This is a chronic infection of the dermis and subcutaneous fat caused by various species of fungus (eumycetoma) or bacteria (actinomycetoma). Both types look the same with a swollen foot and multiple discharging sinuses, but it is important to differentiate between them because the treatment is different.
• Examination of the discharging grains (colour will give a clue as to the cause).
• Culture of the grains to identify the causative fungus or bacteria.
• If no grains can be found a skin biopsy will show them.
• Itraconazole 200 mg twice daily for at least 12 months if it is affordable.
• Surgical excision of affected tissue if disease is limited.
• Amputation if extensive.
• Sulfamethoxazole-trimethoprim mixture 960 mg twice daily for up to two years.
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