Fungal
mycetoma (
eumycetoma) represents one of the most difficult
infections to appropriately manage. The current recommended treatment is based on extensive surgical
debridement combined with prolonged antifungal
therapy with
ketoconazole or
itraconazole. Despite the different phylogenetic positions of black-grain
eumycetoma species, they are all treated with the same
antifungal agents. The in vitro antifungal susceptibility of coelomycetous
eumycetoma agents in the order of Pleosporales presently is largely unknown. Here we determined the in vitro activity of eight
antifungal agents against seven species causing human
eumycetoma using the Sensititre YeastOne method. High minimum inhibitory concentrations (MICs) were found with
fluconazole,
caspofungin,
flucytosine, and
amphotericin B.
Voriconazole and
posaconazole were found to be active against all species tested. Of the species included in the investigation, MICs of Medicopsis romeroi differed from the rest of the
mycetoma causative agents belonging to the order of the Pleosporales. We found significantly lower MICs for
amphotericin B and significantly higher MICs for
fluconazole,
ketoconazole, and
itraconazole against this species. Our results emphasised that identification of black grain
mycetoma agent is important as well as performing susceptibility testing before starting of antifungal treatment.