Case Of Eumycetoma Research Articles

An updated list of eumycetoma causative agents and their differences in grain formation and treatment response.

SUMMARYIn 2023, the World Health Organization designated eumycetoma causative agents as high-priority pathogens on its list of fungal priority pathogens. Despite this recognition, a comprehensive understanding of these causative agents is lacking, and potential variations in clinical manifestations or therapeutic responses remain unclear. In this review, 12,379 eumycetoma cases were reviewed. In total, 69 different fungal species were identified as causative agents. However, some were only identified once, and there was no supporting evidence that they were indeed present in the grain. Madurella mycetomatis was by far the most commonly reported fungal causative agent. In most studies, identification of the fungus at the species level was based on culture or histology, which was prone to misidentifications. The newly used molecular identification tools identified new causative agents. Clinically, no differences were reported in the appearance of the lesion, but variations in mycetoma grain formation and antifungal susceptibility were observed. Although attempts were made to explore the differences in clinical outcomes based on antifungal susceptibility, the lack of large clinical trials and the inclusion of surgery as standard treatment posed challenges in drawing definitive conclusions. Limited case series suggested that eumycetoma cases caused by Fusarium species were less responsive to treatment than those caused by Madurella mycetomatis. However, further research is imperative for a comprehensive understanding.

Mycetoma in Ecuador.

Previous studies on the distribution of mycetoma globally have failed to identify Ecuador as an endemic country. We present data on 35 cases of mycetoma in Ecuador between 1955 and 2021: 5 cases from our experience and 30 cases from the literature. Eight cases of eumycetoma (23%) and 27 cases of actinomycetoma (77%) were diagnosed. Most cases originated from the coastal region of Ecuador. For the first time in an English-language publication, this communication confirms the presence of mycetoma in Ecuador, securing Ecuador's position on the global mycetoma map.

Evaluation of a computational model for mycetoma-causative agents identification.

The therapeutic strategy for mycetoma relies heavily on the identification of the causative agents, which are either fungal or bacterial. While histopathological examination of surgical biopsies is currently the most used diagnostic tool, it requires well-trained pathologists, who are lacking in most rural areas where mycetoma is endemic. In this work we propose and evaluate a machine learning approach that semi-automatically analyses histopathological microscopic images of grains and provides a classification of the disease as eumycetoma or actinomycetoma. The computational model is based on radiomics and partial least squares. It is assessed on a dataset that includes 890 individual grains collected from 168 patients originating from the Mycetoma Research Centre in Sudan. The dataset contained 94 eumycetoma cases and 74 actinomycetoma cases, with a distribution of the species among the two causative agents that is representative of the Sudanese distribution. The proposed model achieved identification of causative agents with an accuracy of 91.89%, which is comparable to the accuracy of experts from the domain. The method was found to be robust to a small error in the segmentation of the grain and to changes in the acquisition protocol. Among the radiomics features, the homogeneity of mycetoma grain textures was found to be the most discriminative feature for causative agent identification. The results presented in this study support that this computational approach could greatly benefit rural areas with limited access to specialized clinical centres and also provide a second opinion for expert pathologists to implement the appropriate therapeutic strategy.

Eumycetoma, a report of two rare cases

Abstract Mycetoma is a chronic, slowly progressive, suppurative, granulomatous disease of the subcutaneous tissue characterized by a localized swelling with multiple sinuses discharging granules that are micro-colonies of the causative agents. Eumycotic mycetoma is caused by saprophytic fungi. It is responsible for considerable physical comorbidity, as many cases may require surgical interventions, including amputations. Facilities for tissue culture and sensitivity testing may not be available at resource poor settings, adding to the disease burden. Identification of organisms and appropriate therapy is essential for a successful treatment outcome. Here, we present two rare cases of eumycetoma caused by Aspergillus.

