CHAPTER XXXVI 

 MYCETOMA, OR MADURA-FOOT 



ACTINOMYCES MADURA (VlNCENT) 



General Characteristics. A non-motile, non-flagellate, sporogenous (?), 

 non-liquefying, non-aerogenic, chromogenic, aerobic and optionally anaerobic, 

 branched, parasitic organism belonging to the higher bacteria, staining by ordi- 

 nary methods and by Gram's method, and pathogenic for man. 



A curious disease of not infrequent occurrence in the Indian prov- 

 ince of Scinde and of rare occurrence in other countries is known as 

 mycetoma, Madura-foot, or pied de Madura. Although described 

 as peculiar to Scinde, the disease is not limited to that province, but 

 has been met with in Madura, Hissar, Bicanir, Delhi, Bombay, 

 Baratpur, Morocco, Algeria, and in Italy. In America less than a 

 dozen cases of the disease have been placed on record. In India it 

 almost invariably affects natives of the agricultural class, and in 

 nearly all cases is referred by the patient to the prick of a thorn. 

 It usually affects the foot, more rarely the hand, and in one instance 

 was seen by Boyce to affect the shoulder and hip. It is more com- 

 mon in men than in women, individuals between twenty and forty 

 years of age suffering most frequently, though persons of any age 

 may suffer from the disease. It is insidious in onset, no symptoms 

 being observed in what might be called the incubation stage of a 

 couple of weeks' duration, except the formation of a nodular growth 

 which gradually attains the size of a marble. Its deep attachments 

 are indistinct and diffuse. The skin over it becomes purplish, thick- 

 ened, indurated, and adherent. The ball of the great toe and the 

 pads of the fingers and toes are the points most frequently invaded. 

 The lesions progress very slowly, and in the course of a few months 

 form distinct inflammatory nodes. After a year or two the nodes 

 begin to soften, break down, discharge necrotic and purulent mate- 

 rial, occasioning the formation of ulcers and sinuses. The matter 

 discharged from the lesions at this stage of the disease is a thin 

 serum, and contains occasional fine round pink or black bodies, 

 similar to actinomyces "grains," described, when pink, as resem- 

 bling fish-roe ; when black, as resembling gunpowder. It is upon the 

 detection of these particles that the diagnosis rests. According to 

 the color of the bodies found, cases are divided into the pale or ochroid 

 and melanoid varieties. 



The progress of the disease causes an enormous enlargement of the 

 affected part. The malady is usually painless. 



