Fig 1. identification of the causative agents: All culture, histopathological and cytological identification reports of patients seen between January 1991 and January 2018 in the Mycetoma Research Centre were retrieved from our electronic database.

Of these patients in 2202 cases no microbiological report was available, of 1853 cases no histopathological report was available and in 2894 cases no cytological report was available leaving 991 mycetoma cases which met our inclusion criteria. The culture identification was considered the golden standard. Of these patients 750 cases were caused by M. mycetomatis, 142 cases by S. somaliensis, 71 were caused by A. madurae and 12 by A. pelletieri. From these cases the histological and cytological reports were compared to the culture results. A histological report or cytological report was either identical to the culture identification or negative. Results for both histology and cytology reports are shown.