Fungi are prokaryotic organisms (T/F)?
False
Eukaryotic
Deep fungal diseases affects the subcutaneous tissues only (T/F)?
False
Subcutaneous tissue and dermis
What are the routes of deep fungal infections?
direct inoculation of the fungi into the skin
Inhalation of their spores leading to a primary lung disease and then dissemination through the blood causing the skin involvement.
What are the two distinct groups of conditions caused by deep fungal infections?
Subcutaneous mycosis
Systemic mycosis
Subcutaneous Mycoses are very common (T/F)?
False
Subcutaneous Mycoses and systemic Mycoses are not common
What group of patients are systemic Mycoses commonly found in?
immuno-compromised
Patients with systemic fungal infections often presents to the physician with signs of skin involvements (T/F)?
False
It’s subcutaneous! Systemic only occasionally
What is the infectious agent in HISTOPLASMOSIS?
Histoplasma capsulatum
Outline the natural reservoir for organism causing HISTOPLASMOSIS?
Soil
Bat
Avian habitat
Microscopic examination of tissue from patient with HISTOPLASMOSIS will reveal what?
Yeast cell in tissue (37°C)
Hyphae, microconidia and macroconidia (tuberculate chlamydospore) at 25 °C
How does one get HISTOPLASMOSIS?
Inhalation of microconidia / primary cutaneous inoculation
Outline 5 risk factors of getting HISTOPLASMOSIS?
Living in endemic areas AIDS Primary immuno-deficiencies Drug induced immunosuppressive states Extremes of age
Mention 5 skin manifestations of HISTOPLASMOSIS?
Erythema nodosum Erythema multiforme Papules pustles noodles.
a target or bulls eye type of skin reaction seen in patients with HISTOPLASMOSIS is known as?
Erythema multiforme
Mention 10 clinical findings in HISTOPLASMOSIS?
Fever, Cough, Fatigue, Headache
Malaise, Myalgia
Abdominal pain
Joint pains and skin lesions(5-6%) of patients mostly females
Enlarged hilar and mediastinal lymph nodes(5-10%)
Haemoptysis
Chestpain
dysphagia
Chills
Individuals exposed to a large innoculum may develop severe dyspnea resulting from diffuse pulmonary involvement.
Broncholithiasis
patients with HISTOPLASMOSIS rarely get better on their own without medication (T/F)?
False
many patients get better on their own without medication
Sub-acute pulmonary histoplasmosis occurs mostly in older patients with underlying pulmonary disease, apical segment, pleural thickening.
False
It’s chronic pulmonary histoplasmosis
Sub-acute pulmonary histoplasmosis is associated with cough, weight loss, fevers, and malaise < 3 months duration (T/F)?
False
It’s often asymptomatic!
However chronic pulmonary histoplasmosis presents with these symptoms Buh for > 3 months
Cavitations,haemoptysis, sputum production and increasing dyspnea are common symptoms in acute pulmonary histoplasmosis (T/F)?
False
It’s chronic pulmonary histoplasmosis
On imaging upper lobe infiltrates and thick walled cavities are usually seen in sub-acute pulmonary histoplasmosis (T /F)?
False
It’s chronic pulmonary histoplasmosis
Fibrosis and scarring may be seen in chronic pulmonary histoplasmosis (T/F)?
True!
Onset of symptoms occur 3-14 days after exposure In sub-acute histoplasmosis (T/F)?
True!
And acute too
What’s the difference between acute and sub-acute histoplasmosis?
Acute (<1month of symptoms)
Subacute(duration<3months)
Approx 30% of patients with sub-acute pulmonary histoplasmosis are asymptomatic (T/F)?
False
It’s 90%
What category of patients are mostly affected by progressively disseminated histoplasmosis?
immuno-compromised
What are the risk factors for progressive pulmonary histoplasmosis?
Exposure to the fungus as an infant AIDS with CD4count(<150cells/μL) use of corticosteroids haematologic malignancy solid organ transplantation patients requiring TNF antagonists(e.g etanercepts, infliximab)
What are the forms of progressively disseminated histoplasmosis?
Acute form
Sub-acute form
Chronic form
What are the symptoms of the acute form of progressively disseminated histoplasmosis?
fever worsening cough weight loss malaise dyspnea cns involvement(5-20%)
What are the symptoms of Sub-acute form of progressively disseminated histoplasmosis?
wide variety of symptoms as a result of dissemination and sub acute expression in the affected organs!
