A mycetoma is a medical condition characterized by the presence of a fungal infection that adversely affects lung cavities and contributes to the development of a mass referred to as a pulmonary aspergilloma, or fungus ball. Originating from an exposure to aspergillus fungi, the condition may also affect other organs, including the kidneys and brain. Individuals with pre-existing medical conditions that affect the lungs or compromised immunity are especially susceptible to mycetoma and should avoid environments conducive to aspergillus fungi growth.
The fungus aspergillus is ubiquitous and thrives in environments where dead or decaying waste is readily available. Elements such as dead leaves, compost, and rotting vegetation offer the fungi ideal conditions for growth. The fungi may also thrive in areas where grain is stored and in the droppings of birds.
Once inhaled, the fungus may either attack healthy lung tissue or come to rest in cavities bored in the tissue by a pre-existing infection or illness. Conditions that may contribute to the formation of cavities within lung tissue may include sarcoidosis, tuberculosis (TB), and lung cancer. After the fungus has invaded the tissue, its presence promotes the formation of a collection of puss, known as an abscess. As the fungus thrives in the tissue, it matures, forming a clump of infection, or fungus ball.
In most cases, individuals who acquire mycetoma may remain asymptomatic, meaning they experience no symptoms at all. Those who become symptomatic may experience a variety of signs that directly affect their respiratory system. Coughing, chest pain, shortness of breath and wheezing are common symptoms associated with this condition. Additional symptoms may include fever, weight loss, and general discomfort. It is not uncommon for individuals who acquire mycetoma and become symptomatic to cough up blood, a condition known as hemoptysis.
A diagnosis of mycetoma may be confirmed through the administration of several testing procedures. Individuals with a suspected fungus ball may undergo a blood test to check for the presence of aspergillus and evaluate aspergillus antibodies. A sputum culture may be taken to assess secretions from the individual’s lungs and bronchial tubes for the presence of bacteria, namely aspergillus. Additional testing may include a computerized tomography (CT) scan and X-ray of the chest area.
Once a diagnosis is confirmed, there is generally no further action taken other than the possible administration of an antifungal medication. In cases where the individual is experiencing hemoptysis, further medical assistance may be necessary. An angiography may be conducted to evaluate the cause of the hemoptysis, which involves the injection of dye into the individual’s blood vessels to determine the location of the bleeding. In some instances, surgery may be necessary if the bleeding becomes life-threatening or is not easily managed with traditional treatment. Severe cases of mycetoma that affect an individual’s limb may necessitate amputation of the affected appendage.
The prognosis for symptomatic individuals is dependent on the severity of their condition and their overall health. Those with an underlying infection or illness may require a more intensive treatment regimen to manage symptoms and alleviate infection. Despite the complexity of surgical treatment, success rates are relatively high and individuals usually make a complete recovery.
Complications associated with mycetoma may become life-threatening if ignored. Individuals may experience difficulty breathing that may worsen with time. Those with hemoptysis may experience a progression of symptoms that result in substantial bleeding that originates in the lung. Acute invasive aspergillosis is an additional risk and involves the spread of the infection to other parts of the body.