{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T07:45:24Z","timestamp":1792568724113,"version":"4.5.0"},"reference-count":75,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Mycetoma describes a heterogeneous group of cutaneous and subcutaneous infections caused by either fungi (eumycetomas) or bacteria (actinomycetomas). It is characterized by a triad of clinical symptoms: painless subcutaneous tumor-like swelling, multiple sinuses and fistulas, and discharged grains in pus. This predominantly affects the feet in more than 70% of patients. It is endemic in the \u201cmycetoma belt\u201d regions, including Africa, South America, and South Asia. Autochthonous mycetoma is rare in the United States of America (USA). We recently reported a Latin American immigrant with eumycetoma in the State of Maryland, USA. With millions of immigrants from endemic regions, the true number of mycetomas in the USA is most likely higher than currently recognized. With the aim to raise the awareness of clinicians about mycetoma, especially dermatologists and podiatrists, we update the development of the epidemiology, etiology, clinical presentations, pathogenesis, diagnosis, differential diagnosis, and treatment of mycetoma.<\/jats:p>","DOI":"10.3390\/jof8070743","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T08:28:25Z","timestamp":1658219305000},"page":"743","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Mycetoma: Development of Diagnosis and Treatment"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8661-2304","authenticated-orcid":false,"given":"Xingpei","family":"Hao","sequence":"first","affiliation":[{"name":"Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD 20850, USA"},{"name":"P4Diagnostix, Beltsville, MD 20705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Cognetti","sequence":"additional","affiliation":[{"name":"P4Diagnostix, Beltsville, MD 20705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhonda","family":"Burch-Smith","sequence":"additional","affiliation":[{"name":"P4Diagnostix, Beltsville, MD 20705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emerald O\u2019Sullivan","family":"Mejia","sequence":"additional","affiliation":[{"name":"P4Diagnostix, Beltsville, MD 20705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene","family":"Mirkin","sequence":"additional","affiliation":[{"name":"Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD 20850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,19]]},"reference":[{"key":"ref_1","unstructured":"Ananthanarayan, B.A., Jayaram, C.K., and Paniker, M.D. (2006). Textbook of Microbiology, Orient Longman Private Ltd.. [7th ed.]."},{"key":"ref_2","unstructured":"Thursby, S.M.A.G. (2004). Veda and Upanishad, Routledge."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"van de Sande, W.W. (2013). Global burden of human mycetoma: A systematic review and meta-analysis. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002550"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1111\/jdv.13008","article-title":"Eumycetoma and actinomycetoma\u2014An update on causative agents, epidemiology, pathogenesis, diagnostics and therapy","volume":"29","author":"Nenoff","year":"2015","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_5","first-page":"104","article-title":"On a New and Striking form of Fungus Disease Principally Affecting the Foot and Prevailing Endemically in Many Parts of India","volume":"6","author":"Carter","year":"1860","journal-title":"Trans. Med. Phys. Soc. Bombay"},{"key":"ref_6","first-page":"929","article-title":"Actinomycoses and mycetomas","volume":"11","author":"Pinoy","year":"1913","journal-title":"Bull. Inst. Past"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Fahal, A.H., Suliman, S.H., and Hay, R. (2018). Mycetoma: The Spectrum of Clinical Presentation. Trop. Med. Infect. Dis., 3.","DOI":"10.3390\/tropicalmed3030097"},{"key":"ref_8","first-page":"173","article-title":"Clinical Features of Mycetoma and the Appropriate Treatment Options","volume":"12","author":"Agarwal","year":"2021","journal-title":"Res. Rep. Trop. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Abbas, M., Scolding, P.S., Yosif, A.A., El Rahman, R.F., El-Amin, M.O., Elbashir, M.K., Groce, N., and Fahal, A.H. (2018). The disabling consequences of Mycetoma. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0007019"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Fahal, A.H. (2017). Mycetoma: A global medical and socio-economic dilemma. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0005509"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Emery, D., and Denning, D.W. (2020). The global distribution of actinomycetoma and eumycetoma. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008397"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tritto, M., Procop, G.W., Billings, S.T., Mirkin, G., and Hao, X. (2021). Eumycetoma, A Neglected Tropical Disease in the United States. J. Am. Podiatr. Med. Assoc., 111.","DOI":"10.7547\/20-150"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Bonifaz, A., Tirado-S\u00e1nchez, A., Calder\u00f3n, L., Sa\u00fal, A., Araiza, J., Hern\u00e1ndez, M., Gonz\u00e1lez, G.M., and Ponce, R.M. (2014). Mycetoma: Experience of 482 cases in a single center in Mexico. