DIAGNOSIS 211 



scribed the appearance of the fungi he found in two different types 

 of cases, so far as the techniques of that day permitted. 



Further studies showed that not two but many fungi were capable 

 of causing mycetoma, and Brumpt ^ described several of these and 

 related them to certain clinical types. Pinoy ^ observed that the 

 mycetomas could be separated into two groups on the basis of the 

 size of the fungi, and he proposed a division between the actinomy- 

 coses caused by Actinomyces and Nocardia, and the true mycetomas 

 caused by fungi having larger hyphae than those of the actinomy- 

 cetes. Chalmers and Archibald ^ accepted this division but proposed 

 the name maduromycosis as a substitute for true mycetomas. Their 

 name has been widely used, sometimes in the sense in which it was 

 proposed but more often as a synonym for mycetoma. 



We prefer the original name, mycetoma, because (1) the name 

 maduromycosis is not specific but designates infections caused by 

 several unrelated species belonging in some eight or ten genera of 

 Hyphomycetes and Ascomycetes, and (2) the name is a source of 

 confusion because of its derivation from a geographical place to 

 which the disease is not limited, and by derivation it suggests both 

 Madurella (a genus of Hyphomycete causing mycetoma) and 

 Nocardia madurae (an actinomycete causing mycetoma of the type 

 not included under maduromycosis) . The name mycetoma properly 

 refers to both types of infection discussed by Pinoy. 



Clinical. Mycetoma is a fungus infection of the skin and sub- 

 cutaneous tissues characterized by swelling, destruction of tissues 

 (including bone in some cases), formation of fistulae, and production 

 of pus in which there are well-organized mycotic granules. The char- 

 acter of these granules varies according to the species of fungus pro- 

 ducing them. They may be hard or soft; white, yellow, red or black; 

 pin-point or up to 3 or 4 mm. in size; and the fungus hyphae may 

 be the 0.5/a to l^u, hyphae of actinomycetes or the larger hyphae and 

 chlamydospores of Hyphomycetes or Ascomycetes. 



When the lesion is on the foot the latter is enlarged and there is 

 usually a characteristic convex swelling of the plantar surface. The 

 infection usually follows a wound such as that caused by penetration 

 of a splinter or thorn and this probably accounts for the frequent 

 occurrence on the foot. Lesions may be on the hand, however, and 

 rarely on other parts of the body. 



Diagnosis. The clinical appearance of a typical case of mycetoma 

 is distinctive, but the diagnosis rests finally upon the laboratory 

 demonstration of the fungus granules. Because of the many fungi 



