Journal of Experimental Agriculture International

Cushion gall disease threatens cacao production by disrupting tissues associated with flowering, yet its epidemiological importance is difficult to assess because symptom terminology, pathogen identification and estimates of damage are inconsistent. This critical narrative review evaluates literature published through 29 July 2026, integrating historical disease investigations with research on fungal taxonomy, cacao development, endophytes, agroecology and disease management. The evidence supports a longstanding association between gall formation and particular isolates identified as Fusarium decemcellulare, historically linked to Albonectria rigidiuscula. It does not establish that every gall phenotype, fungal isolate or newly reported symptomatic plantation represents the same causal process. Experimental gall induction provides stronger evidence than isolation alone, but seedling bioassays cannot automatically explain disease in mature flower cushions. Mixed fungal recovery further complicates attribution, while sequence-based identification and pathogenicity remain separate requirements. Reports from additional production regions justify diagnostic surveillance; they do not, without comparable longitudinal observations and aetiological confirmation, demonstrate a geographically expanding epidemic. Major uncertainties concern transmission, the contribution of host genotype and microclimate, and the relationship between symptomatic cushions and marketable bean yield. Evidence from other cacao diseases supports investigation of sanitation, host resistance and biological control, but cannot substantiate gall-specific efficacy. A decision framework is proposed that separates symptom recognition, organism identity, causal confirmation and economic consequence. Immediate priorities are standardised case definitions, linked culture and sequence collections, repeated measurements of cushion function and yield, and controlled tests of plausible transmission routes. Longer-term priorities include multi-location resistance screening and management trials that account for labour, reproductive tissue damage and environmental trade-offs. Cushion gall is best treated as an under-characterised reproductive disease requiring proportionate precaution and stronger causal evidence, rather than as either a proven global epidemic or an inconsequential anomaly.