DIFFERENCE BETWEEN EUMYCETOMA AND ACTINOMYCETOMA CLINICAL MANIFESTATIONS EUMYCETOMA (TRUE FUNGI) ACTINOMYCETOMA (FILAMENTOUS BACTERIA) SWELLING Single, well defined margins Multiple tumor masses with illdefined margins SINUSES Appear late, few in number Appear early, numerous with raised inflamed opening Progression of disease Less aggressive More aggressive Agents Black granules: Madurella mycetomatis Exophiala Curvularia White granules: Pseudallescheria boydii Acremonium species White to yellow granules: Nocardia species Streptomyces somaliensis Actinomadura madurae (MCC) Pink to red granules:Actinomadura pelletieri Treatment -Anti-fungals (Itraconzole & amphotericin B) for 8-24 months -Surgical debulking if not responding Welsh regimen(Amikacin and cotrimoxazole)