Estimating the burden of mycetoma in Sudan for the period 1991–2018 using a model-based geostatistical approach

Mycetoma is widespread in tropical and subtropical regions favouring arid areas with low humidity and a short rainy season. Sudan is one of the highly endemic countries for mycetoma. Estimating the population at risk and the number of cases is critical for delivering targeted and equitable prevention and treatment services. In this study, we have combined a large dataset of mycetoma cases recorded by the Mycetoma Research Centre (MRC) in Sudan over 28 years (1991–2018) with a collection of environmental and water and hygiene-related datasets in a geostatistical framework to produce estimates of the disease burden across the country. We developed geostatistical models to predict the number of cases of actinomycetoma and eumycetoma in areas considered environmentally suitable for the two mycetoma forms. Then used the raster dataset (gridded map) with the population estimates for 2020 to compute the potentially affected population since 1991. The geostatistical models confirmed this heterogeneous and distinct distribution of the estimated cases of eumycetoma and actinomycetoma across Sudan. For eumycetoma, these higher-risk areas were smaller and scattered across Al Jazirah, Khartoum, White Nile and Sennar states, while for actinomycetoma a higher risk for infection is shown across the rural districts of North and West Kurdufan. Nationally, we estimated 63,825 people (95%CI: 13,693 to 197,369) to have been suffering from mycetoma since 1991 in Sudan,51,541 people (95%CI: 9,893–166,073) with eumycetoma and 12,284 people (95%CI: 3,800–31,296) with actinomycetoma. In conclusion, the risk of mycetoma in Sudan is particularly high in certain restricted areas, but cases are ubiquitous across all states. Both prevention and treatment services are required to address the burden. Such work provides a guide for future control and prevention programs for mycetoma, highly endemic areas are clearly targeted, and resources are directed to areas with high demand.

“Dot-in-circle sign:” An ultrasound and magnetic resonance imaging sign for mycetoma

Mycetomas are chronic infections of the skin, underlying soft tissues, and sometimes extending up to the bones. They can be actinomycetoma or eumycetoma. Mycetoma is more frequent in tropical and subtropical regions. The definitive diagnosis is made by histopathology and culture in most cases, but these procedures are invasive and time consuming. “Dot-in-circle sign” is an important sign present on both ultrasound (USG) and magnetic resonance imaging (MRI) which imply the presence of distinct hypoechoic lesions surrounding a hyperechoic center. The use of these imaging modalities can help in the early diagnosis and preventing complications. We report two cases of eumycetoma affecting the feet, with characteristic USG and MRI features.

P242 Autochthonous cases of Madura foot from Jodhpur, Western Rajasthan, India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMMycetoma has been classified as a neglected tropical disease by the WHO. ‘Madura foot’ is a prominent presentation of phaeoid fungi Madurella complex in India. Maduromycotic mycetoma is frequently encountered in Western Rajasthan, where it is endemic. A high prevalence in this area is due to the desert climate of prolonged hot sunshine and scanty annual rainfall. The classic clinical ‘triad of Mycetoma’ involves a painless hard swelling, multiple fistulas, and discharge of grains.We report two cases of eumycetoma from Western Rajasthan:Case Report 1: A 41-year-old male, farmer presented a history of progressive swelling of the left foot in the last 4 years following trauma to the left sole 5 years ago. Patient took multiple treatments with no improvement. General examination showed a pallor and inguinal lymphadenopathy. Local examination revealed tumefaction with multiple sinuses discharging serosanguinous fluid with occasional black granules. Laboratory tests revealed hemoglobin of 6.2 g/dL. Serology was positive for Hepatitis B virus. Direct 40% KOH microscopy of the crushed grains shows septate branching phaeoid hyphae. Whitish brown dry colonies with diffusible brown pigment were seen on Sabouraud Dextrose Agar at 25°C. Lactophenol Cotton Blue Stain showed dark septate hyphae with chlamydoconidia. Histopathological studies confirmed Eumycetoma. X-rays of his foot showed large destructive bony lesions. Initial therapy given to patient was to correct anemia followed by specific antifungal treatment. A below knee amputation of left leg was performed once the anemia was corrected.Case Report 2: A 55-year-old borderline diabetic male daily-wage worker presented with multiple nodular discharging lesions over the anterior shin of the right leg for past 7 years. The lesion started in leg as a small nodule that ruptured discharging black grains intermittently. He could not recall any significant trauma to his foot. Patient took multiple treatments with temporary relief but the disease recurred. Direct microscopy of 40% potassium hydroxide mount of the crushed grains showing thin septate branching phaeoid hyphae and on Sabourad Dextrose Agar at 25°C. White to brown color colony growth with diffusible brown pigment was seen after 2 weeks of incubation. X-rays indicated no bony involvement. Ultrasonographic study of lesions was suggestive of mycetoma. Patient was treated with itraconazole 400 mg/day for 4 days in the hospital and discharged subsequently.DiscussionThe foot is commonly involved in those with outdoor occupations. The combination of the clinical specific lesions, typical grains, microscopy, and histopathological studies are characteristic of the diagnosis. Radiodiagnosis is useful to determine the extension of the lesions in bone and other tissues. Combined medical and surgical treatment is recommended. Amputation is indicated in advanced mycetoma not responding to medical treatment with a severe secondary bacterial infection.ConclusionWe hope to spread awareness regarding fungal eumycetoma due to Madurella spp, an endemic but neglected tropical disease in Western Rajasthan. Clinical suspicion coupled to direct KOH microscopy, fungal culture, and histopathology can yield a definitive diagnosis. Commencement of medical and/or surgical treatment at an early stage is necessary to prevent complications.