GIT involvement
diarrhea, abdominal pain, abdominal mass, intestinal ulcers
CARDIAC involvement
valvular disease, cardiac insufficiency or vegetations may produce dyspnea, peri-edema, angina and fever, pulmonary rales or wheezes, petechiae or skin lesions
CNS involvement
headache,visual and gait disturbances, confusion, seizures,altered consciousness,and neck stiffness or pain
What are the symptoms of chronic form of progressively disseminated histoplasmosis?
constitutional symptoms
mucous membrane lesions
Presumed ocular histoplasmosis syndrome occurs in 50% of individuals living in endemic areas have ocular involvement (T/F)?
False
1-10%
Presumed ocular histoplasmosis syndrome is Usually associated with eye pain, itchiness and discahrge and Macula involvement may result in blindness (T/F)?
False
Although Macula involvement may result in blindness it’s usually asymptomatic!
What are histo spots?
Atrophic scars containing foci of lymphocytic cell infiltration seen in presumed ocular histoplasmosis syndrome!
Histo spots are constant findings in presumed ocular histoplasmosis syndrome and are usually located posterior to the equator of the eye (T/F)?
False
They are not constant findings!
What % of patients with acute pulmonary histoplasmosis develop rheumatologic manifestations of erythema multiforme, arthritis and erythema nodosum ?
5-6%
Under what situation would acute pulmonary histoplasmosis be associated with rales that mimic ARDS?
in cases with high innoculum, individuals may develop severe hypoxemia associated with tales that mimic ARDS
Hepatosplenomegaly may sometimes be associated with acute pulmonary histoplasmosis (T/F)?
True!
What cardiac complications may be seen in acute pulmonary histoplasmosis and in what % of patients?
Asymptomatic pleural effusion (10%)
Pericarditis with rubs (5%)
non-specific rales and wheeze is a common feature of acute pulmonary histoplasmosis T/F)?
False
Seen in chronic pulmonary histoplasmosis
oropharyngeal ulcers involving the buccal mucosa,tongue,gingiva, and larynx suggestive of dissemination is seen in chronic progressive disseminated histoplasmosis (T/F)?
False
Lesions are not suggestive of dissemination
Dissemination is seen in sub-acute form
Mention 4 differential diagnosis of Sub-acute progressive disseminated histoplasmosis?
Meningitis
Space occupying lesions
Endocarditis
Typhoid
Surgical abdomen is a serious complication of chronic progressive disseminated histoplasmosis (T/F)?
False
It’s sub-acute form
CNS and Endocarditis manifestations may be seen in both acute and sub-acute forms of progressive disseminated histoplasmosis (T/F)?
True!
Oropharyngeal lesions may be seen in acute and chronic forms of progressive disseminated histoplasmosis (T/F)?
True!
A patient diagnosed with HISTOPLASMOSIS presents with dilatation of collaterals in the neck&thorax,edema of the face,neck , upper torso and conjunctiva. What form of histoplasmosis does this ptx have? What has caused this presentation?
Acute progressive disseminated histoplasmosis
This is due to SVC syndrome+ lymphadenopathy severe enough to cause obstruction and increased venous pressure
What are the indications for medical treatment in histoplasmosis?
In cases of prolonged infection
cases of systemic infection
Those involving individuals who are immunocompromised
Otherwise, Most infections in individuals who are immunocompetent are self limiting and do not require therapy
No treatment is usually required in acute pulmonary histoplasmosis (T/F)?
True!
It’s asymptomatic
How would you treat a patient with acute pulmonary histoplasmosis with prolonged symp(>4wks) or those with overwhelming pulmonary involvement?
initiate therapy with itraconazole(6-12wks) response to therapy should be monitored using chest imaging
ptx should be monitored for several years after tx for possible relapse.
How would you manage a patient diagnosed of acute pulmonary histoplasmosis with severe infection?
tx with amphotericin B for 1-2 weeks
once stable it should be changed to itraconazole and should be continued for 1yr
How would you manage a patient diagnosed of acute pulmonary histoplasmosis with ARDS symptoms?
Ptx may require methylprednisolone for 1-2 weeks.
Chronic pulmonary histoplasmosis may resolve without treatment (T/F)?
False
Often fatal if not treated
What is the mortality rate of chronic pulmonary histoplasmosis without treatment and with treatment?
