唑-甲氧苄啶为基础的治疗后有明显改善，1 例完全治愈，1 例失访。
强烈的临床怀疑、对病变的准确分类为外生性真菌或放线菌，并结合培养相关性，对预后和有效治疗至关重要。
