Mycetoma is a chronic infection, newly designated by the World Health Organization (WHO) as a neglected tropical disease, which is endemic in tropical and subtropical regions. It follows implantation of infectious organisms, either fungi (eumycetomas) or filamentous bacteria (actinomycetomas) into subcutaneous tissue, from where infection spreads to involve skin, bone and subcutaneous sites, leading to both health related and socioeconomic problems. In common with other NTDs, mycetoma is most often seen in rural areas amongst the poorest of people who have less access to health care. The organisms form small microcolonies that are discharged onto the skin surface via sinus tracts, or that can burrow into other adjacent tissues including bone. This paper describes the clinical features of mycetoma, as early recognition is a key to early diagnosis and the institution of appropriate treatment including surgery. Because these lesions are mostly painless and the majority of infected individuals present late and with advanced disease, simplifying early recognition is an important public health goal.

The authors declare no conflict of interest.

Figure 1

Figure 1

( A ) A small...

Figure 1

( A ) A small mycetoma swelling engulfing the middle part of the...

Figure 2

Figure 2

Massive actinomycetoma foot with multiple...

Figure 2

Massive actinomycetoma foot with multiple sinuses and discharge.

Figure 3

Figure 3

Surgical specimen with multiple black...

Figure 3

Surgical specimen with multiple black grains.

Figure 4

Figure 4

Foot eumycetoma with skin hyperpigmentation,...

Figure 4

Foot eumycetoma with skin hyperpigmentation, multiple nodules and active sinuses.

Figure 5

Figure 5

Foot eumycetoma with skin hyperpigmentation,...

Figure 5

Foot eumycetoma with skin hyperpigmentation, multiple nodules, active sinuses discharging black grains discharge...

Figure 6

Figure 6

Massive back actinomycetoma with multiple...

Figure 6

Massive back actinomycetoma with multiple nodules and sinuses.

Figure 7

Figure 7

Massive mycetoma foot with dilated...

Figure 7

Massive mycetoma foot with dilated tortuous veins at and proximal to the mycetoma...

Figure 8

Figure 8

Hand eumycetoma with massive deformity.

Figure 8

Hand eumycetoma with massive deformity.

Figure 9

Figure 9

( A ) massive head...

Figure 9

( A ) massive head eumycetoma. ( B ) CT scan showing intra-cranial...

Figure 10

Figure 10

Massive gluteal, perineal and scrotal...

Figure 10

Massive gluteal, perineal and scrotal eumycetoma.

Figure 11

Figure 11

Massive foot actinomycetoma with leg...

Figure 11

Massive foot actinomycetoma with leg and knee inguinal satellite lesions.

Figure 12

Figure 12

Photomicrograph showing A. madurae grains...

Figure 12

Photomicrograph showing A. madurae grains within the lumen of the intact blood vessel...

Figure 13

Figure 13

Massive anterior abdominal eumycetoma spreading...

Figure 13

Massive anterior abdominal eumycetoma spreading to both inguinal regions and scrotum.

Figure 14

Figure 14

X-ray of thigh and knee...

Figure 14

X-ray of thigh and knee eumycetoma showing massive soft tissue shadow, periosteal reaction...

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