50% without treatment
28% with treatment
How are HISTOPLASMOSIS patients with cavitary lesions treated?
Itraconazole given for 1 year
Follow up ptx due to risk of relapse (15%)
What is the definitive management of histoplasmosis patients with Persistent cavitations despite multiple courses of med tx?
Surgery
What are the principles of management of ptx with progressive disseminated histoplasmosis?
Initiate tx for all pt
Haemodynamic and respiratory compromise from pericardial and pleural involvement warrants immediate procedural intervention.
Perform thoracentesis or pericardiocentesis in pt with severe pleural effusions and pericardial tamponade, respectively.
Cutaneous and rheumatologic histoplasmosis are usually self limiting (T/F)?
True
When do we treat patients with cutaneous and rheumatological manifestations of histoplasmosis?
prolonged episodes
those who are immuno-supressed
Anti fungal agents will effectively treat the broncholithiasis seen in histoplasmosis (T/F)?
False
Antigungal TX does not play a role!
What is the definitive management of the broncholithiasis of histoplasmosis?
Bronchoscopic or surgical removal
Outline 6 complications of histoplasmosis?
Mediastinal and hilar lymphadenopathies Lymph node enlargement/compression of surrounding structures Post obstructive pneumonia Bronchoectasis Persistent cough Haemoptysis Dysphagia Histoplasma induced mediastinal fibrosis Adrenal insufficiency Overwhelming sepsis with DIC and GI bleeding Pleural effusions
Dysphagia and pleural effusion are common complications of histoplasmosis (T/F)?
False
They are rare!
Mediastinal and hilar lymphadenopathies seen in histoplasmosis usually resolve (T/F)?
True
What is the most benign non malignant cause of SVC syndrome?
Histoplasma induced mediastinal fibrosis!
Adrenal insufficiency is seen in what form of histoplasmosis?
subacute pulmonary disseminated histoplasmosis regardless of tx
Overwhelming sepsis with DIC and GI bleeding is a common complication of what form of histoplasmosis?
acute proggressive disseminated histoplasmosis
What cells are predominantly found in histoplasmosis associated pleural effusion?
Lymphocyte predominant exudate
Pleuaral biopsy in patients with histoplasmosis will reveal what?
Non-caseating granulomas
Pleural effusion in histoplasmosis resolves spontaneously over several weeks (T/F)?
True
When should Pleural effusion in histoplasmosis be treated?
persists for>3-4 weeks
it occurs in an immuno-compromised pt
Outline 7 differentials of histoplasmosis?
Sarcoidosis Tuberculosis Aspergillosis Aspiration pneumonitis and pneumonia Bacterial pneumonia Viral pneumonia Fungal pneumonia Chlamydial pneumonias Pneumocystis jiroveci pneumonia Pneumococcal infections(pneumonia) Mycoplasma infections(mycoplasma pneumonia) Blastomycosis Coccidiodomycosis and valley fever Carcinoid lung tumour Small cell lung cancer Mediastinal lymphoma Pan coast syndrome
What is the causative organism of coccidioidomycosis
Coccidioides immitis, A dimorphic soil fungus found in the soil in arid areas
What geographical areas are commonly affected by coccidioidomycosis?
Arid areas in the USA(san juan valley califonia, southern Arizona)
nothern Mexico
central and south America
How does one get coccidioidomycosis?
Inhalation of the spores!
In most patients coccidioidomycosis infection becomes disseminated, with ulcers or deep abscesses in the skin (T/F)?
False!
Occurs in a few patients.
What are the risk factors for coccidioidomycosis?
Direct exposure to soil harbouring Coccidiodes Climatic factors Heredity Race Sex (M>F) Age Compromised cell mediated immunity
Coccidioidomycosis is more commonly found in males than females (T/F)?
True
Outline the triad of coccidioidomycosis?
Fever
Erythema nodosum
Erythema multiforme
Skin manifestations of coccidioidomycosis are more common in males than females (T/F)?
False
Commoner in females!
i.e Erythema nodosum and Erythema multiforme
Erythema multiforme may be the first sign of systemic disease in coccidioidomycosis (T/F)?
False
It’s Erythema nodosum
Erythema nodosum are painless nodules commonly found on lower extremities in superficial fungal infections (T/F)?
False!
They are painful and seen in deep fungal infections.
