A farmer present with multiple discharging sinuses in the leg not responding to antibiotics. Most likely diagnosis is:

Ans. (a) Madurella Actinomycetoma, usually responds to antibiotics. Treatment of Mycetonra Actinomycetoma Eumycetoma Prolonged combination chemotherapy, e.g. with streptomycin and either dapsone or cotrimoxazole, cotrimoxazole + amikacin Rarely responds to chemotherapy, some cases caused by Madurella mycetomatic respond to ketoconazole itraconazole, posaconazole