In many endemic areas, due to diagnostic facilities scarcity, the disease diagnosis is often made clinically only, a practice, which may lead to the administration of inappropriate management.
The proper diagnosis of mycetoma necessitate the accurate identification of causative organism and the disease extent. Various diagnostic tools are available for precise organism’s identification and that includes the classical grain culture, histopathological and cytopathological techniques, serodiagnosis as ELISA and CIE and molecular techniques such as PCR. For the disease, extent numerous imaging techniques such as radiography, ultrasonography, CT, MRI are in use. It is interesting to note most of these techniques are not available in majority of mycetoma endemic regions.
Presently in endemic areas, it is recommended for diagnosis to start with lesion ultrasound examination and fine needle aspiration for cytology and cell blocks to identify the causative organism; in cases where this is, not successful deep surgical biopsy is carried out for histological and mycological identification. For massive lesion, radiography and MRI are mandatory to determine the disease extent. Molecular and phenotyping are only done in highly specialized laboratories