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Dermatophytic pseudomycetoma (DPM) is a rarely reported invasive fungal infection of humans and animals, especially cats. This study aimed to identify dermatophytes, breed associations, and the frequency of extracutaneous (EC) involvement in feline DPM. Electronic records and formalin-fixed paraffin-embedded tissue (FFPET) from 32 suspected DPM cases in 30 cats were retrieved from a diagnostic laboratory between 2018 and 2024. To confirm DPM and molecular identity, DNA was extracted from FFPET for ITS2 sequencing, and immunohistochemistry was performed on PCR-negative cases. All cases were confirmed as DPM. Microsporum canis was the only dermatophyte identified. The sensitivity and specificity of ITS2 sequencing for M. canis identification in FFPET were 22/32 (68.8%) and 21/22 (95.5%), respectively. Exotic (36.7%) and Persian (23.3%) but not British breeds (26.3%) were over-represented compared to feline admissions at an affiliated veterinary hospital (8.5%, p < 0.001; 3%, p < 0.001; 21.6%, p = 0.817, respectively). Five cases (16.7%) had EC lesions; two had intra-abdominal masses; two had oral cavity masses, including one which extended into the cranial vault; and one had superficial cervical lymph node invasion. Exotic and Persian breeds are over-represented for DPM and M. canis is the primary cause. EC lesions of DPM may occur more commonly than previously thought. [ABSTRACT FROM AUTHOR]

Objectives: Eumycetoma is a neglected tropical disease (NTD) characterized by subcutaneous lesions and the formation of grains. Attempts to treat eumycetoma involve a combination of antifungal treatment and surgery, although the outcome is frequently disappointing. Therefore, there is a need to identify novel antifungal drugs to treat eumycetoma. In this respect, Medicines for Malaria Venture (MMV) has assembled libraries of compounds for researchers to use in drug discovery research against NTD. Therefore, we screened two MMVOpen compound libraries to identify novel leads for eumycetoma. Methods: A total of 400 compounds from the COVID Box and the Global Health Priority Box were screened in vitro at 100 µM and 25 µM against the most common causative agents of eumycetoma, namely Madurella mycetomatis and Falciformispora senegalensis, and the resulting IC50 and MIC50 values were obtained. Compounds with an IC50 < 8 µM were identified for possible in vivo efficacy studies using an M. mycetomatis grain model in Galleria mellonella larvae. Results: Out of the 400 compounds, 22 were able to inhibit both M. mycetomatis and F. senegalensis growth at 100 µM and 25 µM, with compounds MMV1593278, MMV020335, and MMV1804559 being selected for in vivo testing. Of these three, only the pyrazolopyrimidine derivative MMV1804559 was able to prolong the survival of M. mycetomatis-infected G. mellonella larvae. Furthermore, the grains in MMV1804559-treated larvae were significantly smaller compared to the PBS-treated group. Conclusion: MMV1804559 shows promising in vitro and in vivo activity against M. mycetomatis. [ABSTRACT FROM AUTHOR]

Introduction: (1,3)-β-D-glucan is a panfungal biomarker secreted by many fungi, including Madurella mycetomatis, the main causative agent of eumycetoma. Previously we demonstrated that (1,3)-β-D-glucan was present in serum of patients with eumycetoma. However, the use of (1,3)-β-D-glucan to monitor treatment responses in patients with eumycetoma has not been evaluated. Materials and Methods: In this study, we measured (1,3)-β-D-glucan concentrations in serum with the WAKO (1,3)-β-D-glucan assay in 104 patients with eumycetoma treated with either 400 mg itraconazole daily, or 200 mg or 300 mg fosravuconazole weekly. Serial serum (1,3)-β-D-glucan concentrations were measured at seven different timepoints. Any correlation between initial and final (1,3)-β-D-glucan concentrations and clinical outcome was evaluated. Results: The concentration of (1,3)-β-D-glucan was obtained in a total of 654 serum samples. Before treatment, the average (1,3)-β-D-glucan concentration was 22.86 pg/mL. During the first 6 months of treatment, this concentration remained stable. (1,3)-β-D-glucan concentrations significantly dropped after surgery to 8.56 pg/mL. After treatment was stopped, there was clinical evidence of recurrence in 18 patients. Seven of these 18 patients had a (1,3)-β-D-glucan concentration above the 5.5 pg/mL cut-off value for positivity, while in the remaining 11 patients, (1,3)-β-D-glucan concentrations were below the cut-off value. This resulted in a sensitivity of 38.9% and specificity of 75.0%. A correlation between lesion size and (1,3)-β-D-glucan concentration was noted. Conclusion: Although in general (1,3)-β-D-glucan concentrations can be measured in the serum of patients with eumycetoma during treatment, a sharp decrease in β-glucan concentration was only noted after surgery and not during or after antimicrobial treatment. (1,3)-β-D-glucan concentrations were not predictive for recurrence and seem to have no value in determining treatment response to azoles in patients with eumycetoma. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Atypical presentations of eumycetoma can pose a challenge in the diagnosis and treatment of the disease. Healthcare providers thorough in their differential diagnosis and investigations, even in the absence of classic symptoms, in order to improve early detection and the case management for such a neglected tropical disease. In this communication, we present a case study of an unusual presentation of eumycetoma; a fungal infection that is considered a neglected tropical disease. The patient, a 28‐year‐old male from Sudan, presented with a recurrent mass in the abdominal wall. Despite two surgeries to remove the mass, it continued to recur. Unlike typical cases of eumycetoma, this patient did not exhibit common symptoms such as painless swelling, sinuses, or grain‐containing discharge. The diagnosis was made incidentally after surgical excision of the mass. The abstract highlights the importance of recognizing uncommon presentations and maintaining a high suspicion for rare diagnoses, even in the absence of classic symptoms. Further research is needed to better understand atypical presentations of eumycetoma and improve early detection. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic granulomatous inflammation of the dermis and epidermis caused by filamentous bacteria in 60% of cases (actinomycetoma) or fungi (eumycetoma) in 40% of cases. A 45-year-old female presented with a left foot ulcer and gradually increasing swelling for 13 years in our department. The radiograph revealed multiple punch-out lytic areas in the tarsals with sclerosis and destruction of the calcaneum. The characteristic "dotin- circle" sign was appreciated on both ultrasound and magnetic resonance imaging. The causative organism and the radiological evaluation, especially bone involvement, are the most important factors that determine the choice of treatment. In the initial stages, chemotherapeutic drugs along with surgery are effective. The current concept is with treatment with a combination of drugs under the name of Welsh regimen. [ABSTRACT FROM AUTHOR]