Migrating arthralgias are common findings in coccidioidomycosis (T/F)?
True
What is the triad of desert rheumatism?
erythema nodosum
erythema multiforme
Migrating arthralgias
Nodular lesions in lungs is a feature of disseminated coccidioidomycosis infection (T/F)?
False
It’s a feature of primary infection
What percentage of patients with coccidioidomycosis are asymptomatic?
60%
Outline the common clinical symptoms of coccidioidomycosis infection?
Fever
Cough
Weight loss
Chest pain
These symptoms are seen in 40% of ptx
What is the most common site of disseminated coccidioidomycosis infection?
The skin
Outline the common sites of secondary coccidioidomycosis infection?
Skin
Lungs
Bones
Meninges
What percentage of ptx with coccidioidomycosis have disseminated/secondary infection
1%
What are the reactive cutaneous lesions seen in coccidioidomycosis?
Maculopapular rash Keratotic noodles Cold subcutaneous abscesses Urticaria Sweet’s syndrome Reactive interstitial granulomatous dermatitis
What are the organism specific cutaneous lesions seen in coccidioidomycosis?
Non healing ulcers
Verrucous ulcers due to subcutaneous fluctuant abscesses
Papules
Sinus tract abscesses
Organism specific cutaneous lesions have a pridilection for the nasolabial folds (T/F)?
False
It’s reactive cutaneous lesions
Non healing ulcers may be the 1st or only sign of disseminated infection (T/F)?
False
It’s Cold subcutaneous abscesses
What samples are required in the diagnosis of coccidioidomycosis?
Sputum
Tissue biopsy
How is diagnosis of coccidioidomycosis made?
1. DIRECT EXAMINATION (KOH; H&E) to visualize Spherule 2.CULTURE SDA: Mould colonies at 25 °C 3. SEROLOGY latex agglutination (IgM) test Complement fixation (IgG) Disseminated (> 1:32) 4. SKIN TEST (coccidioidin and spheruline antigens) Negative result may rule out the diagnosis!
What are the differential diagnosis of coccidioidomycosis?
INFLAMATORY
Sarcoidosis
Pars planitis
SLE
INFECTIOUS Syphilis TB Toxoplasmosis Lyme disease
NEOPLASTIC
Primary CNS lymphoma
Systemic lymphoma
leukemia
What are the treatment options for coccidioidomycosis?
Amphotericin B
(0.5-0.7mg/Kg/day); IV
Itraconazole
(200mg b.d); PO
Fluconazole(particularly for meningitis)
(400—800mg/day); PO or IV
Ketoconazole
(400mg/day) PO
What is the causative agent in blastomycosis?
Blastomyces dermatitidis
Blastomycosis is less frequently disseminated (T/F)?
False
It’s Frequently disseminated!
Blastomycosis has a fairly good prognosis (T/F)?
False!
All patients have done very poorly
What %of patients with blastomycosis usually have cns involvement?
3-10%
How do patients get blastomycosis?
Inhalation of infectious particles
Primary cutaneous inoculation
wart-like, hyperkeratotic nodules, which spread peripherally with a verrucose edge, while tending to clear and scar centrally are clinical findings in chronic cutaneous blastomycosis infection (T/F)?
False!
Seen in primary cutaneous blastomycosis infection
Subcutaneous nodules and ulcerations are clinical findings seen in primary cutaneous blastomycosis infection (T/F)?
False
Seen in chronic cutaneous blastomycosis infection
What are the common sites of disseminated blastomycosis infection?
Skin bone GUT CNS spleen
Itemize 5 various clinical findings seen in blastomycosis?
Asymptomatic Pulmonary infection Disseminated infection Chronic cutaneous infection Primary cutaneous infection
Sporotrichosis is otherwise known as?
Rose Gardener’s disease
What is the causative organism of Sporotrichosis?
Sporothrix schenckii
Itemize 3 unique properties of Sporotrix shenckii?
fungus that can be found world-wide in the environment.
The species is present in soil as well as in and on living and decomposing plant material such as peat moss.
can be found in one of two morphologies, hyphal or yeast.
What form of Sporotrix shenckii is found in the environment on plants and decaying matter?
The hyphal form (25c)
What form of Sporotrix shenckii predominates in the host?
The yeast form (37c)
What group of people are commonly affected by Sporotrichosis?
gardeners forest workers manual labourers landscapers Immunocompromised (often exhibit a severe form of the dx)
How do patients get Sporotrichosis?
