Lakshyasri Baishya1, Madhab Kalita2, Ajanta Sharma3*, Bornali Sarma Dutta1 and Debeeka Hazarika4
1Department of Microbiology, Tezpur Medical College, Tezpur, Assam, India.
2Intermediate Reference Laboratory, RNTCP, Gauhati Medical College, Guwahati, Assam, India.
3Department of Microbiology, Gauhati Medical College, Guwahati, Assam, India.
4Department of Dermatology, Venereology & Leprology, Gauhati Medical College, Guwahati, Asam, India.
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 Aspergillusflavuson 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.
Keywords: Aspergillusflavus, Eumycetoma, White grain mycetoma.