Eumycetoma is an infectious disease caused by various fungal pathogens. The disease is characterised by black and pale-yellowish grain discharge. In this communication, we report a case of eumycetoma with a pale grain foot-eumycetoma caused by Fusarium falciforme. The patient presented at the outpatient clinic of the Mycetoma Research Centre in Sudan. The causative agent was initially misidentified as Aspergillus nidulans based on its seemingly similar histopathological appearance. However, sequencing the internally transcribed spacer region of the extracted grain confirmed infection with Fusarium falciforme. Although the patient received Itraconazole and underwent surgical excision, the disease was recurrent. To our knowledge, this is the first report on Fusarium falciforme causing eumycetoma in Sudan, indicating the expansion of the geographical distribution of this pathogen. This calls for raising the awareness of healthcare providers and improving the diagnostic and surveillance systems in at-risk areas to improve the case management and reduce the threat of further spread. Considering the potential impacts of F. falciforme infection including threatening the global health, food security, and ecosystem balance, as well as loss of biodiversity and negative socioeconomic changes in endemic countries, we recommend the implementation of an integrated transdisciplinary One Health strategy for the prevention and control of emerging infectious diseases including F. falciforme. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic localized progressive granulomatous infection of the skin involving subcutaneous and deeper tissues, commonly affecting the lower extremities. We report a case of a 26-year-old male construction worker presented with chief complaints of painful red to skin-colored raised lesions present over his left foot, lesions were multiple discrete erythematous to skin-colored plaques with well-demarcated erythematous erosions and crusting present over the left foot and left thigh region. The patient had been hospitalized several times due to worsening symptoms because of his nonadherence to medications and negligence toward health and medical advice of hospital inpatient admissions. Actinomadurae was isolated and a modified 2-step Ramam treatment regimen was initiated. This case is presented to signify how medication non-adherence and poor health facilities can lead to an increase in treatment course and duration. Early detection and identification of the causative organism and individualized treatment plans are necessary for a better clinical outcome. [ABSTRACT FROM AUTHOR]

Background: Subcutaneous mycoses, a disease of the tropics, are usually missed or misdiagnosed in immunocompetent individuals unless sought for. The study was designed to explore the experience of diagnosing subcutaneous mycoses by histopathological examination in our institute and to find out the epidemiology, clinical features, and histopathological findings of cases with subcutaneous mycosis. Methodology: We reviewed the cases reported as subcutaneous mycoses in the department of pathology over 6 years (2017-2022). The slides were stained with Hematoxylin and Eosin, Periodic acid Schiff (PAS), and Gomori's Methenamine silver (GMS) for identification of the fungi. Clinical details were obtained from the medical records. Results: Twenty-seven cases were retrieved from the archives, reported as subcutaneous mycoses from various sites. They presented with varying symptoms ranging from ulcers, discharging sinuses, nodular swellings, and cystic swelling. Histology from these revealed granulomas with suppuration, necrosis of subcutaneous fat, broad aseptate hyphae with angioinvasion, abscesses, and grains. Conclusion: Mycosis, a disease of the tropics, may manifest in immunocompetent individuals with varied clinical presentations and histology. The intact immune status of the individual results in granuloma formation along with suppuration and giant cells. Diagnosis is usually achieved by a meticulous search for fungus in such lesions. PAS and GMS stains help identify the fungus. [ABSTRACT FROM AUTHOR]

Objectives: Mycetoma is a neglected tropical implantation disease caused by 70 different infectious agents. Identifying the causative organism to the species level is essential for appropriate patient management. Ultrasound, histopathology, culture and two species‐specific PCRs are most the commonly used methods for species identification in endemic regions. The aim of this study was to compare the diagnostic performance of these commonly used assays using sequencing of barcoding genes as the gold standard. Methods: This descriptive cross‐sectional study was conducted at the Mycetoma Research Centre, University of Khartoum, Sudan. It included 222 patients suspected of fungal mycetoma caused by Madurella mycetomatis. Results: 154 (69.3%) were correctly identified by ultrasound, histology, culture and both species‐specific PCRs. In 60 patients, at least one of the diagnostic tests failed to identify M. mycetomatis. Five patients had no evidence of eumycetoma, and for three, only the ultrasound was indicative of mycetoma. The two species‐specific PCRs were the most sensitive and specific methods, followed by culture and histology. Ultrasound was the least specific as it only allowed differentiation between actinomycetoma and eumycetoma. The time to result was 9.38 minutes for ultrasound, 3.76 hours for PCR, 8.5 days for histopathology and 21 days for grain culturing. Conclusion: Currently, PCR directly on DNA isolated from grains is the most rapid and reliable diagnostic tool to identify M. mycetomatis eumycetoma. [ABSTRACT FROM AUTHOR]

Background: Mycetoma also synonymous referred to as Madura's foot is a chronic granulomatous cutaneous infection caused by some genera of fungi and bacteria, leading to progressive and proliferative destruction of soft tissue and the nearby anatomical structures if no intervention is offered on time. Case presentation: We report a case of actinomycetoma in an African adult man residing in a rural-urban setup. After histological confirmation, the client was conservatively managed with oral medication: 1) dapsone 100mg once a day and t r ime thopr im/sul f ame thoxa zol e (s ept r in) 160mg/800mg three times daily for one year with an excellent outcome. Conclusions: The gist of this rare case is to exemplify the role of integrated management of patients without underplaying the role of good clinical practice. Also, a call and advocate for improved health care services in the sub-Saharan countries. This will prevent or reduce avoidable medical complications caused by neglected and treatable diseases like actinomycocetoma. [ABSTRACT FROM AUTHOR]

Introduction: mycetoma is a chronic inflammatory anatomoclinical syndrome consisting of enlargement, deformation of the affected region and nodular lesions. Patient information: it was presented a case of mycetoma of the lower limb caused by Nocardia in a 48-year-old female patient with human immunodeficiency virus, who, after recurrent trauma to both lower limbs, reported to the dermatology office that four years ago he had lesions on his left foot, initially painless nodules that later began with yellowish exudation, moderate pain and inflammation in that area. The anatomopathological and microbiological studies confirmed the presence of the genus Nocardia as the causative agent of actinomycetoma. Antimicrobial therapy with trimethoprim/sulfametosaxol and diaminodiphenyl sulfone was started and total resolution of the lesions was achieved. Conclusions: the diagnosis of this disease should be made from an integral perspective taking into account clinical, epidemiological, microbiological, anatomopathological and radiological aspects that contribute to establish the burden of morbidity and mortality caused by this clinical condition. [ABSTRACT FROM AUTHOR]

