Actinomycetoma

Infectious diseases

Clinicals - History

Fact Explanation
Asymptomatic Though actinomycetoma is a chronic disease it can be asymptomatic in some. Asymptomatic
Though actinomycetoma is a chronic disease it can be asymptomatic in some.
Pain or discomfort at the site of inoculation Actinomycetoma is a rapidly progressing disease and patients may experience pain or discomfort initially which may be neglected. This is due to subcutaneous inflammation or due to secondary bacterial infection. Pain or discomfort at the site of inoculation
Actinomycetoma is a rapidly progressing disease and patients may experience pain or discomfort initially which may be neglected. This is due to subcutaneous inflammation or due to secondary bacterial infection.
Skin manifestations Patients usually present with painless subcutaneous swelling which develops into a subcutaneous nodule after few years. These nodules then indurate and forms a discharging sinus. Skin manifestations
Patients usually present with painless subcutaneous swelling which develops into a subcutaneous nodule after few years. These nodules then indurate and forms a discharging sinus.
Bone invasion Actinomycetoma can infect the bone and cause osteomyelitis. Patients complain of pain over the affected bone and may lead to functional disability. Bone invasion
Actinomycetoma can infect the bone and cause osteomyelitis. Patients complain of pain over the affected bone and may lead to functional disability.
Deep itching sensation This may be due to inflammation in the subcutaneous tissue and bone involvement. Deep itching sensation
This may be due to inflammation in the subcutaneous tissue and bone involvement.
History road traffic accidents or trauma Traumatic inoculation of the organism is a rare but possible way of acquiring the disease. History road traffic accidents or trauma
Traumatic inoculation of the organism is a rare but possible way of acquiring the disease.

Clinicals - Examination

Fact Explanation
Examination of the involved skin Subcutaneous swelling, nodules, induration and discharging sinuses can be seen depending on the time of presentation. Examination of the involved skin
Subcutaneous swelling, nodules, induration and discharging sinuses can be seen depending on the time of presentation.
Regional lymphadenopathy Lymphatic spread of organism to regional lymph nodes and secondary bacterial infection can cause regional lymphadenopathy. Regional lymphadenopathy
Lymphatic spread of organism to regional lymph nodes and secondary bacterial infection can cause regional lymphadenopathy.
Lymphedema Due to lymphatic obstruction and fibrosis. Lymphedema
Due to lymphatic obstruction and fibrosis.
Signs of osteomyelitis Patients are febrile and have localized tenderness and swelling over the affected area. The range of movement is limited in the adjacent joints. Discharging sinuses is also an associated finding. Signs of osteomyelitis
Patients are febrile and have localized tenderness and swelling over the affected area. The range of movement is limited in the adjacent joints. Discharging sinuses is also an associated finding.

