A third or perhaps fourth case of Madura Foot, caused by a species of Actinomyces, is described in a man who never left the United States. It is about the fortieth case of Madura Foot if cases caused by true fungi are included. A great number are probably never recognized but are treated as chronic osteomyelitis, sarcoma tuberculosis or syphilis. The writer knows three such cases, where the diagnosis was made following amputation. Treatment with penicillin and sodium propionate had no effect whatsoever, but sulfadiazine showed a fungistatic action, beginning with the disappearance of the fever and developing into a clinical cure.
The author's conclusion is that, from now on, every case of Actinomyces Madura Foot should be treated with doses of sulfonamides, sufficient to produce blood-levels of about 8 mgm. per cent, during at least three weeks and, if necessary, with repeated courses of this therapy. Advice to amputate the member should never be given before this is seriously tried. Because of the great similarity of the clinical picture of the cases of Madura Foot caused by Actinomyces and those caused by true fungi, the benefit of a trial with all the precautions mentioned above, should be given to every patient suffering from Madura Foot.
P.S. In July 1945 the old-patient came, on my request, in my office for controle. It was more than one year after his discharge. The foot showed a complete clinical cure. The man does all his heavy work as before the disease.