Eumysetoma is a chronic infectious disease characterized by an enlarged subcutaneous mass, often caused by the fungus Madurella mycetomatis. Eumycetoma can affect all age groups, but often occurs in young people between 20 and 40 years, in children rarely 3-4.5% but can be up to 30% of cases, dominant in males with a ratio of 4:1, mainly working agricultural activities. Treatment of eumycetoma with medication antifungal group Triazola (Itraconazole) and surgery are the therapy of choice. We report a case of eumycetoma treated with itraconazole. A 57-year-old man with complaints of progressive chronic wounds. Dermatological status showed multiple nodules, there were sinuses with discharge and grain on the feet. Histopathological examination revealed suppurative granuloma and Splendore-Hoeppli phenomenon in the dermis layer. The patient was diagnosed with eumycetoma and treated with itraconazole 2x200mg. Administration of itraconazole 2x400 therapy in eumycetoma patients is effective and provides clinical improvement. [ABSTRACT FROM AUTHOR]

Background: Eumycetoma is a neglected tropical disease. It is a chronic inflammatory subcutaneous infection characterised by painless swellings which produce grains. It is currently treated with a combination of itraconazole and surgery. In an ongoing clinical study, the efficacy of fosravuconazole, the prodrug of ravuconazole, is being investigated. For both itraconazole and ravuconazole, no clinical breakpoints or epidemiological cut‐off values (ECV) to guide treatment are currently available. Objective: To determine tentative ECVs for itraconazole and ravuconazole in Madurella mycetomatis, the main causative agent of eumycetoma. Materials and Methods: Minimal inhibitory concentrations (MICs) for itraconazole and ravuconazole were determined in 131 genetically diverse clinical M. mycetomatis isolates with the modified CLSI M38 broth microdilution method. The MIC distributions were established and used to determine ECVs with the ECOFFinder software. CYP51A sequences were sequenced to determine whether mutations occurred in this azole target gene, and comparisons were made between the different CYP51A variants and the MIC distributions. Results: The MICs ranged from 0.008 to 1 mg/L for itraconazole and from 0.002 to 0.125 mg/L for ravuconazole. The M. mycetomatis ECV for itraconazole was 1 mg/L and for ravuconazole 0.064 mg/L. In the wild‐type population, two CYP51A variants were found for M. mycetomatis, which differed in one amino acid at position 499 (S499G). The MIC distributions for itraconazole and ravuconazole were similar between the two variants. No mutations linked to decreased susceptibility were found. Conclusion: The proposed M. mycetomatis ECV for itraconazole is 1 mg/L and for ravuconazole 0.064 mg/L. [ABSTRACT FROM AUTHOR]

Objective: Mycetoma is a neglected tropical disease caused by more than 70 different microorganisms and identified by the WHO as one of the high‐priority diseases for developing diagnostic tests. To ensure the production of diagnostic assays for use by clinical staff in endemic regions, target product profiles (TPPs) were designed. Methods: We describe the development of two TPPs: one for a diagnostic test able to identify the causative agent of mycetoma and another that would determine when treatment could be stopped. The TPPs were developed by considering product use, design, performance, product configuration and costs. Results: Version 1.0 TPPs for two uses were posted by WHO for a 1‐month online public consultation on 25 October 2021, and the final TPP was posted online on 5 May 2022. Conclusion: A major difficulty encountered in developing both TPPs was the large number of agents able to cause mycetoma and the lack of specific biomarkers for most of them. [ABSTRACT FROM AUTHOR]

A captive-kept adult male tiger presented with a large cutaneous and subcutaneous mass on the thigh with a fistula. During sedation, multiple nodules were detected and samples for a histopathological exam were collected. Histologically, granulomatous panniculitis and dermatitis were seen around dense aggregates of pigmented fungal hyphae, and a diagnosis of phaeohyphomycosis was made; considering the clinical features, it was classified as a eumycotic mycetoma. This is a rarely reported subcutaneous fungal infection in humans and animals, caused by dematiaceous fungi. Clinically, it is characterized by tumefaction, fistulous sinus tracts, and the formation of macroscopically visible grains. In the literature, only a few infections in wild felids have been reported. In this case, Fontana–Masson staining better showed pigmentation and panfungal PCR and sequencing identified Madurella pseudomyectomatis (OP623507) as the causative agent. Systemic therapy with oral administration of itraconazole was planned, but the patient died during the first period of treatment. The animal was not submitted for post-mortem examination. Visceral dissemination of the agent cannot be excluded. To the authors' knowledge, this is the first report of eumycotic mycetoma by Madurella pseudomycetomatis in a captive tiger. [ABSTRACT FROM AUTHOR]

Introduction: Eumycetoma is a subcutaneous mutilating disease that can be caused by many different fungi. Current treatment consists of prolonged itraconazole administration in combination with surgery. In many centres, due to their slow growth rate, the treatment for eumycetoma is often started before the causative agent is identified. This harbours the risk that the causative fungus is not susceptible to the given empirical therapy. In the open‐source drug program MycetOS, ravuconazole and luliconazole were promising antifungal agents that were able to inhibit the growth of Madurella mycetomatis, the most common causative agent of mycetoma. However, it is currently not known whether these drugs inhibit the growth of other eumycetoma causative agents. Materials and methods: Here, we determined the in vitro activity of luliconazole, lanoconazole and ravuconazole against commonly encountered eumycetoma causative agents. MICs were determined for lanoconazole, luliconazole and ravuconazole against 37 fungal isolates which included Madurella species, Falciformispora senegalensis, Medicopsis romeroi and Trematosphaeria grisea and compared to those of itraconazole. Results: Ravuconazole, luliconazole and lanoconazole showed high activity against all eumycetoma causative agents tested with median minimal inhibitory concentrations (MICs) ranging from 0.008–2 µg/ml, 0.001–0.064 µg/ml and 0.001–0.064 µg/ml, respectively. Even Ma. fahalii and Me. romeroi, which are not inhibited in growth by itraconazole at a concentration of 4 µg/ml, were inhibited by these azoles. Conclusion: The commonly encountered eumycetoma causative agents are inhibited by lanoconazole, luliconazole and ravuconazole. These drugs are promising candidates for further evaluation as potential treatment for eumycetoma. [ABSTRACT FROM AUTHOR]

