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Infectious Diseases
Fusarium falciforme eumycetoma: a diagnostic challenge of a neglected tropical disease
  1. Noralwani Badarol Hisham1,
  2. Shaharuddin Abdul Rhani2,
  3. Razana Mohd Ali3 and
  4. Siti Norbaya Masri1
  1. 1Department of Medical Microbiology, Universiti Putra Malaysia Fakulti Perubatan dan Sains Kesihatan, Serdang, Selangor, Malaysia
  2. 2Orthopaedic Department, KPJ Selangor Specialist Hospital, Shah Alam, Selangor, Malaysia
  3. 3Pathology Department, Universiti Putra Malaysia Fakulti Perubatan dan Sains Kesihatan, Serdang, Selangor, Malaysia
  1. Correspondence to Dr Siti Norbaya Masri; sitinorbaya{at}upm.edu.my

Abstract

Eumycetoma, a subcutaneous infection caused by various fungi with pathognomonic discharging grain, is rarely reported in Malaysia. This case concerns a eumycetoma infection in an immunocompetent man who presented with progressive left foot swelling complicated with pustules, sinuses and pale grain discharge for the past year after recurrent thorn pricks. Histological findings of the grain and tissue showed foci of septate fungal hyphae. Tissue culture yielded no growth. Amplification and sequencing of the rDNA internal transcribed spacer 1 (ITS1), ITS4 and large subunit regions of the tissue identified the causative agent as Fusarium falciforme, highlighting the role of molecular diagnostic method in identifying fungal species in eumycetoma. The patient was treated with surgical excision and oral itraconazole with excellent improvement. However, he presented again with recurrence after defaulting therapy. F. falciforme has been implicated in causing diseases in crops and sea turtles. Therefore, the One Health approach should be adopted to manage this emerging species.

  • Pathology
  • Tropical medicine (infectious disease)

https://doi.org/10.1136/bcr-2023-258657

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—NBH, RMA and SNM. The following authors gave final approval of the manuscript—SAR, RMA and SNM.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.