Mycetoma in north-western Yemen: Clinico-epidemiological and histopathological study.

Background Mycetoma is widespread in Yemen; however, there are only a few documented reports on the entity from this geographical area. Methods A prospective study of 184 cases of mycetoma (male 145 and female 39) from different regions of north-western Yemen was conducted between July 2000 and May 2014. Clinical profile was recorded in a standardized protocol. The diagnosis was based on clinical features, X-ray studies, examination of grains, and histopathology. Results Eumycetoma was diagnosed in 129, caused by Madurella mycetomatis in 124, Leptosphaeria senegalensis in one and pale grain fungus in four, whereas actinomycetoma occurred in 55, caused by Streptomyces somaliensis in 29, Actinomadura madurai in nine, Actinomadura pelletieri in one, and Nocardia in sixteen. Eumycetoma cases were treated with prolonged course of antifungal drugs, mostly ketoconazole, with itraconazole being used in four patients, along with excision or debulking. Results were better when antifungal drugs were given two to three months before surgery and in those who received itraconazole. Actinomycetoma cases were initially treated with co-trimoxazole monotherapy; later streptomycin was added in 30 cases. Six patients who did not show adequate improvement and two others from the start were treated with modified Welsh regimen and with good results. Limitations Identification of different causative agents was done by histopathology and could not be reconfirmed by culture. Conclusion Mycetoma is widespread in north-western Yemen with a higher incidence of eumycetoma and a majority of the cases were caused by Madurella mycetomatis. Modified Welsh regimen in actinomycetoma and itraconazole with excision in eumycetoma showed the best results.

Madura Foot: A Rare Case of Eumycetoma and Proposed Classification and Treatment Guidelines

Madura foot or mycetoma pedis is a chronic granulomatous disease of the foot caused by fungus or gram-positive aerobic bacteria. It is commonly encountered in tropical and subtropical countries but is rare in Malaysia. We reported a 40-year-old Rohingya refugee who has been resident in Malaysia for the past 11 years presented with a long-standing left foot mass that was proven to be a eumycetoma. A wide local excision of the mass and full-thickness skin graft were done, followed by a course of 6-month postoperative itraconazole. He subsequently recovered well without sequela. A high index of suspicion should be raised in a patient presenting with a chronic mass and discharging sinus in order to diagnose and treat mycetoma as early initiation of therapy leads to better outcomes. Based on literature review, we propose a new classification of eumycetoma and its treatment guideline.

A Case of Trauma-Induced Falciformispora lignatilis Eumycetoma in a Renal Transplant Recipient.