It enters through small cuts and abrasions in the skin to cause the infection.
by cat bites or scratches
Inhalation of spores (a rare route of infection largely associated with immunocompromised hosts)
Sporotrichosis affects mainly the skin and bones (T/F)?
False
Affects mainly the skin
other rare forms can affect the lungs, joints, bones, and even the brain.
Sporotrichosis is an acute fungal infection producing nodules and ulcers in the lymph nodes and skin. (T/F)?
False
It’s a chronic infection!
Although S. schenckii has a worldwide distribution but certain areas of the world including africa, have a higher incidence of disease (T/F)?
False
Areas like Peru
What is the most common manifestation of Sporotrichosis?
lymphagitic sporotrichosis
Lymphagitic Sporotrichosis is characterized by a painful red nodule which forms at the site of innoculation (T/F)?
False
The nodule is nearly painless!
Lymphagitic Sporotrichosis is xterised by formation of similar nodules along distal lymphatic channels with intermittent discharge of small amount of pus. (T/F)
False
The similar nodules are formed in proximal lymphatic channels
Itemize 4 other organisms that mimic the proximal extension of lesions often with skip areas seen in Sporotrichosis?
Nocardia brasiliensis
leishmania brasiliensis
mycobacteriun marinum
Mycobacterium kansasii
Ulcerations is a constant feature seen in Sporotrichosis (T/F)?
False
Ulcerations may occur
What specimen are used in the diagnosis of Sporotrichosis?
aspiration fluid pus biopsy material skin scrapings swabs
How is Sporotrichosis diagnosed in the laboratory?
MICROSCOPY
KOH MOUNT of specimen or histopathological examination of tissue sections stained by METHANAMINE SILVER STAIN
CULTURE
The fungus may not be demonstrable in pus or tissue.
Hence, culture is done on media incubated at 250C and 370C
SEROLOGY
A slide latex agglutination test, using PEPTIDO-L-RHAMNO-D-MANNAN as antigen is a reliable, sensitive and specific test
What laboratory investigation is especially helpful in the diagnosis of extracutaneous or systemic infection?
Serology!
Itemize the treatment options for Sporotrichosis?
CUTANEOUS INFECTION
POTASSIUM IODIDE given topically or orally. Therapy should be continued for one month after the resolution of all lesions.
For LYMPHOCUTANEOUS INFECTION ITRACONAZOLE(100-200mg) daily is effective
For DISSEMINATED INFECTION
AMPHOTERICIN B is the drug of choice
Mention 2 differential diagnosis of Sporotrichosis
Fish tank granuloma
Cutaneous leishmaniasis
What is the causative agent in actinomycosis?
Actinomyces israeli
Actinomyces Israeli is a normal flora of the mouth and bowel. (T/F)
True
Actinomycosis is a rare fungal disease (T/F)?
False
It’s a rare bacteria dx
Actinomycosis is a fairly common bacteria disease (T/F)?
False
It’s rare
Actinomycosis is a polymicrobial anaerobic infection (T/F)?
False
polymicrobial aerobic anaerobic infection
Itemize 2 other organisms implicated in actinomycosis?
A. gerencseriae
Propionibacterium propionicus
Actinomycosis is more commonly seen in males than females (T/F)?
True
Which age group are commonly affected in actinomycosis?
20-60yrs
What is a known risk factor for genitourinary actinomycosis in females?
The use of intrauterine devices
The Incidence of oral actinomycosis which is easier to diagnose has increased (T/F)?
False
It’s harder to diagnose!
What condition is known as “the great masquerader”?
Actinomycosis!
What are the clinical features of actinomycosis?
Painful abscesses in the mouth, lungs,breast or GI which grow larger as the disease progresses.
lumpy induration and scarring coexisting with multiple sinuses discharging pus containing ‘sulphur granules’, made up of tangled filaments
What sites are favoured in actinomycosis?
Jaw
Chest and abdominal wall
Diagnosis of actinomycosis is often a difficult one to make (T/F)?
True
What are the treatment options for actinomycosis?
