Mycetoma is a chronic infection in the skin caused by either bacteria (actinomycetoma) or fungi (eumycetoma), typically resulting in a triad of painless firm skin lumps, the formation of weeping sinuses, and a discharge that contains grains. 80% occur in feet.Most eumycetoma is caused by M. mycetomatis, whereas most actinomycetoma is caused by N. brasiliensis, S. somaliensis, A. madurae and Actinomadura pelletieri. People who develop mycetoma likely have a weakened immune system. It can take between 3 months to 50 years from time of infection to first seeking healthcare advice.Diagnosis requires ultrasound and fine needle aspiration.While most cases of mycetoma occur in Sudan, Venezuela, Mexico, and India, its true prevalence and incidence are not well-known. It appears most frequently in people living in rural areas, particularly in farmers and shepherds, who are often men between 20 and 40 years earning the primary incomes for their families. It has been reported since 1840. Noteworthy, the diagnosis of Mycetoma in non-endemic or low endemic areas as Europe and North Africa is challenging. Physicians in these areas are usually unfamiliar with the disease-specific manifestations and need to exercise extra vigilance regarding those patients who are at high risk of contracting Mycetoma infections. Recent evidence suggests that Egypt which borders Sub-Saharan Africa, is a low-endemic country. Additionally, recent evidence suggests that Pakistan which borders India, is a moderate-endemic country. Unlike bacterial acute hematogenous osteomyelitis and septic arthritis, misdiagnosed or delayed diagnosis of Mycetoma osteomyelitis can result in amputation or radical resection.
Calcium is tightly regulated by the parathyroid hormone (PTH). In response to low calcium levels, PTH levels rise, and conversely if there are high calcium levels then PTH secretion declines. However, in the setting of absent, decreased, or ineffective PTH hormone, the body loses this regulatory function, and hypocalcemia ensues. Hypoparathyroidism is commonly due to surgical destruction of the parathyroid glands. Hypoparathyroidism may also be due to autoimmune problem. Some causes of hypocalcaemia are as follows:

Mechanism
Physiologically, blood calcium is tightly regulated within a narrow range for proper cellular processes. Calcium in the blood exists in three primary states: bound to proteins (mainly albumin), bound to anions such as phosphate and citrate, and as free (unbound) ionized calcium; all of these forms are ionised. Only the unbound calcium is physiologically active. Normal blood calcium level is between 8.5 and 10.5 mg/dL (2.12 to 2.62 mmol/L) and that of unbound calcium is 4.65 to 5.25 mg/dL (1.16 to 1.31 mmol/L). Diagnosis
Because a significant portion of calcium is bound to albumin, any alteration in the level of albumin will affect the measured level of calcium. A corrected calcium level based on the albumin level is: Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 * (4.0 - serum albumin [g/dL]). Since calcium is also bound to small anions, it may be more useful to correct total calcium for both albumin and the anion gap. Management
Management of this condition includes:
Intravenous calcium gluconate 10% can be administered, or if the hypocalcaemia is severe, calcium chloride is given instead.