Fig. 126.—Mycetoma. (From Greene.)
Uncomplicated cases do not show fever and the occasional enlargement of lymphatic glands is probably connected with bacterial infections.
There are never visceral metastases in mycetoma as is true of the nearly related actinomycosis.
The process shows no tendency to heal naturally or under treatment but fortunately does not extend, the process being confined to a foot or a hand. The joints are rarely if ever invaded. Unless the sinus-riddled member is amputated the drain on the patient gradually exhausts him and death ensues in ten or fifteen years.
Diagnosis
The distorted appearance of the foot or hand, riddled with sinuses discharging a viscid fluid containing the variously colored granules, which upon microscopical examination are found to be sclerotia of fungi, is absolutely diagnostic. As regards recognition of the causative fungus one should culture the discharge or grains on maltose agar, potato or rather dry blood serum. The recognition of species of fungi is a very difficult matter, even for an expert.
Prognosis
This is absolutely unfavorable as regards the relief of the condition but as regards life it is not unfavorable provided the drain on the system is gotten rid of by amputation of the part.