Mycetoma is a chronic, granulomatous, subcutaneous infection caused by several species of fungi and soil-inhabiting bacteria, and is divided into eumycetoma and actinomycetoma, respectively. Endemicity is described with worldwide distribution within the “mycetoma belt”; however, the global burden is ill-defined. Mycetoma is rare in Australia, with only a few published case reports. Over time, the breadth of eumycetoma pathogens has expanded with local epidemiology accounting for variations in regional prevalence. Direct inoculation of pathogens typically heralds the triad of subcutaneous mass, sinus formation and discharging grains. We describe a case of eumycetoma in a 48-year-old male Filipino renal transplant recipient who presented with a painless slow-growing elbow lesion. Ultrasonography revealed two ovoid masses and surgical excision ensued. Histopathology revealed necrotising granulomata with numerous chestnut-brown thick-walled cells, septate hyphae, and occasional grains. On suspicion of localised chromoblastomycosis, the isolate was sent to a reference laboratory which identified the fungus as Falciformispora lignatilis, an organism not hitherto associated with human infection. Amongst the solid organ transplant cohort, similar atypical presentations have been described. Clinicians need to consider eumycetoma where an epidemiological link with the tropics exists, especially in atypical presentations in transplant recipients, including absent preceding trauma.

Mycetoma and the Community Dermatology Program, Mexico.

The Community Dermatology Program established in the state of Guerrero, Mexico for almost 30y provides an adaptable method of detecting and monitoring skin neglected tropical diseases such as mycetoma, which is endemic in the state. The program utilises general and thematic teaching elements combined with distance learning through teledermatology, direct patient consultations and close collaboration with community teams. Using this approach, a picture of mycetoma in Guerrero has emerged, with a focal hot spot located in the southern part of the state in the Costa Chica region. Although in much of Mexico Nocardia infections dominate, in this area there are also substantial numbers of cases of eumycetoma. This combined approach provides a means of early case detection and long-term surveillance through targeted use of a small specialist team.

Aspergillus Niger Causing Eumycetoma in an Immunocompetent Host: Report of a Case and Review of the Literature

Mycetoma is a chronic granulomatous infection of skin and subcutaneous tissues. It is a neglected disease with severe physical and psychological comorbidity burden as many cases end up with amputations. Proper diagnosis with tissue culture is lacking because of unavailability of facilities in remote areas. Eumycetoma by different Aspergillus species has already been reported in the literature for decades. But here, we are reporting a case of eumycetoma caused by Aspergillus niger, which is the first ever case-report to the best of our knowledge and search. Treatment with voriconazole 400 mg/day was successful without any major side-effects, and saved patient from amputation.

Mycetoma epidemiology, diagnosis management, and outcome in three hospital centres in Senegal from 2008 to 2018.

Mycetoma is a neglected tropical disease caused by various actinomycetes or fungi. The disease is characterized by the formation of tumor like-swellings and grains. Senegal is an endemic country where mycetoma cases are under-or misdiagnosed due to the lack of capacities and knowledge among health workers and the community; and where the management of eumycetoma, burdened by a high amputation rate, is currently inadequate. This study aimed to update data on the epidemiology of mycetoma cases diagnosed in three hospital centres in Senegal over a 10 years-period. A total of 193 patients, diagnosed from 2008 to 2018, were included in the study. The most frequent presentation was eumycetoma (47.2%); followed by actinomycetoma (36.8%); it remained undetermined in 16.1% of the patients. The mean age was 38.3 years (68.4% of the patients were between 15 and 45 years-old); the male: female ratio was a 2.94; and most were farmers. One hundred fifty-six (80.8%) patients had used phytotherapy before attending the hospital. Mycetoma was mainly located to the lower limbs (91.2%). Grains were observed in 85% of the patients; including white (25.6%) and yellow (4.3%) grains. The etiological diagnosis was complex, resulting in negative direct microscopy, culture and/or histopathology findings, which explains that 16.1% remained uncharacterized. In most of cases, actinomycetoma were treated with a combination of cotrimoxazole, amoxicillin/clavulanic acid, and streptomycin; whereas eumycetoma cases were treated with terbinafine. The surgery was done in 100 (51.8%) of the patients including 9 in actinomycetoma, 78 in eumycetoma and 13 in undetermined form. The high number of uncharacterized mycetoma in this study, the delay in attending a qualified health-care facility, and the lack of available adequate antifungal drug, point out the need to strengthen mycetoma management capacities in Senegal.