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003102"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1093\/mmy\/myx061","article-title":"Closing the mycetoma knowledge gap","volume":"56","author":"Fahal","year":"2018","journal-title":"Med. Mycol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S1473-3099(15)00359-X","article-title":"Mycetoma: A unique neglected tropical disease","volume":"16","author":"Zijlstra","year":"2016","journal-title":"Lancet. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zijlstra, E.E., van de Sande, W.W., and Fahal, A.H. (2016). Mycetoma: A Long Journey from Neglect. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004244"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.4269\/ajtmh.16-0710","article-title":"Mycetoma (Madura Foot) in Israel: Recent Cases and a Systematic Review of the Literature","volume":"96","author":"Bitan","year":"2017","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Buonfrate, D., Gobbi, F., Angheben, A., Marocco, S., Farina, C., Van Den Ende, J., and Bisoffi, Z. (2014). Autochthonous cases of mycetoma in Europe: Report of two cases and review of literature. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0100590"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1093\/ajcp\/42.1.75","article-title":"Mycetoma in the United States; A Review and Report of Seven Additional Cases","volume":"42","author":"Green","year":"1964","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1097\/00007611-197512000-00025","article-title":"Maduromycosis (Madura foot) in Kentucky","volume":"68","author":"Warintarawej","year":"1975","journal-title":"South. Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s11046-020-00524-y","article-title":"Eumycetoma of the Foot due to Fusarium solani in a Person with Diabetes Mellitus: Report of a Case and Review of Literature","volume":"186","author":"Das","year":"2021","journal-title":"Mycopathologia"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Abushouk, A., Nasr, A., Masuadi, E., Allam, G., Siddig, E.E., and Fahal, A.H. (2019). The Role of Interleukin-1 cytokine family (IL-1\u03b2, IL-37) and interleukin-12 cytokine family (IL-12, IL-35) in eumycetoma infection pathogenesis. PLoS Negl. Trop. Dis., 13.","DOI":"10.1371\/journal.pntd.0007098"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Nasr, A., Abushouk, A., Hamza, A., Siddig, E., and Fahal, A.H. (2016). Th-1, Th-2 Cytokines Profile among Madurella mycetomatis Eumycetoma Patients. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004862"},{"key":"ref_24","first-page":"12","article-title":"Unusual Presentation of Mycetoma of the Foot: A Rare Case Report","volume":"7","author":"Grover","year":"2017","journal-title":"J. Orthop. Case Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/0035-9203(56)90004-9","article-title":"Mycetoma in the Sudan","volume":"50","author":"Abbott","year":"1956","journal-title":"R. Soc. Trop. Med. Hyg."},{"key":"ref_26","first-page":"477","article-title":"Epidemiology of mycetoma in Mexico: Study of 2105 cases","volume":"128","author":"Tovar","year":"1992","journal-title":"Gac. Med. Mex."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0733-8635(05)70329-6","article-title":"Mycetoma","volume":"14","author":"McGinnis","year":"1996","journal-title":"Dermatol. Clin."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/S1473-3099(04)01131-4","article-title":"Mycetoma caused by madurella mycetomatis: A neglected infectious burden","volume":"4","author":"Ahmed","year":"2004","journal-title":"Lancet Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1111\/ijd.14351","article-title":"The importance of diagnostic imaging of mycetoma in the foot","volume":"58","year":"2019","journal-title":"Int. J. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1186\/2193-1801-3-671","article-title":"The \u201cdot-in-circle\u201d sign in musculoskeletal mycetoma on magnetic resonance imaging and ultrasonography","volume":"3","author":"Laohawiriyakamol","year":"2014","journal-title":"SpringerPlus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"315","DOI":"10.2165\/00128071-200607050-00005","article-title":"Mycetoma: A review","volume":"7","author":"Lichon","year":"2006","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"225","DOI":"10.3109\/13693786.2010.539631","article-title":"Mycoses of implantation in Latin America: An overview of epidemiology, clinical manifestations, diagnosis and treatment","volume":"49","author":"Nucci","year":"2011","journal-title":"Med. Mycol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ahmed, S.A., Kloezen, W., Duncanson, F., Zijlstra, E.E., de Hoog, G.S., Fahal, A.H., and van de Sande, W.W. (2014). Madurella mycetomatis is highly susceptible to ravuconazole. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0002942"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"64","DOI":"10.4103\/0974-777X.52985","article-title":"Histological diagnosis of madura foot (mycetoma): A must for definitive treatment","volume":"1","author":"Alam","year":"2009","journal-title":"J. Glob. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1080\/mmy.39.1.41.50","article-title":"Role of chemokines in fungal infections","volume":"39","author":"Traynor","year":"2001","journal-title":"Med. Mycol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S181","DOI":"10.1080\/14789940500051417","article-title":"Immunity to Aspergillus fumigatus: The basis for immunotherapy and vaccination","volume":"43","author":"Bellocchio","year":"2005","journal-title":"Med. Mycol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1183\/09031936.02.00229102","article-title":"Allergy and immunity to fungal infections and colonization","volume":"19","author":"Crameri","year":"2002","journal-title":"Eur. Respir. