Mycology: mycetoma: practice question

A Microbiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Microbiology · Mycology: mycetoma

Sample item

A farmer from Rajasthan has a painless swollen foot with multiple sinuses discharging black granules. Which diagnosis and treatment are most appropriate?

AEumycetoma by Madurella mycetomatis, treated with itraconazole and surgical excisionBSporotrichosis by Sporothrix schenckii, treated with potassium iodideCActinomycetoma by Actinomadura pelletieri, treated with penicillinDActinomycetoma by Nocardia brasiliensis, treated with cotrimoxazole alone

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Eumycetoma by Madurella mycetomatis, treated with itraconazole and surgical excision

Mycetoma is a chronic granulomatous infection following implantation of soil organisms, with swelling, sinuses and grains. Black grains are produced by fungi such as Madurella mycetomatis, so this is eumycetoma, which needs a prolonged azole and surgery. Actinomycetoma, caused by filamentous bacteria with pale or red grains, responds to antibacterial combinations.

Option by option

A. Eumycetoma by Madurella mycetomatis, treated with itraconazole and surgical excision (correct)
Correct. Black grains indicate fungal eumycetoma, treated with an azole plus excision.
B. Sporotrichosis by Sporothrix schenckii, treated with potassium iodide
Sporotrichosis produces lymphocutaneous nodules and not grains.
C. Actinomycetoma by Actinomadura pelletieri, treated with penicillin
Actinomadura pelletieri gives red grains and is a bacterial actinomycetoma, not matching black grains.
D. Actinomycetoma by Nocardia brasiliensis, treated with cotrimoxazole alone
Nocardia gives pale grains and actinomycetoma, which is managed with antibacterials.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is A, Eumycetoma by Madurella mycetomatis, treated with itraconazole and surgical excision. Mycetoma is a chronic granulomatous infection following implantation of soil organisms, with swelling, sinuses and grains.

Why is "Sporotrichosis by Sporothrix schenckii, treated with potassium iodide" not the answer?

Sporotrichosis produces lymphocutaneous nodules and not grains.

Why is "Actinomycetoma by Actinomadura pelletieri, treated with penicillin" not the answer?

Actinomadura pelletieri gives red grains and is a bacterial actinomycetoma, not matching black grains.

Why is "Actinomycetoma by Nocardia brasiliensis, treated with cotrimoxazole a…" not the answer?

Nocardia gives pale grains and actinomycetoma, which is managed with antibacterials.

What concept does this question test?

It tests Mycology: mycetoma in Microbiology. Black grains are produced by fungi such as Madurella mycetomatis, so this is eumycetoma, which needs a prolonged azole and surgery. Actinomycetoma, caused by filamentous bacteria with pale or red grains, responds to antibacterial combinations.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Mycology: mycetoma?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.