186' An Introduction to Medical Mycology 



Walker, O.: Sulfanilamide in treatment of actinomycosis, Lancet 1:1219, 1938. 



Wolff, M., and Israel, J.: Ueber Reincultur des Actinomyces und seine ueber tragbarkeit 



auf Thiere, Vircbows Arcb. f. Path. Anat. 126:11, 1891. 

 Wright, J. H.: Biology of micro-organism of actinomycosis, J. M. Research 13:349, 1905. 



2. MYCETOMA (MADUROMYCOSIS) 



In this disease, caused by any one of several species of Actinomyces and 

 by other genera, there is deep destruction of a member, usually a foot, 

 with the development of sinus tracts. Over 35 authentic cases have been 

 recorded in this country. 



(a) Etiology.— The disorder is seen in endemic form in India, especially 

 in Madura. It is more common in males than in females. Persons of all 

 ages are vulnerable, but it is rarely seen before puberty. It is more common 

 in those who are barefoot while working in the fields. Injury in the form 

 of an abrasion may be requisite to introduce the infection. 



A number of fungi other than Actinomyces have been described as 

 capable of causing the disease. Although we have had only limited personal 

 experience, it seems that the causative fungus is often difficult to grow on 

 artificial mediums. Many of the fungi described as pathogenic may merely 

 be growing saprophytically in the diseased tissues. 



The subject has been reviewed by Gammel and others. The reader is 

 referred to the articles mentioned in the bibliography for further enlighten- 

 ment on this greatly confused subject. 



(b) Clinical symptoms.— The disease is first manifested by a subcu- 

 taneous swelling. This may become phlegmonous and rupture to the cu- 

 taneous surface. Sinus tracts form, and the infective process burrows into 

 the deeper structures of the foot, which becomes swollen and distorted. 

 On the surface are numerous pea-sized eminences; in the center of each is 

 the orifice of a sinus. The discharge is seropurulent and contains rounded 

 white, yellowish, reddish or blackish granules. The disorder progresses 

 slowly and may last for 30 years (Crocker). The usual period before the 

 patient is incapacitated is from three to seven years. The tumor may become 

 very large, increasing the bulk of the foot to four or five times the normal 

 size. Usually, the destructive process finally involves the small bones. 

 Rarely, some other part of the body may be the site of the disease; an 

 instance of involvement of the hand was reported in 1940 by Lewis and 

 Sachs. In a later communication (Journal of Investigative Dermatology, 

 10:156, 1948) the condition was classed as chromoblastomycosis. 



The disease is solely of local import. Constitutional symptoms are slight, 

 and the internal organs are never involved. 



(c) Prognosis.— If treatment is commenced before too much destruction 