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3065","DOI":"10.4049\/jimmunol.179.5.3065","article-title":"Polymorphisms in genes involved in innate immunity predispose toward mycetoma susceptibility","volume":"179","author":"Fahal","year":"2007","journal-title":"J. Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"527","DOI":"10.3109\/13693786.2012.745201","article-title":"The association between the interleukin-10 cytokine and CC chemokine ligand 5 polymorphisms and mycetoma granuloma formation","volume":"51","author":"Mhmoud","year":"2013","journal-title":"Med. Mycol."},{"key":"ref_40","first-page":"327","article-title":"Nutrition in Wound Care Management: A Comprehensive Overview","volume":"27","author":"Quain","year":"2015","journal-title":"Wounds"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1177\/0884533609358997","article-title":"Understanding the role of nutrition and wound healing","volume":"25","author":"Stechmiller","year":"2010","journal-title":"Nutr. Clin. Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/S0035-9203(98)90957-9","article-title":"Cystic mycetoma: An unusual clinical presentation of Madurella mycetomatis infection","volume":"92","author":"Fahal","year":"1998","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_43","first-page":"57","article-title":"Microscopic potassium hydroxide preparation","volume":"60","author":"Ponka","year":"2014","journal-title":"Can. Fam. Physician Med. Fam. Can."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ahmed, A.A., van de Sande, W., and Fahal, A.H. (2017). Mycetoma laboratory diagnosis: Review article. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0005638"},{"key":"ref_45","first-page":"33","article-title":"Isolation of fungal communities and identification of Scedosporium species complex with pathogenic potentials from a pigsty in Phra Nakhon Si Ayutthaya, Thailand","volume":"44","author":"Kitisin","year":"2021","journal-title":"New Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s40588-014-0001-z","article-title":"The Genus Scedosporium and Pseudallescheria: Current Challenges in Laboratory Diagnosis","volume":"1","author":"Ramsperger","year":"2014","journal-title":"Curr. Clin. Microbiol. Rep."},{"key":"ref_47","first-page":"E11","article-title":"Actinomycetoma: An update on diagnosis and treatment","volume":"99","author":"Arenas","year":"2017","journal-title":"Cutis"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1128\/AEM.05280-11","article-title":"Rapid identification of Pseudallescheria and Scedosporium strains by using rolling circle amplification","volume":"78","author":"Lackner","year":"2012","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3517","DOI":"10.1128\/JCM.00862-06","article-title":"Molecular identification of black-grain mycetoma agents","volume":"44","author":"Bretagne","year":"2006","journal-title":"J. Clin. Microbiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"3280","DOI":"10.1128\/JCM.01544-15","article-title":"Application of Isothermal Amplification Techniques for Identification of Madurella mycetomatis, the Prevalent Agent of Human Mycetoma","volume":"53","author":"Ahmed","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Ahmed, S.A., van den Ende, B.H., Fahal, A.H., van de Sande, W.W., and de Hoog, G.S. (2014). Rapid identification of black grain eumycetoma causative agents using rolling circle amplification. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003368"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2521","DOI":"10.1128\/JCM.00417-17","article-title":"Rapid and Robust Identification of the Agents of Black-Grain Mycetoma by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry","volume":"55","author":"Fraser","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2901","DOI":"10.1128\/jcm.31.11.2901-2906.1993","article-title":"Enzyme-linked immunosorbent assay for serological diagnosis of Nocardia brasiliensis and clinical correlation with mycetoma infections","volume":"31","author":"Welsh","year":"1993","journal-title":"J. Clin. Microbiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1080\/00362177585190541","article-title":"Counterimmunoelectrophoresis in the diagnosis of mycetoma and its sensitivity as compared to immunodiffusion","volume":"13","author":"Gumaa","year":"1975","journal-title":"Sabouraudia"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/00362177885380301","article-title":"Preliminary investigation of the use of the enzyme linked immunosorbent assay (ELISA) in the serodiagnosis of mycetoma","volume":"16","author":"McLaren","year":"1978","journal-title":"Sabouraudia"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.4049\/jimmunol.177.3.1997","article-title":"Translationally controlled tumor protein from Madurella mycetomatis, a marker for tumorous mycetoma progression","volume":"177","author":"Janse","year":"2006","journal-title":"J. Immunol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1093\/trstmh\/trw023","article-title":"Use of immunoblotting in testing Madurella mycetomatis specific antigen","volume":"110","author":"Elbadawi","year":"2016","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2614","DOI":"10.1128\/JCM.01478-16","article-title":"Detection of (1\u21923)-\u03b2-d-Glucan in Eumycetoma Patients","volume":"54","author":"Fahal","year":"2016","journal-title":"J. Clin. Microbiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.trstmh.2012.08.009","article-title":"New MRI grading system for the diagnosis and management of mycetoma","volume":"106","author":"Fahal","year":"2012","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_60","unstructured":"Hao, X., Freedman, D., Yim, J., Le, M., Baglio, R., Levine, D., Saffo, G., Parthasarathy, P., and Mirkin, G. Dermatofibromas on the Foot and Ankle: A Clinicopathological Characterization of 31 Cases. JAPMA, 2022. in press."