Dr Vidyashree Jolad [1]
Dr Jyoti Vijay Kumar [2]
ABSTRACT
Mycetoma is a chronic progressively destructive morbid inflammatory disease usually of the foot but any part of the body can be affected. Infection is most probably acquired by traumatic inoculation of certain fungi or bacteria into the subcutaneous tissue. Advanced cases may cause disfigurement. Homeopathy plays a very major role in the treatment of skin diseases.
The aim of this article is to describe briefly about mycetoma infection and its Homoeopathic management.
KEYWORDS– Skin, Mycetoma, Homoeopathy
INTRODUCTION
MYCETOMA- Is a chronic subcutaneous infection caused by actinomycetes or fungi. This infection results in a granulomatous inflammatory response in the deep dermis and subcutaneous tissue, which can extend to the underlying bone. Mycetoma is characterized by nodules and sinus tracts that discharge watery fluid or pus containing grains. Advanced cases may cause functional disability. The bacteria and fungi causing mycetoma have a worldwide distribution in the soil and plant material found in tropical and subtropical areas.
HISTORY
Mycetoma is a chronic suppurative infection of the skin and subcutaneous tissues that affects the lower limbs in more than 80% of cases.
The first written account of Mycetoma was found in an ancient Indian religious book, ATHARVA VEDA where it was mentioned as “anthill foot”.
In 1842, Gill a French missionary, described the first clinical cases of Mycetoma in Madura, southern India, naming it “Madura Foot”
In1860, Carter used the term ‘Mycetoma’ being the first to describe the disease under this name.
In 1913, Piony observed the etiological factors of this disease.
The first attempt to map the distribution of Mycetoma throughout the world made by Abott in 1956.
EPIDEMIOLOGY AND RISK FACTORS
Mycetoma found worldwide, it is endemic in tropical and subtropical countries.
The countries with highest incidence of disease are Sudan, Mexico and India. Cases have also been reported in other African countries such as Egypt, Senegal, Cameroon, and Nigeria.
Mycetoma are considered as occupational diseases of individuals who work in rural areas, such as farmers and Shepherds.
Mycetoma can affect all age groups, but it occurs more commonly in young men aged between 20 and 40 years, with male to female ratio 3:1
Overall, most cases occurs in arid and hot climates, which have short period of heavy rain fall with milder temperatures.
TRANSMISSION
Transmission, most probably occurs when the causative organism enters the body through minor trauma or a penetrating injury, commonly thorn pricks. There is a clear association between mycetoma and individuals who walk barefooted and are manual workers
ETIOLOGY
Mycetoma is caused by various species of fungi and bacteria.
There are mainly two types
- Actinomycotic Mycetoma-is caused by aerobic species of actinomycetes belonging to the genera Nocardia, Streptomyces, and Actinomadura with Nocardia brasiliensis, Actinomadura madurae.
- Eumycetoma- It is caused by Pseudallescheria boydii, Madurella grisea, Acremonium spp, Curvularia lunata, Leptosphaeria senegalensis, and the most common being Madurella mycetomatis.
PATHOGENESIS
The causative organism enters through sites of local trauma (e.g. cut on the hand, foot, local trauma related to carrying soil contaminated material)
A neutrophil response initially occurs, which may be followed by a granulomatous reaction. Spread occurs through skin facial planes and can involve the bone. Haematogenous spread is uncommon.
T-cells responses also seem to play an important part in the development of Mycetoma.
Th2-like responses (interleukin-10 and IL-4) were found in primary lesions and in draining Lymph nodes in S.somaliensis infection and after stimulation of peripheral blood mononuclear cells by M.mycetomatis antigens.Th1 responses are found in the acute phase of infection and in healthy endemic controls.
SITES OF INFECTION
The feet are the most common site for infection.
Other sites includes…
-Hands
-Neck
-Shoulder
-Chest
-Arms
CLINICAL PRESENTATION OF MYCETOMA
Over 75% of patients have a lesion of lower extremity, most commonly in the foot (70%) followed by hand involvement.
The pathognomic features is a triad of
Painless firm subcutaneous mass
Multiple sinus formation
A purulent or seropurulent discharge containing grains.
DIAGNOSIS
Mycetoma is suspected when there is a typical triad of symptoms and signs.
Diagnosis of the causative organisms can be made by microscopic observation of grain, and skin biopsy for pathology are necessary to identify organisms.
Radiology and USG enable assessment of disease extent and bony involvement.
CT- useful to provide detailed assessment of soft tissue and visceral involvement.
