(Podelcoma; Ulcus grave; Madura foot; Fungus foot of India)
Definition – An endemic parasitic disease caused by a vegetable fungus, usually confined to the feet, legs or hands and characterized by disintegration of the skin and deeper structures.
Symptoms – While insidious and superficial in its onset, in time there may appear edema, swelling, large vesicles, papules, pustules and nodules, which break down and give exit to a thin seropurulent or sanious discharge containing blackish or paler yellowish-white granules. In mild cases a single finger or toe may be involved but in others the lesions may be numerous. The disease usually progresses slowly by tunneling into the tissues for months or years until the feet or other parts affected become riddled with sinuses, extending not only into the softer parts but involving the periosteum and bones. Though the disease may last for twenty or thirty years, the whole foot often becomes involved in from two to six years and swollen to two or three times its natural size. The leg and hand, rarely the scrotum and other parts, are sometimes attacked and the condition tends to increase progressively, unless arrested by treatment, until the patient dies from exhaustion or some other intercurrent disease. There is a striking absence of adenitis and septic poisoning occurs only when due to some secondary process.
Etiology and Pathology – This condition is endemic in India, has never occurred in Europe and only five authentic cases have been reported in the United States. Males are more apt to be attacked than females because they work barefooted in the fields and a slight traumatism or break in the cutaneous surface of the foot affords the necessary point of entrance for the causative actinomyces Madurae which consist of mycelium presenting branching threads and ovoid spores. This disease so closely resembles actinomycosis and the clinical similarity is so marked, that some authorities feel that the etiological fungus is the same. But this is not so, because the actinomyces are brilliantly colored by acid fuchsin, while the fungus found in mycetoma is not materially affected. The granules mentioned as occurring in the discharge are either black, like grains of gunpowder or poppy seeds, or if paler they resemble fish-roe. These bodies contain the pathological fungus.
Diagnosis – Mycetoma when well developed, especially where the disease is endemic, could hardly be mistaken for any other disease. Add to this the region involved, the presence of the black or paler bodies in the discharge, the absence of any visceral involvement and there should be no difficulty in differentiating it from actinomycosis of the skin.
Prognosis and Treatment – Spontaneous cures are unknown and a chronic course may be expected unless prompt treatment is instituted. This consists in early, complete and thorough surgical removal of the diseased part, together with the internal use of potassium iodid in gradually increasing doses. Amputation may be indicated but should be well beyond the limits of the affected parts to be at all curative.