Actinomycetoma in the United States

Actinomycetoma (Madura foot) caused by Actinomadura madurae occurred in an Indiana factory worker. Previous cases of culture-proven actinomycetoma from the United States and reports of drug therapy were reviewed. Treatment with sulfonamides, streptomycin, dapsone, and other antimicrobial agents has been effective. Trimethoprim-sulfamethoxazole (TMP-SMZ) therapy was effective in our case, but sulfadiazine was not. In vitro, SMZ was 16 times more active against the infecting strain of A. madurae than was sulfadiazine, and TMP was inactive, suggesting that our patient's satisfactory treatment might have been due to SMZ alone. Prolonged therapy is usually necessary. Relatively simple immunologic procedures and antimicrobiol susceptibility tests have been useful in the diagnosis and management of actinomycetoma. With appropriate antimicrobial therapy, surgical excision or amputation usually can be avoided. Recommendations for the medical management of actinomycetoma are summarized.