This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Microbiology
A farmer presents with multiple discharging sinuses in the leg not responding to antibiotics. Most likely diagnosis is - 
Select and explain. 
A. Madurella, B. Actinomycetoma, C. Nocardia, D. Sporothrix
A: Madurella
Answer: A: Madurella 
Explanation: Multiple discharging sinuses not responding to antibiotics suggest the diagnosis of mycetoma.


Actinomycetoma may respond to antibiotic therapy. eg. combination of streptomycin and dapsone or combination of streptomycin and trimethoprim-sulfamethoxazole.
Actinomycetoma is caused by Actinomadura, Nocardia and Streptomyces.
Eumycetoma rarely responds to antibiotics, some cases caused by madurella mycetoma have appeared to respond to ketoconazole or itraconazole.