Mycoses 2016; 1–7 wileyonlinelibrary.com/journal/myc | 1 © 2016 Blackwell Verlag GmbH Received: 22 May 2016 | Revised: 21 September 2016 | Accepted: 24 September 2016 DOI: 10.1111/myc.12579 Summary Mycetoma is a chronic granulomatous, subcutaneous disease endemic in tropical and subtropical countries. It is currently a health problem in rural areas of Africa, Asia and South America. Nine cases of mycetoma were analysed in a retrospecive study. All isolates were ideniied by morphological features. The level of species ideniicaion was reached by molecular tools. Deiniive ideniicaion of fungi was performed using sequence analysis of the ITS of the ribosomal DNA region and the ribosomal large- subunit D1/D2. Ideniicaion of acinomycetes was accomplished by the 16S rRNA gene sequence. Six unusual clinical isolates were ideniied: Aspergillus ustus, Cyphellophora oxyspora, Exophiala oligosperma, Madurella pseudomycetomais, Nocardia farcinica and Nocardia wallacei. The prevalence of mycetoma in Venezuela remains unknown. This study represents the irst report in the literature of mycetoma caused by unusual pathogens ideniied by molecular techniques. KEYWORDS Molecular ideniicaion, Mycetoma, Unusual pathogens, Venezuela 1 Departamento de Ciencias Básicas, División de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León, Mexico 2 Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico Correspondence Dr Gloria M. González, Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico. Email: gmglez@yahoo.com.mx Funding informaion Vicerrectoría Académica of the Universidad de Monterrey ORIGINAL ARTICLE Molecular ideniicaion of unusual Mycetoma agents isolated from paients in Venezuela Olga C. Rojas 1,2 | Rafael B. R. León-Cachón 1 | Maria Moreno-Treviño 1 | Gloria M. González 2 1 | INTRODUCTION Mycetoma is a neglected, granulomatous, chronic, subcutaneous infec- ion of tropical and subtropical countries. Sudan appears to have the highest number of cases per capita of any country in the world. 1,2 Most cases of mycetoma occur in India, Mexico, Sudan and Venezuela, 3–5 al- though there are reported cases in other countries such as Argenina, Brazil, Iran and Somalia. 6–10 Sporadic cases have also been reported in countries with mild weather. 11 In Venezuela few cases of myce- toma have been reported in the literature. This country is located on the northern coast of South America, at laitudes deined as the “mycetoma belt”, between laitudes 15° South and 30° North around Tropic of Cancer. This region has low humidity and a low annual rain- fall with well-deined alternaing rainy and dry seasons. 5,12,13 Not all evidence of mycetoma has been reported in the literature. Mycetoma is characterised by the formaion of a tumour-like swelling with drain- ing sinuses that expel grains. The size, consistency and colour of the grain deine the aeiological agent, which can be bacterial or fungal. Distribuion is not equal around the world; in Lain America mycetoma is usually caused by acinomycetes in comparison to Africa, which has a higher incidence of eumycetoma. It is important to highlight that the distribuion of the aeiological agents can difer even in the same re- gions of a country. 3 It is important to difereniate bacterial and fungal aeiological agents because therapy difers with each form. Based on colour of the grains, acinomycetes produce sot, white, yellow or red grains, whereas, eumycetoma produce grains that are black or white, with the later being less in proporion. Grain colour is an easy method for making an iniial aeiological classiicaion; however, a 60-year-old paient from Sudan presented a yellow-grain mycetoma that was ini- ially treated as an acinomycetoma and ater a lack of response it was recognised that a new fungal agent, Pleurostomophora ochracea, was the cause. 14 As both, acinomycetes and fungi, are implicated as causaive agents, it is important to disinguish them to ensure that correct treatment is given. Acinomycetoma is treated with anibioics, and eumycetoma with a combinaion of anifungals and surgery. 4,15 Although mycetoma can be diagnosed clinically, this is not conclusive