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Mycetoma — DTM&H MCQ

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HardDermatological tropical conditionsMycetomaDTM&H

A Sudanese farmer has a chronic painless foot mass with multiple sinuses discharging black grains. Which investigation most directly distinguishes eumycetoma from actinomycetoma and guides treatment?

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Correct answer: E — Examine grains by microscopy and submit for bacterial and fungal culture

The best answer is “Examine grains by microscopy and submit for bacterial and fungal culture”. The organism is concentrated in the grains, so direct microscopy followed by appropriate culture distinguishes fungal eumycetoma from bacterial actinomycetoma and determines whether prolonged antifungal-plus-surgical or antibacterial treatment is needed. Deep histology may show the process but omitting microbiology limits identification; superficial swabs are readily contaminated; MRI stages extent rather than reliably identifying aetiology; and serum beta-D-glucan is not a validated grain classifier.

Reference: WHO, Mycetoma fact sheet: https://www.who.int/news-room/fact-sheets/detail/mycetoma