D. All of the above.
Ans:D. All of the above.
The patient is suffering from Mycetoma(Madura Foot)
- It is a chronic infection of skin and subcutaneous tissue.
- It was initially named Madura foot, after the region of Madura in India where the disease was first identified.
- It occurs mainly in tropical areas in India, Africa, South America, Central America, and southeast Asia.
- Mode of infection:
- Organisms are normally present in environment (soil and dust).
- Infection occurs in bare-footed persons after minor penetrating skin injury inoculating soil organisms, occurring preferentially in rural areas, usually among labourers who
- Age and sex: Mycetoma commonly affects adults aged 20 to 40 years, predominantly males.
- Mycetoma infection can be caused by fungi (mycotic mycetoma or eumycetoma)or bacteria by the actinomycetes group, including species of Streptomyces, Actinomadurae, and Nocardia(actinomycotic mycetoma or actinomycetoma).
- Mycetoma due to actinomycetes should be differentiated from actinomycosis, which is an endogenous suppurative infection caused by Actinomyces israelii, other species of Actinomyces, or related bacteria, typically affecting the cervical-facial, thoracic, and pelvic sites.
- Involvement of the lower extremities is common, and the disease presentation, whether caused by fungi or bacteria, is quite similar.
- Mycetoma infection typically results in a granulomatous inflammatory response in the deep dermis and subcutaneous tissue, which can extend to the underlying bone.
- Approximately one month or more after the injury, a nodule forms under the skin surface. The nodule is painless, even as it increases in size over the following months. Eventually,the nodule forms a tumor, or mass of abnormal tissue. The tumor contains cavities—called sinuses—that discharge blood-or pus fluid. The fluid also contains tiny grains, less than two thousandths of an inch in size.
- The color of these grains depends on the type of bacteria or fungi causing the infection.
- As the infection continues, surrounding tissue becomes involved, with an accumulation of scarring and loss of function.The infection can extend to the bone, causing inflammation, pain, and severe damage.