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Maduramycosis, also known as mycetoma or Madura foot, is a chronic, granulomatous, and progressive infection of the skin, subcutaneous tissue, and underlying bone, caused by either true fungi (eumycetoma) or filamentous bacteria (actinomycetoma).

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It is classically characterized by the triad of:

Painless subcutaneous swelling
Multiple sinus tracts
Discharge containing colored granules (representing the causative organism)

Epidemiology

Parameter	Details
Endemic regions	Tropical and subtropical areas — particularly India (Madurai region), Sudan, Africa, Mexico, and South America
Common sites	Foot (70–80%) → known as Madura foot; can also affect hand, back, or shoulder
Population	Rural males, agricultural and barefoot workers
Causative organisms	– Eumycetoma (fungal): Madurella mycetomatis, Exophiala jeanselmei
	– Actinomycetoma (bacterial): Nocardia brasiliensis, Streptomyces somaliensis, Actinomadura madurae

Pathogenesis

Entry through minor trauma or puncture wound (thorn prick, contaminated soil).
Organisms inoculate into subcutaneous tissue → chronic granulomatous inflammation.
Formation of microabscesses with granules (compact masses of organisms).
Progressive destruction of soft tissues and bone, leading to sinus tracts, deformity, and fibrosis.
Infection spreads contiguously, not hematogenously.

Clinical Features

Stage	Findings
Early	Painless firm swelling (often plantar aspect of foot)
Intermediate	Formation of multiple draining sinuses with discharge of colored granules
Late / Chronic	Diffuse induration, deformity, ulceration, multiple sinuses, discharging granules (black = fungal, white/yellow = bacterial)
Pain	Typically mild or absent
Systemic signs	Absent; disease is localized and indolent
Complications	Secondary bacterial infection, osteomyelitis, pathological fractures, lymphedema, amputation (advanced cases)

![Eumycetoma development. (A) The fungal causative agent is introduced into the subcutaneous tissue via a minor trauma such as a thorn prick. (B) Inside the tissue, the fungus will form a grain. (C) Subcutaneous nodules will form, which will further extend into the subcutaneous tissue. (D) Picture of a mycetoma lesion in real life. (E) The eumycetoma causative agents will invade the bone and cavities (c) will form.

Van De Sande WWJ, Fahal AH. An updated list of eumycetoma causative agents and their differences in grain formation and treatment response. Clinical Microbiology Reviews. 2024;37(2). doi:10.1128/cmr.00034-23](attachment:2c1b5f7a-916b-488a-a0ee-6ea83aed7e51:cmr.00034-23.f003.jpg)

Eumycetoma development. (A) The fungal causative agent is introduced into the subcutaneous tissue via a minor trauma such as a thorn prick. (B) Inside the tissue, the fungus will form a grain. (C) Subcutaneous nodules will form, which will further extend into the subcutaneous tissue. (D) Picture of a mycetoma lesion in real life. (E) The eumycetoma causative agents will invade the bone and cavities (c) will form.

Epidemiology

Pathogenesis

Clinical Features

Radiology