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Abstract：
Mycetoma is a chronic granulomatous infectious disease that can affect the skin, subcutaneous tissue, fascia and bone. It can be caused by filamentous bacteria or fungi and usually involves the legs and feet. Mycetoma is endemic in tropical and subtropical regions and is easily misdiagnosed in clinical practice because of its nonspecific clinical features and lack of awareness of the disease. Although mycetoma is very rare in mainland China, an increasing number of cases have been reported in recent years. Here, we report a case of mycetoma in a patient who was misdiagnosed many years before receiving the correct treatment, leading to disease progression and motion limitation. The grains that represent microorganismal colonies were important clues for diagnosis. We also reviewed reported cases of mycetoma in mainland China. The majority of cases were reported from southern regions. Actinomycetoma was more commonly reported than was eumycetoma. The causative agents of actinomycetoma included Nocardia brasiliensis, N. asteroides, N. otitidiscaviarum, N. ninae and Gordonia terrae, and the causative fungi of eumycetoma were identified as Madurella mycetomatis, Fonsecaea pedrosoi and Acremonium falciforme. Notably, the diagnosis of mycetoma was delayed from months to decades in all of the patients, likely due to a lack of clinical experience. Our literature review suggests the importance of increased awareness of mycetoma in clinical practice, especially in non-endemic regions. Further investigative studies are needed to determine the real incidence of the disease in China.
摘要：
Mycetoma是一种慢性肉芽肿性传染病，可影响皮肤，皮下组织,筋膜和骨头。它可以由丝状细菌或真菌引起，通常涉及腿和脚。Mycetoma在热带和亚热带地区流行，由于其非特异性的临床特征和对该病的认识不足，在临床实践中容易被误诊。尽管菌丝瘤在中国大陆非常罕见，近年来报告的病例越来越多。这里,我们报告了一例在接受正确治疗之前被误诊多年的患者的肌瘤，导致疾病进展和运动受限。代表微生物菌落的颗粒是诊断的重要线索。我们还回顾了中国大陆报道的肌瘤病例。大多数病例来自南部地区。放线菌瘤比瘤更常见。放线菌瘤的病原体包括巴西诺卡氏菌，N.小行星，N.otidiscaviarum，N.Ninae和Gordoniaterrae，Eumycetoma的致病真菌被鉴定为Madurellamycetomatis，Fonsecaeapedrosoi和镰刀菌。值得注意的是,在所有患者中，细菌瘤的诊断从几个月推迟到几十年，可能是由于缺乏临床经验。我们的文献综述表明在临床实践中提高对肌瘤的认识的重要性。特别是在非流行地区。需要进一步的调查研究来确定该疾病在中国的实际发病率。
