Key points for mycetoma

• Treatment of actinomycetoma usually depends on two drugs such as co-trimoxazole plus rifampicin. The latter is given for up to 6 months while the other medication is continued until clinical recovery.

• Sulphonamides or sulphones can be used instead of co-trimoxazole and streptomycin instead of rifampicin.4,6

• Another proposed two-step regimen based on a small case series involves an intensive phase of therapy with penicillin, gentamicin and co-trimoxazole for 5-7 weeks, followed by maintenance therapy with amoxicillin and co-trimoxazole.7

• Successful outcome of treatment is less likely for eumycetomas. Therapy is therefore based on the premise of control of the infection by suppression of the disease, using fluconazole,8 itraconazole9,10 or terbinafine11 plus amphotericin B.4 Patients are followed over years.

• Where necessary, surgery is used to supplement the medical approach for slowing eumycetomas. Indications for amputation are advancing disease threatening the whole limb (for example involvement of the femur) and severe pain.

• Arterial perfusion with amphotericin B has also been tried for eumycetoma, with variable success rates.12

QUESTION

Can mycetoma be treated successfully?

Sporotrichosis

Figure 36.3 Lymphangitic sporotrichosis
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