MADUKA DISEASE 



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Cultures should be made both under aerobic and anaerobic conditions. 

 Tubes of agar or glycerin agar should be inoculated and incubated at 

 37° C. ; deep tubes of melted glucose agar should also be used, the 

 inoculated material being diffused through the medium, separate colonies 

 may thus be obtained. Owing to the slow growth of the actinomyces, 

 however, the obtaining of pure cultures is somewhat difficult, unless the 

 pus is free from contamination with other organisms. 



Madura Disease. 



Madura disease or mycetoma resembles actinomycosis both as 

 regards the general characters of the lesions and the occurrence 

 of the parasite in the form 

 of colonies or "granules." 

 There is no doubt, how- 

 ever, that the two con- 

 ditions are distinct, and 

 it also appears established 

 that the two varieties of 

 Madura disease {vide 

 infra) are produced by 

 different organisms. This 

 disease is comparatively 

 common in India and in 

 various other parts of the 

 tropics : it has also been 

 met with in Algiers and 

 in America. Its course 

 is of an extremely chronic 

 nature, and though the 

 local disease is incurable 

 except by operation, the 



parasite never produces secondary lesions in internal organs. 

 Vincent also found that iodide of potassium, which has a, high 

 value as a therapeutic agent in many cases of actinomycosis, had 

 no effect in the case of Madura disease studied by him. It most 

 frequently affects the foot ; hence the disease is often spoken of 

 as " Madura foot." The hand is rarely affected. In the parts 

 affected there is a slow growth of granulation tissue which has an 

 irregularly nodular character, and in the centre of the nodules 

 there occurs purulent softening which is often followed by the 

 formation of fistulous openings and ulcers. There are great 

 enlargement and distortion of the part and frequently caries and 

 necrosis of the bones. Within the softened cavities and also in 

 the spaces between the fibrous tissue, small rounded bodies or 



Fiu. 97. — Streptothrix niadura, showing 

 branching filaments. From a culture on 

 agar. 



Stained with carbol-thioniu-blue. x 1000. 



