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ABSTRACT
When “grains” (condensed clusters of organisms) are observed in the gross or microscopic specimens, one should consider three main categories: Bacteria-induced Mycetoma, Eumycetoma, and Botryomycosis.
Mycetoma is a tumorous infection of the skin and subcutaneous tissue. It is caused by either actinomycotic bacteria or eumycotic imperfect fungi. The three cardinal features are 1) tumefaction or the appearance of indolent inflammatory nodules and secondary fibrosis, 2) formation of sinus tracts and fistulas that may have the capability of penetrating deep tissue, and 3) the presence of grains or granules in the affected tissue and discharge. Although mycetoma is relatively uncommon,
increasing mobility and an ever-changing demographic picture should heighten our awareness of this disease. Characteristic histopathologic findings and microbiologic identification establish the diagnosis. Consequently, when evaluating what might seem like an ordinary skin or fungal infection, we must widen our suspicion to include mycetoma. Effective treatments for actinomycetoma are available, whereas
eumycetoma often presents a treatment challenge.
Botryomycosis is a chronic, suppurative disease that is often mistaken clinically and histologically as a fungus infection. Actually, it is caused by bacteria.
Staphylococcus aureus is the most common causative organism, but many other bacteria have also been reported, such as Pseudomonas aeruginosa, E. coli, Proteus species, Bacillus species, and so on. If the clinical lesions are small, surgical excision should be considered. Most of the patients will respond to systemic and topical antibiotics.
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