Successful Limb Salvage in a Case of Advanced Long-Standing Eumycetoma of the Foot Using Adjunctive Local Amphotericin B Delivery Through Bioabsorbable Beads.

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.

Mycetoma: A Common Yet Unrecognized Health Burden in Central India.

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.

Epidemiological profile and spectrum of neglected tropical disease eumycetoma from Delhi, North India.

Mycetoma is a chronic granulomatous, suppurative and progressive inflammatory disease that usually involves the subcutaneous tissue and bones after traumatic inoculation of the causative organism. In India, actinomycotic mycetoma is prevalent in south India, south-east Rajasthan and Chandigarh, while eumycetoma, which constitutes one third of the total cases, is mainly reported from north India and central Rajasthan. The objective was to determine the epidemiological profile and spectrum of eumycetoma from a tertiary care hospital in Delhi, North India. Thirty cases of eumycetoma were diagnosed by conventional methods of direct microscopy, culture and species-specific sequencing as per standard protocol. The spectrum of fungal pathogens included Exophiala jeanselmei, Madurella mycetomatis, Fusarium solani, Sarocladium kiliense, Acremonium blochii, Aspergillus nidulans, Fusarium incarnatum, Scedosporium apiospermum complex, Curvularia lunata and Medicopsis romeroi. Eumycetoma can be treated with antifungal therapy and needs to be combined with surgery. It has good prognosis if it is timely diagnosed and the correct species identified by culture for targeted therapy of these patients. Black moulds required prolonged therapy. Its low reporting and lack of familiarity may predispose patients to misdiagnosis and consequently delayed treatment. Hence health education and awareness campaign on the national and international level in the mycetoma belt is crucial.

Eumycetoma on histopathology presenting at unusual site: A rare entity.

Mycetoma, an uncommon chronic infection of skin and subcutaneous tissues commonly seen in tropical and subtropical countries. It is caused by true mycetes named eumycetoma and filamentous bacteria belonging to group actinomycetes. The incidence is more common in agricultural workers walking in bare foot. Foot is most commonly affected. Other less commonly affected sites includes hand, knee, chest and head and neck region. Both forms of mycetoma present as a progressive, subcutaneous multiple nodular swelling with discharging sinuses containing black colour granules. The treatment of these two etiologies is entirely different, a definite diagnosis after histopathological examination is mandatory. We here by present a case of eumycetoma affecting knee joint.

Gallbladder Carcinoma and Its Mimics

Background: Symptomatic gallstone disease is most common indication for routine cholecystectomy. Gallstones cause various histological changes in gallbladder ranging from metaplasia to dysplasia and gallbladder carcinoma. Aims: Study was conducted to evaluate histopathological lesions in gallbladder diseases, correlate clinical and histopathological diagnoses in cholecystectomies and to know prevalence of incidental gallbladder carcinoma in our region.Material and method: All cholecystectomy specimens received in histopathology laboratory during study period of one year were included. Detailed gross and microscopic examination was done in each case. Slides were stained by Hematoxylin and Eosin stain. Results: Total 290 cholecystectomy specimens were studied over a period of one year. Clinically suspicion of gallbladder carcinoma was raised in five cases due to preoperative and intraoperative findings of thickened gallbladder wall with adherence to surrounding structures and presence of gallstones. On microscopy, three cases of these were reported as xanthogranulomatous cholecystitis, one as nonspecific chronic cholecystitis and one was rare case of eumycetoma of gallbladder. On histopathological examination suspicion of gallbladder carcinoma was raised in three cases of dysplasia and final diagnosis was biliary intraepithelial neoplasia-3 in two cases and biliary intraepithelial neoplasia-1 in one case. Histopathologically two cases (0.69%) were reported as gallbladder carcinoma and clinically there was no suspicion of gallbladder carcinoma in both cases. However in one case suspicion of gallbladder carcinoma was raised intraoperatively while one case was of incidental gallbladder carcinoma (0.34%).Conclusion: Gallstones disease can mimic gallbladder carcinoma clinically while incidental gallbladder carcinoma can occur in grossly normal looking gallbladder.DOI: 10.21276/APALM.1611

