Figure 1.
Different grains obtained from eumycetoma and actinomycetoma lesions.
In this figure different grain types are shown. A: An eumycetoma surgical excision with numerous black grains, indicative for M. mycetomatis. B: An actinomycetoma surgical biopsy with numerous yellow grains, indicative for S. somaliensis. C: Grains of Madurella mycetomatis fixed in formalin. D: Histological slide of a Madurella mycetomatis grain inside subcutaneous tissue. The grain is clearly seen as a round brown structure (arrow) (×100). E: Histological slide of a S. somaliensis grain inside subcutaneous tissue (arrow) (×400).
Figure 2.
Imaging techniques used in mycetoma.
A: A radiograph of the foot, showing soft tissue shadow (arrow), and multiple large cavities (c) in line with eumycetoma. B: A typical sonogram of scrotal eumycetoma. In this sonogram multiple cavities with thick walls and multiple hyper-reflective echoes (arrow) are seen, which are in line with grains. C: An MRI of the foot, showing massive soft tissue and bone destruction. In this MRI, grains appear as conglomerates of small (2–5 mm) round hyperintense lesions (arrow).
Table 1.
Radiographic classification of bone involvement in mycetoma as described by Abd El Bagi [7].
Table 2.
MRI classification of mycetoma lesions based on the Mycetoma Skin, Muscle, and Bone Grading (MSMB) system according to El Shamy et al. [15].
Figure 3.
Obtaining grains via Fine Needle Aspiration.
Figure 4.
Flow diagram of histological identification of causative agents of mycetoma, based on references [18], [19], [23].
Table 3.
Primers used for molecular diagnostics.
Figure 5.
Identifying mycetoma causative agents by culture.
A: Madurella mycetomatis grown on sabouraud agar. B: Microscopic appearance of Madurella mycetomatis stained with calcofluor white. C: N. brasiliensis colony. D: Microscopic appearance of N. brasiliensis.
Table 4.
Primers used for LAMP.