Investigations - Diagnosis

Fact Explanation
Biopsy Examination of the biopsy specimens under the microscope enables identification of the organism which is the mainstay of the diagnosis. Biopsy
Examination of the biopsy specimens under the microscope enables identification of the organism which is the mainstay of the diagnosis.
Fine-needle aspiration Allows obtaining samples for the microscopic examination. Hematoxylin-eosin and May-Grünwald-Giemsa staining are used. Three genera of disease causing organisma Nocardia, Actinomyces, and Streptomyces can be separately identified. Weekly acid fast gram-positive, beaded, branching filaments are seen in Nocardia. Fine-needle aspiration
Allows obtaining samples for the microscopic examination. Hematoxylin-eosin and May-Grünwald-Giemsa staining are used. Three genera of disease causing organisma Nocardia, Actinomyces, and Streptomyces can be separately identified. Weekly acid fast gram-positive, beaded, branching filaments are seen in Nocardia.
Culture Obtained tissue samples can be cultured in Löwenstein-Jensen media. Usually this takes a long time for the diagnosis. Culture
Obtained tissue samples can be cultured in Löwenstein-Jensen media. Usually this takes a long time for the diagnosis.
Serology Serological tests include immunodiffusion, counterimmunoelectrophoresis, enzyme-linked immunosorbent assay, and Western blot. Serology
Serological tests include immunodiffusion, counterimmunoelectrophoresis, enzyme-linked immunosorbent assay, and Western blot.
X-ray films of involved bones Periosteal thickening, lytic lesions, osteopenia are early radiological signs. Cortical thinning and disuse osteoporosis are also seen in X-ray films. X-ray films of involved bones
Periosteal thickening, lytic lesions, osteopenia are early radiological signs. Cortical thinning and disuse osteoporosis are also seen in X-ray films.
CT scanning CT and MRI are preferred imaging modalities in diagnosis of osteomyelitis. These investigations are highly sensitive but CT is considered superior in detecting the sequestra. Obtaining biopsy specimens from deeper sites can be done with CT guidance. CT scanning
CT and MRI are preferred imaging modalities in diagnosis of osteomyelitis. These investigations are highly sensitive but CT is considered superior in detecting the sequestra. Obtaining biopsy specimens from deeper sites can be done with CT guidance.
MRI Enable visualizing bone and soft-tissue involvement in actinomycetoma. MRI
Enable visualizing bone and soft-tissue involvement in actinomycetoma.
PET scan This is considered a useful investigation in assessment and diagnosis of chronic osteomyelitis. PET scan
This is considered a useful investigation in assessment and diagnosis of chronic osteomyelitis.
Ultrasonography Aids in diagnosis of chronic osteomyelitis. Doppler studies will demonstrate the hyperemia around the site of involvement. Ultrasonography
Aids in diagnosis of chronic osteomyelitis. Doppler studies will demonstrate the hyperemia around the site of involvement.

Investigations - Management

Fact Explanation
Sinography Allows visualization of sinus tract by injecting a radio-contrast material in to the sinus tract. This is important in deciding the best management option of sinuses. This can be combined with CT for better visualization. Sinography
Allows visualization of sinus tract by injecting a radio-contrast material in to the sinus tract. This is important in deciding the best management option of sinuses. This can be combined with CT for better visualization.

Management - Supportive

Fact Explanation
Health education Farmers, soldiers, herdsmen and field labourers who work bare foot are at risk of acquiring the disease by traumatic inoculation of the organisms in to the skin. These people should be advised to wear boots and gloves to minimize the risk. Health education
Farmers, soldiers, herdsmen and field labourers who work bare foot are at risk of acquiring the disease by traumatic inoculation of the organisms in to the skin. These people should be advised to wear boots and gloves to minimize the risk.

Management - Specific

Fact Explanation
Antibiotic therapy Cotrimoxazole, dapsone, streptomycin, sulfadoxine-pyrimethamine, rifampicin and amoxicillin-clavulanic acid are effective in treatment. To prevent the occurrence of drug resistant organisms and for effective treatment combination of drugs is preferred over monotherapy. Cotrimoxazole can be combined with streptomycin, amikacin, dapsone and penicillin. Dapsone with ampicillin, amikacin or streptomycin can also be used for treatment. Treatment is usually given in five weeks cycles and repeated when necessary to prevent relapses. Antibiotic therapy
Cotrimoxazole, dapsone, streptomycin, sulfadoxine-pyrimethamine, rifampicin and amoxicillin-clavulanic acid are effective in treatment. To prevent the occurrence of drug resistant organisms and for effective treatment combination of drugs is preferred over monotherapy. Cotrimoxazole can be combined with streptomycin, amikacin, dapsone and penicillin. Dapsone with ampicillin, amikacin or streptomycin can also be used for treatment. Treatment is usually given in five weeks cycles and repeated when necessary to prevent relapses.
Surgery Patients with chronic osteomyelitis benefit from surgical debridement under antibiotic coverage. Surgery
Patients with chronic osteomyelitis benefit from surgical debridement under antibiotic coverage.

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