Mycetoma and others

Question 1

What is mycetoma?

Answer 1

Chronic sub-cutaneous infection; usually localized, deeper extension to bone and joints may occur
Mostly on feet

Question 2

How Is mycetoma transmitted?

Answer 2

Soil

Question 3

Characteristic appearance of the mycetoma?

Answer 3

Fistulae, grains and tumour like swellings

Question 4

Types of mycetoma?

Answer 4

Eumycetoma/fungal vs actinmycetoma/bacterial vs botriomycetoma

Question 5

Characteristics of fungal mycetoma?

Answer 5

Slowly growing, not aggressive, fewer fistulae
30 different species - black fungi pathopneumonic - phaeohyphomycetes
Most common species is madurella mycetomatis

Question 6

Diagnosis of eumycetoma?

Answer 6

Fine needle aspiration and KOH culture

Question 7

∆∆

Answer 7

Bacterial mycetoma
Botryomcosis
Lobomycosis
Sporotrochosis
Chromoblastomycosis
Cutaneous TB

Question 8

What do you see on microscopy in fungal mycetoma?

Answer 8

Grains in centre of abscess
Hyphae

Question 9

What is actinomycetoma?

Answer 9

Bacterial mycetoma
More common than fungal
Caused by: nocardia, streptomyces or actinomadura
Small grains, pale, more locally invasive disease

Question 10

Management of bacterial mycetoma?

Answer 10

Long term Rx with TMP/SMX + aminoglycoside or rifampicin or dapsone

Question 11

What is botromycosis?

Answer 11

Chronic suppurative infection caused by staph aureus (can also be caused by pseudomonas and anaerobes)
Characterised by grain discharge, nodules and fistulae

Question 12

What is chromoblastomycosis?

Answer 12

Fungal infection, causing verrucous or cegetant lesions, tumoral in nature
black dots

Question 13

What proportion of mycetomas are fungal/actinomycetoma?

Answer 13

40%/50%

Question 14

Which bacteria cause actinomycetoma?

Answer 14

Nocardia/streptomyces/actinomadura - aerobic

Question 15

Cause of eumycetoma?

Answer 15

Madurella mycetomatis

Question 16

Key features of eumycetoma?

Answer 16

Slow progressive following a trauma
Fewer fistula with eu
Black grains
Larger grains
Sinuses are more proliferative

Question 17

Diagnosis?

Answer 17

Eumycetoma
Grain at centre of abscess
See hyphae

Question 18

Mx of eumycetoma?

Answer 18

Itaconazole
More role for surgery although Rx first line is medical

Question 19

Red grains coming out of mycetoma, diagnosis?

Answer 19

Actinomadura

Question 20

White yellow grains coming out of mycetoma?

Answer 20

Could be any but suspicious of streptomyces and nocardia

Question 21

Organism for actinomycetoma in Africa/america?

Answer 21

Streptomyces vs Nocardia

Question 22

Actinomycetoma key features?

Answer 22

Smaller grains, more locally invasive, more fistulae

Question 23

Key features of bacteria on microscopy on actinomyetoma?

Answer 23

aerobic

Question 24

Where does actinomycetoma occur?

Answer 24

Limbs and chest

Question 25

Epidemiology of botriomycetoma?

Answer 25

Immunocompromised but can do immunocompetent

Question 26

How does presentation of botrio differ?

Answer 26

Head and neck more
Direct inoculation
Extends to submit and bone
Yellow white grains

Question 27

Where else can botriomycetoma occur?

Answer 27

Visceral

Question 28

Difference on FNA and histology for botrio vs actinomycetoma?

Answer 28

Bacteria cocci or rods - botrio
Filamentous - actino