Mazurska stop

Mazurska stop - chronic fungal infection of the foot. Observed among residents of subtropical and tropical countries, in the USSR is rare. Characterized by severe destruction of all tissues of the foot. Conservative treatment is ineffective. May require amputation.
Cm. also Mycosis.

Mazurska stop (synonym: mycetoma, maduromycosis) is a chronic disease of the foot, at least - of other areas of the body caused actinomycetoma, mold and other fungi. Mazurska stop observed mainly among rural residents tropical and subtropical countries. The individual cases described in the countries of Western Europe and in the USSR.
Etiological maduromycosis divided into two groups: 1) close to actinomycosis caused actinomycetoma (Actinomyces somaliensis, Act. mycetomae and others), and 2) the actual mycetoma due to fungi (Penicillium mycetomagenum, Penicillium linki and others). Have up to 50 different fungi isolated at mazurskoj stop.
Epidemiology and pathogenesis mazurskoj feet are not completely understood. Transmission from person to person is not there. Infection occurs, apparently, if the damage bare feet thorns thorny plants.
Over and symptoms. The incubation period is from 10 days to many
years. Appear gradually increasing in number dense separated nodes, skin above them is red-violet and brown tint. Nodes are softened and opened to the outside fistulous moves (Fig. 1). Pus-containing white or yellow grain (plexus mycelium, cellular elements, detritus). The process covers the aponeurosis, muscles, tendons and often bones. Stop increasing and deformed. Lymph nodes are usually not affected. Options mazurskoj foot - Paramatma, where grains are rare, and a false mycetoma with epitheliomatous enlargement and the lack of grains in the discharge. Histological examination are determined by the productive-purulent inflammation around the thick wreath of mycelium fungus, infiltrates of the giant, epithelioid cells, leukocytes and rusalivka Taurus; endo - and periarteriit, indefinite.
Diagnosis mazurskoj foot is placed on the basis of clinical and x-ray data (see below), finds fungus and the given reaction of binding complement with relevant fungal antigens. Lasting results of cachexia.
X-ray picture mazurskoj foot extremely characteristic. Found deep involvement in the pathologic process of the foot bones with a sharp prevalence of the phenomena of destruction over secondary reactive changes. All the bones of the foot (mainly DiViSy medium metatarsal) propisyvayutsya racemose destructive lesions in diameter from 3 to 10 mm, which initially in the form of boundary value erosion affect cortical substance, and then fully grasp and spongy structure. Remain normal only phalanx and usually the distal ends of all or part of the metatarsal bones. In typical cases, the bone-eaten from inside and outside, extremely thinning, between articular surfaces - wide diastase. However bone elements of the foot is still mostly do not lose their normal relationship, i.e. stop retains its musculoskeletal properties.
The osteosclerosis and significant periosteal reaction are rare; sequestration is not observed. Noticeable small osteoporosis distal parts of the skeleton of the foot (Fig. 2). Pathological process applies to the skeleton diffuse by switching nodes in many places directly from soft tissue to the bone skeleton of the foot.
Treatment with iodine, x-rays, drugs gold ineffective. There is evidence of positive action sulfones (DDS), tetracycline, terramycin. Cm. also Actinomycosis, Mycosis.

Fig. 1. Mazurska stop (disease duration 10 years).
Fig. 2. Osteoporosis bones of the foot.