Mycetoma (stopa madurska) jest przewlekłą, postępującą i destrukcyjną chorobą zakaźną skóry, tkanki podskórnej, a niekiedy zajmuje również mięśnie, kości i sąsiadujące narządy. Schorzenie charakteryzuje się obrzmieniem stopy, która jest zniekształcona, a skóra pokryta jest licznymi guzowatymi wykwitami prowadzącymi do powstawania przetok.
Obecnie sklasyfikowano około 70 różnych baterii, grzybów i promieniowców, które mogą wywołać mycetomę. Do zakażenia dochodzi, gdy drobnoustroje przebywające w glebie, wodzie lub w roślinach, wnikają przez uszkodzoną skórę (np. w wyniku zakłucia się kolcami roślin).
Mycetoma występuje w środowiskach tropikalnych i subtropikalnych, które charakteryzują się krótkimi porami deszczowymi i długimi porami suchymi. Obszarem endemicznym choroby są wiejskie rejony Indii, Sudanu, Ameryki Południowej i Środkowej. Osoby podróżujące do miejsc występowania choroby nie powinny chodzić boso po ziemi. Istotna jest również ochrona przed wszelkimi uszkodzeniami skóry. Zakażenie obserwowane jest u pacjentów w każdym wieku, jednak najczęściej dotyka młodych mężczyzn w wieku od 15 do 30 lat.
Jakie są objawy stopy madurskiej?
Mycetoma zazwyczaj dotyczy odsiebnych części kończyn dolnych, zwłaszcza stóp, ale może również objąć inną część ciała (np. plecy, pośladki). W praktyce klinicznej u pacjentów początkowo obserwuje się niewielkie guzy, które z czasem rozwijają się i prowadzą do powstania sączącej się rany. Dochodzi do rozwoju przewlekłego obrzęku z ziarniniakami i ropniami, które mają skłonność do tworzenia licznych przetok prowadzących do rozległych zniekształceń. Stopa jest zdeformowana, a zmiany mogą rozprzestrzenić się do kości i stawów. Stan ogólny pacjenta zazwyczaj jest dobry, a zmiany nie są bolesne. Nieleczona choroba może doprowadzić do uszkodzeń mięśni.
Biorąc pod uwagę powolny postęp choroby, jej bezbolesny charakter, a także niedostatek placówek medycznych w obszarach endemicznych – często dochodzi do infekcji urazu, co niejednokrotnie prowadzi do konieczności amputacji kończyny. Z kolei deformacja stopy może powodować niepełnosprawność.
Rozpoznanie i leczenie mycetomy
Rozpoznanie mycetomy opiera się na obrazie klinicznym i identyfikacji drobnoustrojów, które wywołały zakażenie. Badaniu mikroskopowym poddaje się wydzielinę ropną pochodzącą ze zmian lub z fragment z biopsji.
Wczesne wykrycie i rozpoczęcie leczenia może zmniejszyć niepełnosprawność i całkowicie wyeliminować zakażenie. Leczenie stopy madurskiej zależy od etiologii choroby. Zazwyczaj wdraża się chirurgiczne usunięcie zmian lub leczenie farmakologiczne z pomocą antybiotyków lub leków przeciwgrzybiczych. Leczenie niejednokrotnie jest długotrwałe i może nieść za sobą wiele skutków ubocznych, np. w postaci nawracających infekcji.
Źródła: medycynatropikalna.pl, cdc.gov.pl, who.int
Przeczytaj także: Zmiany skórne w przebiegu leiszmaniozy – pasożytniczej choroby tropikalnej
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