A farmer presents with multiple dicharging sinuses in the leg not responding to antibiotics. Most likely diagnosis is -
Ans. is 'a' i.e., Madurella . Multiple discharging sinuses not responding to antibiotics suggest the diagnosis of mycetoma. . Actinomycetoma may respond to antibiotic therapy. eg. combination of streptomycin and dapsone or combination of streptomycin and trimethoprim sulfamethoxazole. . Actinomycetoma is caused by Actinomadura, Nocardia and streptomyces. . Eumycetoma rarely respond to antibiotics, some cases caused by madurella mycetoma have appeared to respond to ketoconazole or itraconazole.
Madurella
Actino-mycetoma
Nocardia
Sporothrix