Subcutaneous fungal infections, which typically result from traumatic introduction (implantation) of fungal elements into the skin or underlying tissues, can present as a range of different clinical entities including phaeohyphomycosis, chromoblastomycosis, subcutaneous nodules or masses, and genuine eumycetoma. Here, we mined our laboratory information management system for such infections in humans and domestic animals for the period 2016–2022, including (i) fungal isolates referred for identification and/or susceptibility testing; (ii) infections diagnosed at our laboratory using panfungal PCR approaches on infected tissue; and (iii) organisms cultured in our laboratory from biopsies. In total, 106 cases were retrieved, involving 39 fungal species comprising 26 distinct genera. Subcutaneous infections with Alternaria species were the most frequent (36 cases), which possibly reflects the ubiquitous nature of this common plant pathogen. A substantial proportion of Alternaria spp. isolates exhibited reduced in vitro susceptibility to voriconazole. Notably, a significant number of subcutaneous infections were diagnosed in renal and other solid organ transplant recipients post transplantation, suggesting that humans may harbour "inert" subcutaneous fungal elements from historical minor injuries that present as clinical infections upon later immunosuppression. The current study underscores the diversity of fungi that can cause subcutaneous infections. While most organisms catalogued here were responsible for occasional infections, several genera (Alternaria, Exophiala, Phaeoacremonuim, Scedosporium) were more frequently recovered in our searches, suggesting that they possess virulence factors that facilitate subcutaneous infections and/or inhabit natural niches that make them more likely to be traumatically inoculated. [ABSTRACT FROM AUTHOR]

Mycetoma is a neglected invasive infection endemic in tropical and subtropical regions, presenting as a chronic subcutaneous inflammatory mass that can spread to deeper structures, leading to deformities, disabilities, and potentially mortality. The current treatment of eumycetoma, the fungal form of mycetoma, involves antifungal agents, such as itraconazole, combined with surgical intervention. However, this approach has limited success, with low cure rates and a high risk of recurrence. This study addresses to the urgent need for more effective therapeutics by designing and synthesising 47 diversely pharmacomodulated imidazo [1,2- b ]pyridazine derivatives using a simple synthetic pathway with good yields and purity. Of these, 17 showed promising in vitro activity against Madurella mycetomatis , the prime causative agent of eumycetoma, with IC 50 ≤ 5 μM and demonstrated significantly lower cytotoxicity compared to standard treatments in NIH-3T3 fibroblasts. Notably, compound 14d exhibited an excellent activity with an IC 50 of 0.9 μM, in the same order then itraconazole (IC 50 = 1.1 μM), and achieved a favourable selectivity index of 16 compared to 0.8 for itraconazole. These promising results warrant further research to evaluate the clinical potential of these novel compounds as safer, more effective treatments for eumycetoma, thus addressing a profound gap in current therapeutic strategies. [Display omitted] • Design and synthesis of 47 original imidazo [1,2- b ]pyridazine derivatives. • Antifungal activity against M. mycetomatis , the major cause of eumycetoma. • 17 compounds with in vitro IC 50 ≤ 5 μM against Madurella mycetomatis. • Most active compound 14d with IC 50 of 0.9 μM and selectivity index of 16. • Imidazo [1,2- b ]pyridazines as potential candidates for treating eumycetoma. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic, suppurative, localized, and destructive infection involving skin, subcutaneous tissue, fascia, muscle and sometimes invade the underlying bone. The infection is prevalent in tropical countries and involves chiefly adults. Etiologically, it is classified into eumycetoma and actinomycetoma caused by fungus and bacteria respectively. Clinically, mycetoma presents as a triad of firm to soft swelling with multiple sinuses and discharging grains of different colors. Mycetoma is reported rarely in children. We report an 11-year-old boy diagnosed with actinomycetoma of the left foot with classical clinical, histological, and radiological features. [ABSTRACT FROM AUTHOR]

Eumycetomas of craniocerebral are rare, and we report an extraordinary case of maduramycosis involving brain and skull bone in a middle-aged male who presented with complaints of headache, behavioral abnormalities, and memory disturbances for 3 months. Imaging showed a frontal lesion. It was mistaken for a tumor clinically and radiologically. Craniocerebral eumycetoma usually presents as a mass on the scalp with sinuses. Our case presented as a brain tumor without a soft tissue mass or discharging sinuses. It is essential to keep in mind this mode of presentation, and only a biopsy will aid in diagnosis. [ABSTRACT FROM AUTHOR]

• Infection with Pseudallescheria boydii has increased among immunocompromised patients • P. boydii has been shown to be pathogenic in immunocompetent patients • It mimics histological features of aspergillosis • Early detection reduces the risk of mortality • Surgical resection along with appropriate antifungal therapy is advocated [ABSTRACT FROM AUTHOR]

Mycetoma is a neglected tropical disease that is associated with poor communities and socioeconomically impaired individuals in the tropical and sub-tropical areas. Interestingly, the disease is caused by either bacteria (actinomycetoma) or fungus (eumycetoma). The latter form of the disease, eumycetoma, is the most common type in Africa. Eumycetoma is characterized by a prolonged disease duration and low cure rate. The effective case management of eumycetoma largely depends on the accurate diagnosis and identification of the causative agent to the species level and evaluating its susceptibility to the available drugs. This review summarizes the currently available and used antifungal agents for the treatment of eumycetoma and discusses optimizing the newly developed antifungals as a potential second line for eumycetoma treatment. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic granulomatous infection caused by fungi or bacteria, known as eumycetoma and actinomycetoma, respectively. Mycetoma commonly affects young males belonging to low socioeconomic strata, usually barefooted agricultural workers. It mainly affects lower and upper limbs presenting as a painless swelling with discharging sinus. Rarely, is it encountered in the intracranial location. The diagnosis relies on the clinical presentation and identification of the etiological agents within the tissue, by histology and special stains. It is important to specify the fungal or bacterial etiology, because the treatment of each is completely different. The management of such infections is challenging and should involve early diagnosis, the use of antibacterials or antifungals, and surgical removal of the lesion. To the best of our knowledge, only seven cases of intracranial mycetoma have been reported. The present case highlights the rarity of this lesion, thereby contributing to the existing literature and presenting its diagnostic implications. [ABSTRACT FROM AUTHOR]

