Question

A farmer presents to you with swelling on foot and multiple discharging sinuses in the lower limb. Granules from the discharge were examined under the microscope, shown below. Which of the following is true regarding this condition?

• A. Both bacteria and fungi can be causative
• B. Undergoes lymphatic spread
• C. There is lymphocyte accumulation
• D. Involves only superficial tissues

Answer 1

The Correct Option is A

This clinical scenario describes a patient with swelling of the foot and multiple discharging sinuses on the lower limb, a presentation suggestive of mycetoma. Mycetoma, also known as "Madura foot," is a chronic granulomatous disease characterized by swelling, discharging sinuses, and the presence of colored granules in the discharge.

To solve this problem, we need to consider the characteristics of mycetoma:

• Etiology: Mycetoma can be caused by a variety of microorganisms, most commonly filamentous fungi (eumycetoma) and bacteria (actinomycetoma). Therefore, the statement "Both bacteria and fungi can be causative" is true.
• Spread: Mycetoma primarily spreads through local extension, and lymphatic spread is not characteristic of this condition, making the option "Undergoes lymphatic spread" incorrect.
• Immune response: While mycetoma elicits a chronic inflammatory response, it is typically characterized by granuloma formation with neutrophils rather than lymphocyte accumulation. Thus, the statement "There is lymphocyte accumulation" does not accurately describe the condition.
• Tissue involvement: Mycetoma typically involves deeper tissues, including subcutaneous tissue, and may extend to bone if untreated. It does not involve only superficial tissues, so the option "Involves only superficial tissues" is incorrect.

To conclude, the option "Both bacteria and fungi can be causative" correctly reflects the etiology of mycetoma, aligning with the clinical details provided.