Clinical and Histological Characteristics of Mycetoma in a Tertiary Health Institution in Northeastern Nigeria.

Abstract

Mycetoma are pathological and inflammatory pseudo-tomours often affecting the lower limb and the foot, where it is called "watering can foot," but can rarely affect other parts of the body. It is a bacterial (actinomycetoma) or fungal (eumycetoma) infection of the skin, subcutaneous tissue and dermis, which may extend to underlying bone. The classical clinical feature of both forms of mycetoma is tumescence with formation of abscesses, painless nodules and sinus tract that discharge grains containing aggregate of the etiological agent. The disease is thought to occur after inoculation of soil organisms during penetrating injury. This occur most commonly in rural settings among labourers who work bare foot. As one of the neglected diseases listed by the WHO, determination of the prevalence and characterization of mycetoma in Nigeria is needed to provide a guide to its management in our environment. We retrospectively reviewed documented cases of mycetoma over an eleven year period (2004 -2014) that presented for care at University of Maiduguri Teaching Hospital A total of 35 cases of mycetoma were recorded over the eleven year period, with estimated prevalence of 0. 65 per 100000 hospital visits. Lower limb was the most affected region among males <45 years. Characterization of 17 available cases using special stains indicated that 15 cases (88.2%) were due to actinomycetes and only 2 cases (11.8%) resulted from eumycetoma. Identification and characterization of mycetoma is important, its management requires antimicrobial therapy. In chronic and advanced disease, surgery may be indicated especially in those caused by fungi to avoid deformity, amputation, and death.

Keywords: Mycetoma, Histopathological characterization, Special stains.