Molecular diversity among clinical isolates of Madurella mycetomatis, the prime fungal agent of human mycetoma in Sudan, could possibly explain the diverse clinical presentations of this severely debilitating infectious disease. In addition, culture-independent DNA-mediated typing tests need to be developed for this organism, since M. mycetomatis DNA, but not the organism itself, can be identified in soil, the material from which infections are thought to originate. A collection of 38 different clinical M. mycetomatis isolates was characterized by large-scale random amplification of polymorphic DNA using 20 different primer species. These analyses, involving at least 2,600 annealing sites, showed a complete lack of DNA fingerprint variation among the various isolates. From the resulting homogeneous DNA fingerprints, seven fragments were cloned and sequenced, and novel, species-specific PCR restriction fragment length polymorphism (RFLP) tests were designed. The seven PCR RFLP tests were successfully performed on the 38 different M. mycetomatis strains. However, again all M. mycetomatis DNA patterns obtained appeared to be identical, whereas patterns produced using DNAs from other fungal species were clearly discriminatory. These results suggest that there is little genetic variation among clinically relevant M. mycetomatis strains from Sudan. The data tentatively imply that different manifestations of mycetoma are due to differences in host susceptibility rather than differential virulence of the causative agent.Mycetoma presents as a chronic, relatively painless, subcutaneous granulomatous lesion which is characterized by the formation of multiple sinuses. In ϳ40% of all infections, a fungus is the causative agent, the sclerotia of which are shed through these sinuses in the form of fungal grains (10, 13). The color of these grains has diagnostic value. Green grains identify Aspergillus flavus as the most likely causative agent, whereas white grains are usually produced by Pseudallescheria boydii, Aspergillus nidulans, or Acremonium kiliense. Brownish grains are produced by Neotestudina rosatii, while deep-black grains are produced by species such as Curvularia lunata, Exophiala jeanselmei, Pyrenochaeta romeroi, Leptosphaeria senegalensis, Madurella grisea, and Madurella mycetomatis. The last fungus is the most prevalent mycetoma agent in Sudan (10). Although this agent has been shown to occur in various geographic regions, most cases of M. mycetomatis mycetoma occur in a relatively comprehensive "mycetoma belt" (1). The precise mechanism of infection remains enigmatic, but it is frequently suggested that traumatic inoculation of fungus-containing soil, assisted by the presence of plant materials such as thorns, provides a likely route of inoculation (10,11,13,19). However, successful cultivation of the organism from soil has been documented only sparsely, although recent molecular detection has revealed that fungal DNA can be detected quite easily in soils from different regions in the mycetoma belt (1). Becau...