Diagnosis
Diagnosis is by biopsy, visualising the fungi under the microscope and culture, which show characteristic fungal filaments and vesicles characteristic of the fungi. Other tests include ELISA, immunodiffusion, and PCR with DNA sequencing (so-called DNA barcoding).X rays and ultrasonography may be carried out to assess the extent of the disease. X rays findings are extremely variable. The disease is most often observed at an advanced stage that exhibits extensive destruction of all bones of the foot. Rarely, a single lesion may be seen in the tibia where the picture is identical with chronic osteomyelitis. Cytology of fine needle aspirate or pus from the lesion, and tissue biopsy may be undertaken sometimes. Some publications have claimed a "dot in a circle sign" as a characteristic MRI feature for this condition (this feature has also been described on ultrasound). Differential diagnosis
The following clinical conditions may be considered before diagnosing a patient with mycetoma:

Tuberculous ulcer
Kaposis sarcoma, a vascular tumour of skin usually seen in AIDS. Leprosy
Syphilis
Malignant neoplasm
Tropical ulcer
Botryomycosis, a skin infection usually caused by the bacteria Staphylococcus aureus. Prevention
No vaccine is available. Simple hygienic precautions like wearing shoes or sandals while working in fields, and washing hands and feet at regular intervals may help prevent the disease. Treatment
Surgery combined with itraconazole may be given for up to year when the grains are black. Posaconazole is another option. Voriconazole can be used for infections caused by Fusarium species.Ketoconazole has been used to treat eumycetoma but has many side effects.
Actinomycetes usually respond well to medical treatment, but eukaryotic infections are generally resistant and may require surgical interventions including salvage procedures as bone resection or even the more radical amputation. Epidemiology
The disease is more common in males aged 20–40 years who work as labourers, farmers and herders, and in travellers to tropical regions, where the condition is endemic. History
Madura foot or maduromycosis or maduramycosis is described in ancient writings of India as Padavalmika, which, translated means Foot anthill. The first modern description of Madura foot was made in 1842 from Madurai (the city after which the disease was named Madura-mycosis) in India, by Gill. The fungal cause of the disease was established in 1860 by Carter. Society and culture
In 2016, the World Health Organization recognised eumycetoma as a neglected tropical disease. Traditionally occurring in regions where resources are scarce, medicines may be expensive and diagnosis is frequently made late, when more invasive treatment may be required. References


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