Introduction: Fungal infections are mostly an opportunistic infection in immunocompromised patients and posttraumatic in immunocompetent adults. However, there has been a recent increasing trend of cases among immunocompetent adults with no history of trauma. Very few case series describing the clinicopathological picture of prevalent fungi are available from the various regions of India. Aims and Objectives: The present study aims to analyze clinicopathological features of various cases of fungal etiology with unique or rare presentations. Materials and Methods: This study included a clinicopathological analysis of surgical specimens received for histopathological examination at our hospital with special emphasis on cases with rare or unique presentations during the 1-year period from June 2019 to June 2020. Results: A total of 11 cases of fungal lesions with rare or unique clinicopathological presentations were selected for analysis. Majority of the patients were male, and most of them were from a rural background. There were four cases of aspergillosis, two cases of fungal keratitis, one case of renal aspergillosis, and one case of a subcutaneous swelling with discharging sinus. There were three cases of chromoblastomycosis, which presented as subcutaneous swellings with no lesion of overlying skin. There was an incidental finding of Candida sp. in two esophageal endoscopic biopsies, which primarily revealed esophageal adenocarcinoma. There was one case each of eumycetoma and mucormycosis. However, the mucormycosis case occurred in the setting of fungal abscess with osteomyelitis of the left mandible. Conclusion: Fungal lesions have revealed an increasing trend of infections in immunocompetent individuals in recent years, with various unique clinicopathological presentations. Therefore, there is a need for increased vigilance and analysis of such cases. [ABSTRACT FROM AUTHOR]

A 13‐year‐old female neutered domestic short‐hair cat was presented with chronic progressive vestibular ataxia, lethargy and anorexia. Clinical examination revealed bilateral mucopurulent nasal discharge. Neurological examination revealed obtundation, a right head tilt, ambulatory tetraparesis, generalised vestibular ataxia, decreased postural reactions in all limbs, right Horner's syndrome, spontaneous conjugate jerk rotatory nystagmus and right positional ventral strabismus. Neuroanatomical localisation was observed in the right central vestibular system. Computed tomography revealed a solitary ill‐defined contrast‐enhancing mass lesion at the level of the right cerebellopontine angle. Cerebrospinal fluid (CSF) analysis revealed mild mononuclear pleocytosis and fungal elements. CSF culture was positive for Curvularia spp. Further tests for underlying diseases were all negative. The cat was treated with antibiotic and antifungal treatment, but it deteriorated rapidly and was euthanased. Necropsy of the brainstem mass lesion revealed pyogranulomatous inflammation. Panfungal polymerase chain reaction (PCR) targeting the internal transcribed spacer (ITS) region and subsequent sequencing identified Curvularia lunata in the formalin fixed brain tissue. This is the first report of brainstem phaeohyphomycosis by Curvularia lunata (Pleosporales) in a cat. In addition, this is the first report among animal and humans where fungal elements of Curvularia lunata were found in the CSF cytology. Opportunistic fungal pathogens should be always considered within the differential diagnoses list in cats with neurological signs and advanced imaging findings compatible with solitary mass lesions in the brain. In feline patients with pyogranulomatous meningoencephalitis and a suspicion of a fungal aetiology, panfungal PCR for the ITS region and sequencing should be performed regardless of the absence of fungal elements in histopathology. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mycetoma is considered a neglected disease. It mainly affects the poor population working in the agriculture field. The majority of the cases are diagnosed in the medical unities of primary care. Only a few goes to the specialty's hospitals. OBJECTIVE: To investigate the frequency, type of mycetoma and other epidemiological characteristics of this disease in patients attending a high specialty hospital. MATERIALS AND METHODS: A retrospective, observational and analytic study of the mycology reports from Medical Mycology Laboratory of Specialties Hospital, National Medical Center Siglo XXI, Mexico City, was conducted from 1993 to 2016. RESULTS: Thirty-six cases of mycetoma were recorded: 25 actinomycetomas (22 Nocardia spp and 3 Actinomadura madurae) and 11 eumycetomas (9 dematiaceous fungi and 2 hyaline fungi). Thirty-four of the cases were men between 20 and 50 years old (94.4%). The majority of them were working in the agriculture field. Alcoholism of different level was detected in 100% of the patient as well as smoking in 50% of them. Generally, the patients with actinomycetoma had good therapeutical responses compared to the patients with eumycetoma whose response could only permit the slowdown of the disease spread. CONCLUSIONS: In Mexico, even in an advanced specialty hospital, the eumycetoma prognostic is poor due to the lack of antifungic sensitivity studies and of the special studies for rapid diagnostic like PCR and to the weak therapeutic answer. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic granulomatous disease that is more common in tropical regions with predominant involvement of foot. Spinal mycetoma presenting as lumbar canal stenosis is extremely rare. We hereby present a case of fungal eumycetoma of vertebral column in a 42-year-old male who presented with chronic progressive low back pain and features of lumbar canal stenosis without any skin swelling or discharging sinuses. The "dot-in-circle" sign, a highly specific magnetic resonance imaging (MRI) and ultrasonography (USG) sign of mycetoma has been described in the literature as a pathognomonic feature of mycetoma involving the musculoskeletal system. We describe the importance of characteristic imaging features with dot in circle sign in the diagnosis of eumycetoma of lumbar spine. [ABSTRACT FROM AUTHOR]

Background Mycetoma is a chronic, granulomatous infection of skin, soft tissues and bones which developed after traumatic inoculation of pathogenic spores deep in to the tissues. Classical triad consists of swollen tissues, draining sinuses and coloured grains. Objective This study aimed to document clinical impact, side effects and safety profile of voriconazole in Aspergillus eumycetomas. Methods Retrospective study of clinical, histopathological and culture proven cases of Aspergillus eumycetomas treated with voriconazole between October 2017 to March 2020. Voriconazole 400 mg/day was given for six to 15 months. Results Six patients were selected for the study. Male to female ratio was 1:1. Mean age of cases was 45.33 years; five belonged to rural areas; most common occupation was farmer; feet were involved in five while knee was involved in one case only. Mean delay in diagnosis was 9.33 years. KOH mount showed filamentous, septate, acute-angled, dichotomously branched hyphae in all cases. Histopathology was diagnostic in four cases. Culture was positive in all cases and reported Aspergillus flavus in three, Aspergillus niger in two and Aspergillus fumigatus in one case. Bone involvement was none to minimal. Cultures became negative after three months of therapy while clinical improvement required at least six months of drug treatment. Surgical intervention was required in four cases. None of the case ended up for amputation. Five cases achieved complete clinical and microbiological cure. Limitations Single center study, small sample, lack of molecular identification facilities. Conclusion Voriconazole is safe and efficacious for treatment of eumycetomas caused by Aspergillus species. [ABSTRACT FROM AUTHOR]

