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The recognition of Mycetoma: much needed attention finally given to long neglected tropical disease (NTD)

At the risk of sounding naïve, I’m going to tell you that I had never heard of mycetoma – although a quick google search revealed images resembling elephantiasis. As a student studying global health, I was a little disappointed with myself; I mean I have at least heard of the other neglected tropical diseases (NTDs). But if mycetoma was unfamiliar to me, how many other people had never heard of this disease?

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Featured

  Mycetoma – a long journey out of the shadows

Mycetoma is an important disease that affects the poorest of communities, and which has, for a long time, received little scientific or clinical attention. In part, this has been due to the fact that it is only prevalent in certain countries or in specific regions of countries; also, its progression is slow, it is not painful and managing the disease does not form a major part of the training of frontline health workers. The goal of reducing the use of, and eliminating the need for, amputation is an important target.

 Cheap over-the-counter nail drug found to work on crippling flesh-eating disease

‘Momentous’ breakthrough as trial finds treatment for nail infections to be highly effective for neglected tropical disease. A cheap and easily taken drug used to treat fungal nail infections has been found to work against a devastating flesh and bone-eating disease found across Africa, Asia and the Americas. Researchers say the breakthrough offers hope to thousands of patients who have suffered decades of neglect and can face amputations if the disease is left untreated. Results of the clinical trial for a new treatment for mycetoma, which took place in Sudan, have shown that the oral drug fosravuconazole is up to 85% effective and has no side-effects.

 My journey with Mycetoma

The fact is that mycetoma is a neglected disease, the patients are of low socioeconomic status, of low health education, of low visibility, with no voice. They frequently present late with advanced disease. These factors led to a high level of disinterest in mycetoma globally, and no support was offered to the MRC. This made my endeavour to find a cure feel all the more important and meaningful. At that time, there was only one drug for treating eumycetoma; ketoconazole. It was ineffective, expansive, toxic and not accessible. The treatment required long-term care and multiple trips to the centre. Amputation, which is a social stigma in the country, was the only available treatment for many patients with advanced disease.

Articles of Interest

A Disease So Neglected It's Not Even On 'Most-Neglected' Lists

Mycetoma is as disabling as it is putrid. This much has been known for centuries. When the English physician Philip Manson described mycetoma in his seminal textbook from the 1950s, Manson's Tropical Diseases, he wrote that patients' limbs sprout "warty outgrowths resembling barnacles," and those tumors, dissected, contain strands "resembling the excrement of earthworms."

Clinical Features of Mycetoma and the Appropriate Treatment Options

Recently, World Health Organization (WHO) has recognized mycetoma to be a “neglected tropical disease” as the disease has not received much attention despite the great medical and financial burden. The various nomenclatures include “Anthill foot” and “Madura foot”. It was only when the etiology was confirmed to be fungal, the word “mycetoma” was proposed by Carter. Later when both bacterial and fungal organisms were found to be causing mycetoma, the formal classification into Maduramycosis and Actinomycosis was recognized.

Eumycetoma

Mycetoma is characterized by a progressive and chronic granulomatous infection affecting the skin and subcutaneous tissue. Mycetoma can be classified as "eumycetoma" when it is caused by fungi or "actinomycetoma" when caused by bacteria in the order Actinomycetes. Therefore, eumycetoma is a deep fungal infection of the skin and subcutaneous tissue commonly caused by the filamentous fungi Madurella mycetomatis.

Have you heard of Mycetoma?

Mycetoma characterised by chronic granulomatous inflammatory disease, is one of the most neglected diseases. It is so neglected that estimates of incidence and prevalence are not accurate (WHO). Mycetoma caused by bacteria and fungi are termed actinomycetoma and eumycetoma, respectively. Clinically, mycetoma presents as a slow growing tumour-like structure with grains that contain the causative agent.

Mycetoma: An Update

Mycetoma is a localized chronic, suppurative, and deforming granulomatous infection seen in tropical and subtropical areas. It is a disorder of subcutaneous tissue, skin and bones, mainly of feet, characterized by a triad of localized swelling, underlying sinus tracts, and production of grains or granules. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is entirely different, a definite diagnosis after histopathological and microbiological examination is mandatory, though difficult.

