Madura foot, or mycetoma, is a chronic localized infection of the skin, subcutaneous tissue, fascia, and muscle. Tumefaction, draining sinuses, and grains that are made up of aggregates of organisms characterize it. Although it is a well-defined clinical entity, it may be caused by a wide array of bacteria and fungi.

EPIDEMIOLOGY

Mycetomas are seen most commonly in countries with tropical and hot temperate climates that lie between the tropics of Cancer and Capricorn. Mycetoma is relatively common in Mexico, where it is the most common manifestation of deep mycotic infection. Other locations in the Western Hemisphere where the incidence is high include Central and South America. It is an uncommon disease in the United States, where it is seen mostly in the Southeast. Other locations worldwide where mycetomas are reported with some frequency include Senegal, Sudan, Somalia, India, and Southern Asia.

Men are affected about 4 to 5 times as often as women, with the peak incidence between ages 20 and 40 years. Farmers and other rural workers who work outdoors or go barefoot are most commonly affected.

CAUSES

Mycetomas fall into two broad categories based on the causative organism: actinomycetomas, which account for 60% of all mycetomas worldwide, are caused by aerobic bacteria, including Nocardia, Streptomyces, and Actinomadura species (Table 26.1); eumycetomas are caused by true fungi, and many organisms have been implicated (Table 26.2). The distribution of agents varies with geographic location.