Actinomycetoma leg ulcers in north India

Actinomycetoma is a chronic subcutaneous infection caused by aerobic branching actinomycetes. Its clinical features are firm tumefaction of the affected site and the presence of abscesses, nodules, and sinuses that drain a seropurulent exudate containing filamenting granules. Cutaneous actinomycetoma has traditionally been deemed uncommon in the northern part of India, but recent studies have refuted this long-held notion. Thus, clinicians have to be more vigilant when they come across patients with long-standing cutaneous lesions with typical mycetomic features, as early diagnosis and treatment hold the key to a cure.

This prospective study was carried out from June 2009 to December 2012 and comprises 13 cases of chronic nonhealing ulcers of the lower limb subsequently diagnosed as mycetoma. Socioetiological aspects, prevalence, early diagnosis, and treatment modalities of this condition are described in the study along with a simple, yet inclusive, scoring system to evaluate the post-treatment results.

Ten out of 13 cases with clinical suspicion of actinomycetoma were diagnosed with the condition. A majority of these diagnosed patients were middle aged and belonged to lower socioeconomic status. There was no sexual preponderance. Early treatment in the form of modified Welsh regime (amikacin + cotrimoxazole + rifampicin) was started and showed acceptable results. Post-treatment outcomes were measured on the basis of a new scoring system (Masoodi's score) devised by the authors. Two patients had a score of > 7 (good), 5 patients had a score of 4-6 (fair), and 3 patients had a score of ≤ 3 (poor).

Correct identification of the infective aetiological agent is imperative to direct therapy against actinomycetoma. Treatment success depends on an early diagnosis and instigation of treatment. Efficacy of chemotherapy, if started after an early diagnosis in the form of modified Welsh regime, produces acceptable results in the form of clinical and physical remission or cure. The functional and cosmetic parameters do not respond as well to treatment and the authors propose a new scoring system which takes into account the post-treatment results in totality.