Mycetoma is a clinical term for an infection associated with trauma to the foot which causes inoculation of any of a dozen fungal species. Actinomycetes such as Nocardia may produce a similar disease. The usual clinical appearance is of massive induration with draining sinuses. Some of the fungi that cause mycetoma are geographically wide-spread; most cases, however, occur in the tropics, probably because the chronically damp, macerated skin of the feet that causes predisposition toward mycetoma occurs most often among those who go barefoot in the tropical environment. This finding is illustrated by the case of a college rower in Seattle who developed mycetoma; he was the only member of his shell who insisted on rowing barefoot. Once established, the treatment of myce-toma is difficult. No antimicrobic stands out as particularly helpful. The precise microbio-logic features depend on the agent involved. Hyphae are usually present in tissue but may be difficult to demonstrate because of a tendency to form microcolonial granules.
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