Subcutaneous mycoses in Peru: a systematic review and meta-analysis for the burden of disease.

There is a worrying lack of epidemiological data on the geographical distribution and burden of subcutaneous mycoses in Peru, hindering the implementation of surveillance and control programs. This study aimed to estimate the disease burden of subcutaneous mycoses in Peru and identify which fungal species were commonly associated with these mycoses. We performed a meta-analysis after a systematic review of the published literature in PubMed, LILACS, and SciELO to estimate the burden of subcutaneous mycoses in 25 regions in Peru. The disease burden was determined in terms of prevalence (number of cases per 100,000 inhabitants) and the number of reported cases per year per region. A total of 26 studies were eligible for inclusion. Results showed that sporotrichosis was the most common subcutaneous mycosis (99.7%), whereas lobomycosis, chromoblastomycosis, and subcutaneous phaeohyphomycosis were rare. Cases of eumycetoma and subcutaneous zygomycosis were not found. Of the 25 regions, the burden of sporotrichosis was estimated for four regions classified as endemic; in nine regions, only isolated cases were reported. The highest burden of sporotrichosis was in Apurimac (15 cases/100,000 inhabitants; 57 cases/year), followed by Cajamarca (3/100,000 inhabitants; 30/year), Cusco (0.5/100,000 inhabitants; 4/year), and La Libertad (0.2/100,000 inhabitants; 2/year). In two regions, the mycoses predominantly affected children. Sporotrichosis is the most common subcutaneous mycosis in Peru, with a high disease burden in Apurimac. Chromoblastomycosis, lobomycosis, and subcutaneous phaeohyphomycosis are rare mycoses in Peru.

Review of 21 cases of mycetoma from 1991 to 2014 in Rio de Janeiro, Brazil

Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria that form grains in the tissue. The purpose of this study is to describe the epidemiologic, clinic, laboratory, and therapeutic characteristics of patients with mycetoma at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil, between 1991 and 2014. Twenty-one cases of mycetoma were included in the study. There was a predominance of male patients (1.3:1) and the average patient age was 46 years. The majority of the cases were from the Southeast region of Brazil and the feet were the most affected anatomical region (80.95%). Eumycetoma prevailed over actinomycetoma (61.9% and 38.1% respectively). Eumycetoma patients had positive cultures in 8 of 13 cases, with isolation of Scedosporium apiospermum species complex (n = 3), Madurella mycetomatis (n = 2) and Acremonium spp. (n = 1). Two cases presented sterile mycelium and five were negative. Six of 8 actinomycetoma cases had cultures that were identified as Nocardia spp. (n = 3), Nocardia brasiliensis (n = 2), and Nocardia asteroides (n = 1). Imaging tests were performed on all but one patients, and bone destruction was identified in 9 cases (42.68%). All eumycetoma cases were treated with itraconazole monotherapy or combined with fluconazole, terbinafine, or amphotericin B. Actinomycetoma cases were treated with sulfamethoxazole plus trimethoprim or combined with cycles of amikacin sulphate. Surgical procedures were performed in 9 (69.2%) eumycetoma and in 3 (37.5%) actinomycetoma cases, with one amputation case in each group. Clinical cure occurred in 11 cases (7 for eumycetoma and 4 for actinomycetoma), and recurrence was documented in 4 of 21 cases. No deaths were recorded during the study. Despite of the scarcity of mycetoma in our institution the cases presented reflect the wide clinical spectrum and difficulties to take care of this neglected disease.