MRI- A “dot-in-circle sign” seen. The dots are tiny hypotense foci seen within the lesions.
DIFFERENTIAL DIAGNOSIS
Bacterial infections
Leprosy
Cutaneous tuberculosis
Non tubercular mycobacterial infections.
Osteomyelitis, Actinomycosis
Non infectious disease
Podoconiosis
Malignant tumors such as sarcoma of the skin and soft tissue or bones.
COMPLICATIONS
- The disease causes disfigurement but is rarely fatal.
- In advanced cases, deformities or ankylosis may occur.
- Chronic neglected infection may necessitate amputation.
- Immunocompromised patents may develop invasive infection.
- Lymphatic obstruction and fibrosis may cause lymph edema.
- Complications may results from toxicity due to prolonged antimicrobial or antifungal therapy.
PREVENTION
-Prevention is best accomplished by impacting on the incidence of the traumatic inoculation of causative agents.
-Wearing of shoes and clothing to protect against splinters and thorn pricks should be stressed.
-Complications can be prevented by early identification and treatment of lesions usually with minor surgery.
REPERTORIAL–rubrics
[Boericke]–Skin-Actinomycosis–Hecla, hippoz, kali-iod, nit-ac
[Clarke]–Clinical-Actinomycosis–kali-iod, nit-ac
[Phatak]-A-Z-Actinomycosis-Hecla, kali-iod, nit-ac
[Murphy]-Skin-Actinomycosis- Hecla, hippoz, Kali-I, nit-ac, pyrog, thymol.
HOMOEOPATHIC MANAGEMENT
SULPHUR
Swollen and ulcerative skin, inflammatory abscess.
Itching of the skin, bleeding, readily and secreting a fetid or yellow thick discharge.
Excoriation of skin lancating and tensive pain.
General modalities-
<standing, warmth in bed.
>from drawing up affected limbs.
HEPAR SUPHUR
Abscess, suppurating glands very sensitive.
Unhealthy skin, papules prone to suppurate.
Ulcers with bloody suppuration.
Great sensitive to slight touch.
Modalities –
< lying on painful side, touch
> Warmth
PETROLEUM
The skin is rough, exfoliates, bleeds the tissues are hardened.
Papular eruptions which extend deeply.
Ulceration of tissues, sore skin.
Modalities< motion, in winter
> Warm air, dry weather.
SILICEA
Abscess, boils and ulcers.
Painless swelling of glands.
Offensive pus, indurated tumors.
Modalities< in the morning, from washing, lying on left side.
> Warmth, summer, in wet or humid weather.
REVIEW OF LITERATURE
- As per the latest article (Nov 2020) “Efficacy of Homoeopathy in Mycetoma” by Dr. Ashima Khanna, Total 11 medicines like Graphites, Sulphur, Rhustox, Sepia, Hepar sulph, Kali sulph, Lycopodium, Petroleum, Silica, Psorinum, and Calc carb were found to be useful in the treatment of Mycetoma. The study proved the efficacy of Homoeopathy in the in cases of mycetoma, only if medicines are selected strictly according to the principles and laws of Homoeopathy.
- As per the case report “Recurrence of Actinomycosis effectively stopped with Homoeopathy” by Dr. Prasad Arvind Rasal, based on the totality of symptoms Lycopodium 30C and Calc Flour 6X improved the case of actinomycosis and also prevented its recurrence
REFERENCES
- API Text book of medicine 9thed
- Mycetoma-An update https://www.ncbi.nlm.nih.gov/pmc/articles/PM5527712/
- Mycetoma: reviewing a neglected disease https://onlinelibrary.wiley.com/doi/10.1111/ced.13642
- Mycetoma: An epidemiological, etiological, clinical, laboratory and therapeutic review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871356/#!po=0.446429
- Efficacy of Homoeopathy in Mycetoma https://www.ijsr.net/get_abstract.php
- Actinomycosis effectively stopped with Homoeopathy. https://www.welcomecure.com/treated-cases/actinomycosis/actinomycosis-case1
- Homoeopathic Materia Medica-William Boericke, M.d
- A dictionary of practical Materia Medica- JH CLARKE.
- Mycetoma https://www.who.int/news-room/fact-sheets/detail/mycetoma
Dr.Vidyashree Jolad [1]
PG Scholar, Department of Practice of Medicine, A.M Shaikh Homoeopathic Medical College, Belagavi.
Dr.Jyoti Vijay Kumar [2]
HOD, PG Guide, Professor, Department of practice of Medicine, A.M Shaikh Homoeopathic Medical College, Belagavi.
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