02163nas a2200265   4500000000100000008004100001653001200042653001700054653003300071653001300104653001500117653001700132653001600149653001900165100001300184700001600197700001400213700001300227700001500240245011900255300001200374490000700386520149000393022001401883       2015                            d10aTherapy10aPathogenesis10aNegelected Tropical Diseases10aMycetoma10aEumycetoma10aEpidemiology10aDiagnostics10aActinomycetoma1 aNenoff P1 aSande W W J1 aFahal A H1 aReinel D1 aSchöfer H00aEumycetoma and actinomycetoma--an update on causative agents, epidemiology, pathogenesis, diagnostics and therapy.  a1873-830 v293 a<p>Mycetoma is a chronic putrid infection of the cutaneous and subcutaneous tissue concerning predominantly the feet, and more rarely other body parts. Mycetoma can be caused by both fungi (eumycetoma) and bacteria (actinomycetoma). Mode of infection is an inoculation of the causative microorganism via small injuries of the skin. The clinical correlate of both forms of mycetoma is tumescence with abscesses, painless nodules, sinuses and discharge. The latter is commonly serous-purulent and contains grains (filamentous granules) which can be expressed for diagnostic purposes. Distinctive for both eumycetoma and actinomycetoma, are the formation of grains. Grains represent microcolonies of the microorganism in vivo in the vital tissue. The most successful treatment option for eumycetomas offers itraconazole in a dosage of 200&nbsp;mg twice daily. This triazole antifungal is considered as 'gold standard' for eumycetomas. Alternatively, the cheaper ketoconazole was widely used, however, it was currently stopped by the FDA. Actinomycetomas should be treated by the combination of trimethoprim-sulphamethoxazole (co-trimoxazole 80/400 to 160/800&nbsp;mg per day) and amikacin 15&nbsp;mg/kg body weight per day. Mycetomas are neglected infections of the poor. They are more than a medical challenge. In rural areas of Africa, Asia and South America mycetomas lead to socio-economic consequences involving the affected patients, their families and the society in general.</p>
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