PENICILLIN
In cases of allergy, use DOXYCYCLINE
Sulfonamides such as SULFAMETHOXAZOLE may be used as an alternative regimen. (2-4g/day)
Response to therapy is slow and may take months
HYPERBARIC OXYGEN THERAPY may also be used as an adjunct to conventional tx when the dx is refractory to antibiotics and surgical tx
Maduramycosis is an acute infection of the skin and/or subcutaneous tissue resulting in tumefaction(swelling) studded with sinuses discharging grains. (T/F)?
False
It’s a chronic infection
What body sites is typically affected in maduramycosis?
Feet, Lower extremities ,hands (but it can occur in almost any region of the body)
What group of individuals are at increased risk for mycetoma?
Farm workers!
Mycetoma due to true fungi infection is known as?
Eumycetoma
Mycetoma due to aerobic bacteria infection is known as?
Actinomycetoma
Eumycetoma and actinomycetoma have very different clinical findings (T/F)?
False
Both types have similar clinical findings.
Itemize the fungal organisms causing maduramycosis?
FUNGI Madurella mycetomatis Madurella grisea Leptospaeria senegalensis Neotestudina rosatii Fusarium moniliforme Fusarium soloni
Itemize the bacteria(actinomycetes) organisms causing mycetoma foot
ACTINOMYCETES Actinomadura madurae Actinomadura pelletieri Nocardia brasiliensis Nocadia asteroides Streptomyces somaliensis
What group of mycetoma causing organism causes RED discharge?
Actinomadura pelletieri
What group of mycetoma causing organism causes WHITE or YELLOW discharge?
Acremonium strictum Actinomadura madurae Aspergillus nidulans Noetestudina rosatii Phaeoacremonium krajdenii Pseudallescheria boydii
What group of mycetoma causing organism causes BLACK discharge?
Aspergillus terreus Curvularia lunata Cladophialophora bantiana Exophiala jeanselmei Leptosphaeria senegalensis Leptosphaeria tompkinsii Madurella grisea Madurella mycetomatis Pyrenochaeta romeroi
2 common causative organisms in maduramycosis are?
Actinomadura madurae
Streptomyces somaliensis
What is the classic triad of mycetoma?
Tumefaction (tumor-like swelling)
Multiple draining sinuses
Sclerotia (granules/grains in sinuses)
Mycetoma originates in the sub-cutaneous tissue (T/F)?
True
Mention 3 characteristics of the infected site in mycetoma?
PAINLESS swelling
woody induration
sinus tracts that discharge pus intermittently
Systemic symptoms commonly develops in maduramycosis (T/F)?
False
Systemic symptoms do not develop
Mycetoma can sometimes spread to distant sites (T/F)?
False
Spread to distant sites does not occur
Affects surrounding muscle and bone
What are the differential diagnoses of mycetoma foot?
Chronic osteomyelitis of bacterial or tuberculous origin(characteristics grain are not discharged)
Elephantiasis(no sinus tract)
Primary cutaneous actinomycosis(develops on the exposed site, very rare type of actinomycosis,a normal flora of the mouth)
Mycetoma can be accurately diagnosed by what?
Fine Needle Aspiration (FNA) cytology.
What is the distinct appearance of mycetoma lesion in a cytology smear?
presence of polymorphous inflammatory cells consisting of an admixture of neutrophils, lymphocytes, plasma cells
How is mycetoma diagnosed in the laboratory?
Granules differ in colour, shape, dimension and composition!
1)Transport in distilled water or sterile normal saline
Black granules usually fungal
Small red granules – Streptomyces
Whitish yellow granules either bacterial or fungal
KOH of granules- presence or absence of hyphae
Histological stains of biopsy from sinus tract
The causative organism is cultured in Sabouraud’s dextrose agar medium.
What are the treatment options for maduramycosis?
ACTINOMYCETOMA
may respond to prolonged combination chemotherapy!
STREPTOMYCIN(14mg/kg daily IM for 3 months) and either DAPSONE(1.5mg/kg 12 hourly orally) or TMP-SMX
EUMYCETOMA
rarely responds to chemotheraphy!
some cases caused by Madurella mycetomatis have appeared to respond to KETOCONAZOLE or ITRACONAZOLE.
SURGERY;(amputation) may be a valuable alternative to the often poor results of medical treatment, which is with systemic antibiotics or antifungal drugs, depending on the organism isolated.
Adequate vaccination may prevent against maduramycosis (T/F)?
False
No vaccine is available
How may we prevent mycetoma foot?
Simple hygienic precautions
wearing shoes or sandals while working in fields washing hands and feet at regular intervals