Mycetoma is a chronic suppurative infection of the deep soft tissues and bones, most commonly of the limbs but also of the abdominal or chest wall or head. It is caused by either aerobic or anaerobic branching Gram-positive bacilli, Actinomycetales (actinomycetoma – 60%, or by true fungi, Eumycetes (eumycetoma – 40%). Many fungi cause eumycetomas, the most common being Madurella mycetomatis, M. grisea, Leptosphaeria senegalen[1]sis and Scedosporium apiospermum. Actinomycetomas are caused by Actinomadura, Nocardia and Streptomyces spp. Both groups produce characteristically coloured grains, the colour depending on the organism (black grains – eumycetoma, red and yellow grains – actinomycetoma, white grains – either). The disease occurs mostly in thetropics and subtropics.


The disease is acquired by inoculation (e.g. from a thorn) and most commonly affects the foot (Madura foot). Mycetoma begins as a painless swelling at the implanta[1]tion site, which becomes chronic and progressive, grows and spreads steadily within the soft tissues, eventually extending into bone. Nodules develop under the epider[1]mis and these rupture, revealing sinuses through which grains (fungal colonies) may be discharged. Sinuses heal with scarring, while fresh sinuses appear elsewhere.

Deeper tissue invasion and bone involvement are less rapid and extensive in eumycetoma than actinomycetoma. There is little pain and usually no fever or lymphadenopathy, but there is progressive disability.


Diagnosis is confirmed by demonstration of fungal grains in pus, and/or histopathological examination of tissue. Culture is necessary for species identification and susceptibility testing. Serological tests are not available.


The medicines that can be thought of use are:-

  • Calcarea carb
  • Graphites
  • Pulsatilla
  • Sepia
  • Mezereum.