Amphotericin B but not itraconazole is able to prevent grain formation in experimental Madurella mycetomatis mycetoma in mice

DEAR EDITOR,
Eumycetoma is a chronic, granulomatous infectious disease which is characterized by the formation of large subcutaneous masses and the production of grains. The most common causative agent is the fungus Madurella mycetomatis. Treatment for eumycetoma is disappointing. It needs a combination of antifungal therapy and surgery. The current antifungal agent used for treating eumycetoma is itraconazole (ITZ), because in 2013 the use of ketoconazole was restricted. Unfortunately with this treatment recurrent infections are common and for many patients amputation is unavoidable. Therefore more potent drugs and model systems for mycetoma to predict treatment efficacy are urgently needed. Here we used a previously developed eumycetoma mouse model to determine if there is a correlation between the in vitro activity and the in vivo efficacy of ITZ and amphotericin B (AMB), representing two different classes of antifungal agents to which M. mycetomatis is susceptible. [...]