We are reporting a case of eumycetoma caused by Aspergillus niger, which is the second ever case- report to the best of our knowledge and search. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic subcutaneous granulomatous inflammation due to infection by fungus (Eumycetes) and bacteria (Actinomycetes) by penetrating inoculation of the microorganism into an injured skin. Late presentation is common, which leads to various deformities. In a standard setting, mycetoma diagnosis requires a combination of clinical assessment, histopathological features, and culture. However, microbiological culture takes time to be ready. Therefore, the classical histomorphological features supported by histochemical stains are the options to provide a fast diagnosis for the commencement of appropriate treatment. We described two cases of eumycetoma and actinomycetoma, emphasising the differences in their histomorphological features and histochemical stains that may facilitate the diagnosis. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic granulomatous infection of the skin and underlying tissues, which affects remote populations in tropical and subtropical countries. We report the case of a 35-year-old male with an over 10 year history of left foot mycetoma, who initially presented with diffuse non-draining papules, edema, and dull chronic pain of the left foot. Radiographic imaging depicted erosive changes throughout the left midfoot and forefoot, while bone biopsy of the left navicular and first metatarsal confirmed actinomycetes. After being prescribed amoxicillin-clavulanate and trimethoprim-sulfamethoxazole and undergoing surgical debridement, the patient had marked improvements with less frequent pain and fewer blisters. One year later, the patient's ankle joint remained untouched by mycetoma, yet his condition began to deteriorate with the reemergence of draining granules and chronic pain. As of now, the patient has been scheduled for below-the-knee limb amputation. The treatment of mycetoma aims to preserve limb function and prevent recurrences, but further research and investigations are necessary. [ABSTRACT FROM AUTHOR]

Mycetoma is disorder of subcutaneous tissue, skin, and bones, mainly the feet. Etiologically divided in Eumycetoma and actinomycetoma, since the treatment of both is different, the diagnosis is mandatory. This is the case of 35-year-old lady with swelling in left foot with multiple discharging sinuses for 5 years that was none responding to antifungal treatment. Change of treatment after the culture confirmation of Actinomadura species improves patient condition drastically. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic, granulomatous infection mainly involving the foot and is caused either by bacteria (actinomycetoma) or fungi (eumycetoma). Eumycetoma is notoriously resistant, posing a therapeutic challenge. There are no specific treatment guidelines but generally a combination of systemic antifungals and local surgical treatment is the accepted standard. Advanced unresponsive lesions generally require amputation. We present a case of eumycetoma of 15-year duration with extensive involvement of foot including bones. Patient had been advised amputation from various tertiary care centers but we decided to give a limb salvage trial. The patient underwent soft tissue debridement along with oral antifungal therapy. Additionally, amphotericin B-impregnated bioabsorbable beads were inserted locally into the bony cavities to supplement the treatment. There has been no recurrence till date. This case is reported in view of successful limb salvage in an advanced eumycetoma case with an unprecedented use of adjunctive local antifungal delivery. [ABSTRACT FROM AUTHOR]

Context: Mycetoma is a chronic suppurative infective disorder of skin, subcutaneous tissue, fascia, and bones caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. Triad of tumefaction, discharging sinuses, and grains characterizes the disease. Aims: This study was undertaken to study the clinical spectrum and treatment response of mycetoma in central India. Settings and Design: It was a retrospective study of clinical and/or biopsy-proven and treated cases of mycetoma from November 2015 to October 2016. Subjects and Methods: Medical records of diagnosed and treated mycetoma patients were enrolled retrospectively during November 2015 and October 2016. Case records of patients were evaluated with respect to demographic, clinical, microbiological details, bone involvement, and treatment. Type of therapies and outcome, wherever available, were also assessed. Statistical Analysis: Statistical analysis was done using proportion, mean, and percentages. Results: Eleven cases (male = 8) were seen during the study period (seven actinomycetoma and four eumycetoma). Foot and lower extremity was the most common site (9/11), whereas upper extremity and forehead were involved in one case each. On culture, the organisms isolated were Phialophora and Fusarium. Modified Welsch regimen was started in six of seven patients with actinomycetoma, whereas one was started on sulfamethoxazole–trimethoprim and a combination of amoxicillin and clavulanic acid therapy. All four cases of eumycetoma were treated with itraconazole. On follow-up, six cases of actinomycetoma cases showed significant improvement. Two cases of eumycetoma showed mild to moderate improvement and one case required surgical intervention. One case each of actinomycetoma and eumycetoma were lost to follow-up. Conclusion: Mycetoma has been recognized as a neglected tropical disease by the World Health Organization, recently. There are very few case reports from the central part of India. Prominent case detection in our study emphasizes the need of larger studies to know the extent of disease in this part of India. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic, slowly progressing granulomatous subcutaneous infection caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). The present case report is a rare case of Actinomycotic Mycetoma involving wrist due to Streptomyces species. A 53-year-old male presented with multiple swellings over the right wrist and forearm with sinuses discharging sero-purulent pus since 3 years. Patient underwent incision and drainage and appropriate antibiotic course after the complete diagnosis. This case report emphasises the role of meticulous clinical examination assisted by microbiological cultures and histopathological studies which are mandatory in the diagnosis, management and assessment of the prognosis of such unusual cases. [ABSTRACT FROM AUTHOR]

The article highlights the diagnosis and management of patients with mycetomas in a dermatological unit of the University of Milan in Italy including information on epidemiology, dermatopathology, and patients' characteristics.