Mycetoma: Development of Diagnosis and Treatment

With the aim to raise the awareness of clinicians about mycetoma, especially dermatologists and podiatrists, we update the development of the epidemiology, etiology, clinical presentations, pathogenesis, diagnosis, differential diagnosis, and treatment of mycetoma.

Mycetoma: reviewing a neglected disease

Mycetoma caused by either filamentous fungi (eumycotic) or bacteria (actinomycotic) has recently been recognized by the World Health Organization as a neglected tropical disease. Although mycetoma is preventable and treatable, especially in the early stages, it carries high morbidity and a huge socioeconomic burden.

Mycetoma: The Spectrum of Clinical Presentation

This paper describes the clinical features of mycetoma, as early recognition is a key to early diagnosis and the institution of appropriate treatment including surgery. Because these lesions are mostly painless and the majority of infected individuals present late and with advanced disease, simplifying early recognition is an important public health goal.

The disabling consequences of Mycetoma

Mycetoma is a neglected tropical disease endemic in tropical and subtropical countries, particularly Sudan. The disease is characterised by the triad of painless subcutaneous mass, multiple sinuses and discharge that contain grains. It is a chronic, debilitating disease most commonly affecting the feet or hands and leads to substantial morbidity, loss of function and even amputation. It predominantly affects poor, rural populations and patients typically present late with advanced disease and complications.

The Healthy Diet For Mycetoma Patients

Mycetoma is a chronic, neglected tropical disease caused by certain types of bacteria and fungi found in soil and water. These organisms may enter the body through a break in the skin, often on a person’s foot. It appears clinically as a small painless subcutaneous mass that grows slowly, and then multiple oozing sores discharging purulent fluid-containing grains develop. It spreads to affect the skin, deep structures and bone leading to massive tissue destruction, deformities and disability. The disease treatment duration is long and has many side effects hence, nutrition support is mandatory. Several nutrients play important roles in mycetoma wound healing and response to treatment.

Unravelling the challenges of mycetoma: a case series highlighting diagnostic dilemmas and therapeutic triumphs

It commonly affects men, farmers and field workers. Differentiating eumycetoma from actinomycetoma can be challenging but is required before starting prolonged treatment.

What is mycetoma?

Current treatments for fungal mycetoma are difficult to administer, often unaffordable, and difficult to access. Treatment takes many months and is not always effective. Often, amputation is the only option to stop progression of the disease. Even after amputation, there is a high chance of recurrence. The disfigurement and disability caused by mycetoma can lead to social stigma, discrimination, and mental health challenges. The disease places a heavy burden on communities and health services in affected areas. Children and young adults are most at risk.

Why Mycetoma? Q&A with Annie Liang and Simran Dhunna

In this Q&A, they share the moment they learned about mycetoma, and what motivated them to find a way to make the world care about this neglected disease.

Resources

InfoNTDs

Mycetoma is a unique neglected tropical disease. It is a morbid chronic progressive inflammatory condition caused by certain fungi (eumycetoma) or bacteria (actinomycetoma). It is characterised by devastating distortions, disabilities, high morbidity and it has various negative impacts in term of health and socio-economically on patients, communities and health authorities.

Mycetoma Research Center

The Mycetoma Research Centre (MRC), established in 1991 under the auspices of the University of Khartoum, has gained global recognition as a preeminent authority dedicated to mycetoma management, research and community engagement.

Mycetoma Young Researchers Association

MYRA aims to encourage young researchers to participate and take part in the mycetoma research field.

Doctor Fungus

Mycetomas caused by fungi are usually resistant to chemotherapy, although anecdotal reports of response to long-term therapy with ketoconazole has been appeared. Surgical debridement may be necessary, and amputation is sometimes the final step.

Avens

Treatment of eumycetoma remains problematic. In the treatment of mycetoma, antibiotic or antifungal therapy should be attempted first and may need to be combined with surgery, especially for eumycetoma lesions in the extremities. External beam radiotherapy in doses ranging from 3.5-14 Gy has been considered successful treatment in a few selected cases.

CDC

Mycetoma causes painless masses underneath the skin. Most cases occur in equatorial regions of Africa, Latin America, and Asia known as the “mycetoma belt." It is more common among men than women and farmwork increases risk.