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Hao, X., Billings, S.D., Wu, F., Stultz, T.W., Procop, G.W., Mirkin, G., and Vidimos, A.T. (2020). Dermatofibrosarcoma Protuberans: Update on the Diagnosis and Treatment. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061752"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.21873\/anticanres.13323","article-title":"Dermatofibrosarcoma Protuberans on Adult Toes: A Case Report and Review of the Literature","volume":"39","author":"Madden","year":"2019","journal-title":"Anticancer. Res."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Hao, X., Yim, J., Robles-Sherman, E., Firestone, L., Bannerjee, A., Vieweger, D., Daughtry, E., Le, M., Mirkin, G., and Rubenstein, S. Clinicopathological characterization of the Kaposi sarcoma on the foot and ankle: Analysis of 11 Pptients seen in our clinics. JAPMA, 2022. in press.","DOI":"10.7547\/21-175"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"6175","DOI":"10.21873\/anticanres.13825","article-title":"Acral Lentiginous Melanoma of Foot and Ankle: A Clinicopathological Study of 7 Cases","volume":"39","author":"Hao","year":"2019","journal-title":"Anticancer Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1111\/j.1365-2133.2005.06534.x","article-title":"Madurella mycetomatis mycetoma treated successfully with oral voriconazole","volume":"152","author":"Lacroix","year":"2005","journal-title":"Br. J. Dermatol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.4269\/ajtmh.2006.75.1106","article-title":"Successful treatment of black-grain mycetoma with voriconazole","volume":"75","author":"Loulergue","year":"2006","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1590\/S0036-46652005000600006","article-title":"Posaconazole treatment of refractory eumycetoma and chromoblastomycosis","volume":"47","author":"Negroni","year":"2005","journal-title":"Rev. Inst. Med. Trop. Sao Paulo"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Karrakchou, B., Boubnane, I., Senouci, K., and Hassam, B. (2020). Madurella mycetomatis infection of the foot: A case report of a neglected tropical disease in a non-endemic region. BMC Dermatol., 20.","DOI":"10.1186\/s12895-019-0097-1"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/1346-8138.15651","article-title":"Fosravuconazole to treat severe onychomycosis in the elderly","volume":"48","author":"Noguchi","year":"2021","journal-title":"J. Dermatol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s11046-021-00540-6","article-title":"Treatment Outcome with Fosravuconazole for Onychomycosis","volume":"186","author":"Shimoyama","year":"2021","journal-title":"Mycopathologia"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"C\u00e1rdenas-de la Garza, J.A., Welsh, O., Cu\u00e9llar-Barboza, A., Suarez-S\u00e1nchez, K.P., De la Cruz-Valadez, E., Cruz-G\u00f3mez, L.G., Gallardo-Rocha, A., Ocampo-Candiani, J., and Vera-Cabrera, L. (2020). Clinical characteristics and treatment of actinomycetoma in northeast Mexico: A case series. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008123"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Suleiman, S.H., Wadaella el, S., and Fahal, A.H. (2016). The Surgical Treatment of Mycetoma. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004690"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Wadal, A., Elhassan, T.A., Zein, H.A., Abdel-Rahman, M.E., and Fahal, A.H. (2016). Predictors of Post-operative Mycetoma Recurrence Using Machine-Learning Algorithms: The Mycetoma Research Center Experience. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0005007"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Welsh, O., Al-Abdely, H.M., Salinas-Carmona, M.C., and Fahal, A.H. (2014). Mycetoma medical therapy. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003218"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e111","DOI":"10.5001\/omj.2020.29","article-title":"Successful Treatment of Recalcitrant Actinomycetoma of Gluteal Area with Combined Medical Treatment and Surgical Excision with Graft Reconstruction","volume":"35","year":"2020","journal-title":"Oman Med. J."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/8\/7\/743\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:53:51Z","timestamp":1760140431000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/8\/7\/743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,19]]},"references-count":75,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["jof8070743"],"URL":"https:\/\/doi.org\/10.3390\/jof8070743","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,19]]}}}