Introduction: Myectoma named because it forms a tumor like mass. It is chronic granulomatous disease characterized by localized infection of subcutaneous tissue by actinomycetes or fungi, described first by John Gill in 1842 in Madurai Tamil Nadu India so it is called Madura of foot. They are characterized by indolent tumefaction of the effected area. Multiple sinus tracts and granules that contains the agent. The organism enters though local trauma in foot, hand or eyes from saprophytic soil. After entry to the body they form sub-cutanous nodules containing suppurative granulomas, multiple cavities and sinus tracts. The sinus tracts discharge exudate with fine granules. These granules are colonies of causal organisms. Objectives: Histopathological evaluation of mycetomas, their differentiation and gender wise involvement in region of Thar. Methods: Retrospective study of mycetomas performed in period between January 2012 to December 2016 at Muhammad Medical College Mirpurkhas sindh Pakistan. 21 cases of mycetomas were selected from remote areas of Thar by their addresses on the proformas. All 21 cases of mycetomas were retrieved and classified in eumycetomas and actinomycetomas by different stains. Results: In 21 cases of mycetoma infection 09 (42.8%) were male and 12 (57.1%) female. Male to Female ratio was 0.75:1. Out of 21 cases 14 (66.6%) were eumyatomas and 07 (33.3%) were actinomycetomas. Common organ involved was foot. Conclusion: In region of Thar eumycetomas are common than actinomycetomas. In gender wise involvement of infection female are more infected than male. Fungal infections are "hidden killers" in Pakistan. [ABSTRACT FROM AUTHOR]

Mycetoma is a localized chronic, suppurative, and deforming granulomatous infection seen in tropical and subtropical areas. It is a disorder of subcutaneous tissue, skin and bones, mainly of feet, characterized by a triad of localized swelling, underlying sinus tracts, and production of grains or granules. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is entirely different, a definite diagnosis after histopathological and microbiological examination is mandatory, though difficult. Serological test exists but is not so reliable; however, molecular techniques to identify relevant antigens have shown promise. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Actinomycetoma responds to antibiotic therapy, but prolonged treatment is necessary.This review focuses on the etiopathogenesis, clinical features, laboratory diagnosis, and treatment of mycetoma. [ABSTRACT FROM AUTHOR]

Objective: To determine whether combination therapy would improve therapeutic outcome in eumycetoma caused by Madurella mycetomatis.Methods: Survival, colony-forming units (CFU), melanisation and histopathology in M. mycetomatis-infected Galleria mellonella larvae treated with amphotericin B, itraconazole, terbinafine or combinations thereof were determined.Results: Compared to larvae treated with 5% glucose, enhanced survival was obtained when M. mycetomatis-infected larvae were treated with amphotericin B, but not when they were treated with itraconazole or terbinafine. Combination therapy did not increase survival compared to 5% glucose-treated larvae, itraconazole-treated larvae or terbinafine-treated larvae. Compared to amphotericin B monotreatment, a significant decrease in survival was noted when this therapy was combined with either itraconazole or terbinafine. CFU, melanisation and histopathology did not differ between monotherapy, combination therapy or 5% glucose-treated larvae.Conclusions: Combining different classes of antifungal agents did not enhance the survival of M. mycetomatis-infected G. mellonella larvae. Instead of improving the therapeutic outcome, combining either itraconazole or terbinafine with amphotericin B resulted in significantly lower survival rates of infected larvae than amphotericin B monotherapy. This experimental study does not provide support for the use of combined amphotericin B and itraconazole, combined itraconazole and terbinafine or combined terbinafine and amphotericin B and should be confirmed in other animal models. [ABSTRACT FROM AUTHOR]

Mycetoma is a slowly progressive, chronic granulomatous infection of skin and subcutaneous tissue caused by traumatic inoculation of either fungi (eumycotic) or bacteria (actinomycotic). The disease is characterized by triad of tumefaction, discharging sinuses and grains. Here, we report a case of eumycetoma in an infant presenting with multiple discharging sinuses in lower limb. Aspirate and biopsy tissue from the sinuses were processed. The discharge revealed presence of white grains. Potassium hydroxide (KOH) mount revealed presence of hyaline septate hyphae. Histopathological examination showed granulation tissue and fungal hyphae. Repeated culture on sabouraud's dextrose agar (SDA) with chloramphenicol showed growth of Aspergillus flavus on each occasion. Antifungal susceptibility testing was done following Clinical Laboratory Standard Institute (CLSI) M38-A2 protocol and showed high minimum inhibitory concentration (MIC) for fluconazole, caspofungin, anidulofungin and micafungin. The patient responded to itraconazole. Hence, exact categorization of lesion is essential for effective therapy and better prognosis. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is a chronic granulomatous infectious disease caused by filamentous bacteria or by fungi. The disease is endemic in certain tropical and subtropical areas of the world but can be found elsewhere posing sometimes a diagnostic challenge for clinicians. Case presentation: A 65-year- old man presented with a right foot swelling evolving for 25 years. During that time, several diagnosis and treatments have been made without any improvement. The disease spread to bones and misdiagnosed as Kaposi's sarcoma. Transtibial amputation has been performed and the histopathological examination revealed finally the diagnosis of eumycotic mycetoma. The patient recovered well after surgery and orthopedic prosthesis was prescribed for him. Conclusion: Mycetoma in non endemic areas is usually misdiagnosed and mismanaged leading to unnecessary and inappropriate surgery. Health practitioners should be aware of that fact in order to provide an accurate management. [ABSTRACT FROM AUTHOR]

Knowledge regarding host immune response to chromoblastomycosis and eumycetoma is limited, particularly concerning cytokines and antimicrobial peptides production. This was a retrospective study of 12 paraffin-embedded tissue samples from patients diagnosed with chromoblastomycosis or eumycetoma from histological findings and tissue culture. DNA extraction and polymerase chain reaction ( PCR) from tissues were done to evaluate human interleukin-17A ( IL-17A), interferon-gamma ( IFN-γ), tumour necrosis factor-alpha ( TNF-α), interleukin-1 beta ( IL-1β) and human beta-defensin-2 ( HBD-2) expressions. Human beta-actin primer was used for confirming DNA detection, and DNA extracted from psoriasis lesional skin samples was used as positive controls. The twelve paraffin-embedded sections used in this study consisted of five chromoblastomycosis and seven eumycetoma tissues. All PCR reactions showed beta-actin band at 51 bp in all clinical specimens, confirming adequate DNA levels in each reaction. As positive control, the psoriasis skin samples revealed bands for IL-17A at 174 bp, IFN-γ at 273 bp, TNF-α at 360 bp, IL-1β at 276 bp and HBD-2 at 255 bp. For the chromoblastomycosis and eumycetoma tissues, PCR analyses showed IL-17A band at 174 bp in two eumycetoma tissues and HBD-2 band at 255 bp in a chromoblastomycosis tissue. This study demonstrated IL-17A expression in human eumycetoma and HBD-2 expression in human chromoblastomycosis for the first time. However, their role in immune response remains to be elucidated. [ABSTRACT FROM AUTHOR]

