The danger of walking barefoot and a simple scratch on the skin

Walking barefoot on the grass or along the promenade is considered a form of romantic date. But no one sees this process as a way to pick up a skin infection. Indeed, when the skin is injured by the slightest object, a wound appears on the skin - the entrance gate for infection. In addition to bacteria, which everyone is afraid of when injured, there are also fungi that can also penetrate the wound on the skin and provoke the development of diseases. The pathological process that appears as a result of the penetration of fungi into the wound, and what it forms, is called mycetoma.

Mycetoma is also called Madura foot, maduromycosis, maduromycetoma. This pathological process is a non-contagious disease, which is characterized by the formation of a painless infiltrate on the foot or hand with limited edges on one side. As a result, the limbs are deformed.

What causes mycetoma? Processes taking place in the wound

Mycetomas are divided into 2 types:

• Eumycetoma - Caused by true fungi.
• Actinomycetoma - develops during reproduction of actinomycetes.

The first cases of mycetoma were described in the middle of the 19th century in the Indian province of Madura

Mycetoma is provoked by more than 20 species of fungi - saprophytes that live in the soil and on plants. Actinomycotic mycetoma is caused by 6 types of mycelial or "filamentous" bacteria. At the same time, fistulas, granulomas are formed, the process of isolation of drusen is underway, bone tissue is involved in the pathological process. Drusen can be of different colors, and this depends on the pathogen. When the skin is damaged, the pathogen enters the wound upon contact with an infected agent. In this case, the localization of mycetomas depends on the entrance gate. The most common sites for mycetoma are the feet and hands. Later, the process tends to spread to the subcutaneous tissue, bones and connective tissue.

Clinical presentation of skin infection with fungi

The incubation period varies and ranges from 1 month to 1 year. In the initial stages, the lesion is painless. The process is always one-sided. The primary element of the disease is a nodule. It has a tendency to enlarge and abscess. At the same time, adjacent tissues - muscles, fascia and bones - are drawn into the process. As a result of this, microabscesses are formed, foci of tissue fibrosis appear. An indurative edema appears, which covers the entire affected hand or foot. At the same time, blood circulation and lymph flow in the limbs are very disturbed. The skin on the surface has a purple-bluish hue, thinner. With a skin infection, a lot of subcutaneous nodes and fistulas form. Verrucous elements and nodes ulcerate, fistulous passages appear. These passages have a bloody-purulent discharge.

With all these processes, the supporting function of the affected limb remains unchanged for a long time, but osteomyelitis, tendinitis and reactive arthritis may develop. In this case, the patient first feels stiffness in the joint, and later there is a violation of the functioning of the joint. In this picture, characteristic “punch holes” can be seen on the radiograph.

In the clinical course of eumycetoma, bone destruction is observed much less frequently, the course is more favorable.

Stages of diagnosis and methods of treatment of mycete

For diagnosis, a discharge from the fistula or a biopsy is taken. The ability to identify the pathogen depends on the age of the fistula. To isolate the culture, Lowenstein-Jensen medium is used and cultivated for 10 days.

Histological examination of the biopsy or postoperative material reveals microabscesses. In the center of them are drusen, which are surrounded by an eosinophilic zone.

Mycetoma is differentiated from chronic arthritis, chronic osteomyelitis, bacterial mycetoma, botryomycosis, tumors, cold abscess, phlegmon, post-injection infiltrate.

Complex treatment of actinomycotic mycetoma includes:

antibiotic therapy,
appointment of angioprotectors,
immunotherapy,
symptomatic treatment,
use of detoxification agents as indicated,
ultrasound therapy with potassium iodide in pulse mode (thermal physiotherapy is contraindicated),
washing of fistulous passages with an antiseptic solution with hydrogen peroxide,
surgical treatment - radical excision of granulomas and nodes or palliative opening and drainage of abscessed areas.

A feature of the treatment of eumycetes (mold mycetoma) is the replacement of antibiotic therapy with long-term use of antimycotics (3-9 months), antibiotics are used only when a secondary infection is attached. Otherwise, the treatment tactics are the same as for actinomycotic mycetoma.

To avoid infection with mycetoma, it is important to observe personal hygiene rules, to avoid skin injuries. In case of cuts, injections, macerations and other damage to the skin, they should be immediately treated with an antiseptic.