The use of natural, nontoxic, convenient and eco-friendly dyes for histopathological diagnosis avoids some of the synthetic dyes’ hazards. I used an aqueous extract of henna at a concentration of 20 g/ml and acidified with acetic acid to stain mycetoma grains. Henna stained mycetoma grains orange-red to brown. The engulfed mycetoma grains within inflammatory cells stained well with henna extract compared to hematoxylin and eosin (H & E) and hexamine silver. [ABSTRACT FROM AUTHOR]

Chronic subcutaneous infections caused by Aspergillus species are considered to be extremely rare. Because these fungi are among the most common laboratory contaminants, their role as eumycetoma causative agents is difficult to ascertain. Here, we report the first case of A. flavus eumycetoma confirmed by isolation, molecular identification and immunohistochemical analysis. Patient was a 55-year-old male from Sudan suffering from eumycetoma on his left foot for a period of 17 years. He developed swelling, sinuses and white grain discharge was observed. He has been operated nine times and was treated with several regimens of ketoconazole and itraconazole without improvement. Initial diagnosis based on histology and radiology was Scedosporium eumycetoma. However, examination of the biopsy revealed A. flavus, which was identified by molecular analysis and MALDI- TOF MS. Immunohistochemistry using antibody directed against Aspergillus species was positive. Because of the earlier treatment failures with ketoconazole and itraconazole, therapy with voriconazole was initiated. However, in vitro susceptibility testing yielded a lower Minimum Inhibitory Concentration (MIC) value for itraconazole (0.25 μg ml−1) than for voriconazole (1 μg ml−1). Based on the presented results, A. flavus can be considered as one of the agents of white-grain eumycetoma. [ABSTRACT FROM AUTHOR]

Eumycetoma is a chronic infection of the skin and subcutaneous tissue caused by filamentous fungi, which usually occurs in tropical or subtropical countries. We report a case of an immunocompromised patient presenting with presumed eumycetoma in the United States and his subsequent treatment with voriconazole. The use of voriconazole and liposomal amphotericin B halted the progression and allowed gradual resolution of the infection. The patient will require close monitoring and long-term therapy with voriconazole to obtain a clinical cure. Voriconazole and liposomal amphotericin B are potential initial treatment options, with long-term voriconazole maintenance therapy, for an Aspergillus-induced eumycetoma. [ABSTRACT FROM AUTHOR]

Background: Mycetoma is a chronic granulomatous disease caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). It usually involves the subcutaneous tissue after a traumatic inoculation of the causative organism. We reviewed retrospectively 13 patients with mycetoma. Materials and Methods: This study reports the etiologic agents and distribution of mycetoma in 35 cases from 1994 to2009 in Iran. The diagnostic of mycetoma were confirmed by histopathology and direct preparation, culture techniques, and histopathology of granules and surgical biopsies, radiological examination of the affected site. Results: Mycetoma was identified in 35 patients of 168 suspected patients (20.8%). They occurred in 22 male and 13 females. Their ages ranged from 14 to 80 years. The duration of the disease ranged from two months to 38 years. Sixteen patients had eumycetoma, and 19 patients had actinomycetoma, one of them had mix infections by eumycetoma and actinomycetoma. The majority of the patients were from central and states in south and north of Iran. The feet were most affected site (65.7%) of the cases, followed by hands (25.7%), face (2.8%), and trunk (2.8%), and buttock (2.8%). Most patients (68.5%) were more than 40 year‑old. The male to female ratio was 5:3. The disease was abundant among housewife in urban and farmer in rural area of Iran. The most common prevalent mycetoma agents in this study were Actinomyces sp. There was a history of risk factors in 28.6% of patients in this study. Conclusion: Mycetoma occasionally occurs particularly in the South, Central, and North of Iran, and seen most often in persons, who live in hot, humid climates. If there are risk factors for invasive fungal infections traumatic inoculation with any fungus may result in rapid local spread and systemic disease, often with fatal outcome. [ABSTRACT FROM AUTHOR]

Abstract: Objective of the study: Mycetomas are chronic sub-cutaneous tropical infections in which exogenous causative agents, fungal (eumycetes) or bacterial (actinomycetes), generate grains. The typical presentation is multi-fistulized pseudotumors. This disease, particularly eumycetoma, is difficult to treat. It is a major health problem in tropical and subtropical countries. In France, the disease is rare, but patients have access to a broader range of treatments. The authors had for objective to present the cases of mycetomas diagnosed in developed country and their management. Patients and methods: A retrospective study was made on the clinical presentation and management of mycetomas from 1995 to 2011, in the Bobigny Avicenne teaching hospital. Results: Six patient files were studied. The patients were men with a median age of 31 years (16–70). Five patients were from Sub Saharan Africa, one from Sri Lanka. The etiologies were one actinomycetoma and five eumycetomas. There was bone involvement in five cases. There was one atypical presentation: a primary intra-osseous mycetoma. Three patients were cured including two by surgical management and one by medical treatment (actinomycetoma). Antifungal therapy failed (four patients) in every case (voriconazole, itraconazole, ketoconazole, terbinafine, caspofungin). Conclusion: The results of this study made in a non-epidemic zone revealed that despite a typical clinical presentation, the diagnosis and management were delayed because this imported disease is rare in France. The patients received new broad-spectrum triazole and caspofungin, but none were cured with antifungal therapy alone. [Copyright &y& Elsevier]

Although several parts of India are endemic to Eumycetoma, it is rare in Kerala. However, the transportation revolution and the consequent mobility, globalisation and shifts of migrant communities have resulted in spread of diseases far beyond their original geographies. Kerala is increasingly experiencing the effects of these, in the spread of infective diseases like dengue, chikungunya etc. Here we report a case of Eumycetoma masquerading as a soft tissue sarcoma. An awareness of this condition can assist in early definitive diagnosis and and planning an effective management strategy. [ABSTRACT FROM AUTHOR]

Madura foot is a deep mycosis commonly seen in tropical and subtropical countries such as India. Its incidence is likely to rise in temperate regions as well, due to the increase in worldwide travel. The cases presented here are all agricultural workers from a rural part of northern India who had induration, fibrosis and minimal discharge from sinuses over the foot. Although culture remains the gold standard diagnostic test, this case report highlights the importance of histopathology in the early diagnosis and differentiation of common causative agents in Madura foot as repeated cultures are sometimes negative. Thus for mycetomas in which causative infectious agents cannot be isolated, histology may prove beneficial by avoiding inadvertent use of combined antifungal and antimicrobial agents so that a correct therapeutic modality can be decided, prognostic outcome be explained to the patient, and a preventable cause of deformity and disability can be identified and treated at an early stage. [ABSTRACT FROM AUTHOR]