Clinical Features of Mycetoma and the Appropriate Treatment Options

Abstract

Mycetoma is a chronic, suppurative and debilitating granulomatous infection seen mainly in tropical and subtropical areas and is now declared as a neglected tropical disease by the World Health Organization. The clinical diagnosis is usually characterized by a classical triad of localized swelling, underlying sinus tracts, and production of grains or granules, but unusual presentations are also seen. It is classified into eumycetoma caused by the fungus, and actinomycetoma caused by the bacteria. The clinical presentation of both is almost similar and a definite diagnosis is essential before starting the treatment as it differs for both. Surgical debulking followed by a prolonged course of medical therapy now forms the mainstay of treatment due to the long course of the disease and suboptimal response. This review focuses on the various usual as well as unusual clinical presentations of mycetoma, established treatment regimens as well as recent changes in the mode of administration of drugs and newer drugs for mycetoma.

Reporting of mycetoma cases from skin and soft tissue biopsies over a period of ten years: A single center report and literature review from Pakistan

“…Consequently, these body parts are at higher risk to traumatic inoculation especially feet. These findings are consistent with the available data [ 21 – 23 ], as living and working conditions are similar across the tropical world where this disease is endemic.…”

Eumycotic mycetoma involving the right foot: A new Tunisian case

“…Combination of more than one drug is preferred to increase the response and prevent the development of resistance. 15 Actinomycetoma is commonly treated with an association of trimethoprim and sulfamethoxazole with aminosids (amikacin or netilmicin), for weeks. 2 Some existing reports indicate to prolong antibiotics until 5–6 months after complete healing of all sinuses.…”

Mycetoma: Development of Diagnosis and Treatment

“…Treatments for eumycetoma and actinomycetoma are different [ 8 ]. Eumycetoma is treated with antifungal agents in combination with surgical excision, whereas actinomycetoma is treated with antibacterial agents.…”

“…No specific antifungal medications have been developed for eumycetoma. Currently, recommended agents for eumycetoma include itraconazole (400 mg daily or 200 mg twice daily) [ 8 ], voriconazole (400 mg daily) [ 65 , 66 ], posaconazole (800 mg daily) [ 67 ], and terbinafine [ 68 ], individually or in combination. Ravuconazole was recently shown to be effective against M. mycetomatis in an in vitro study [ 33 ].…”

“…Typically, mycetoma presents as a triad of painless subcutaneous tumor-like swelling, multiple sinuses and fistulas, and discharged grains in pus [ 7 ]. If untreated, the pathogens can spread through muscular fascial spaces, or lymphatics, into muscles and bones, and lead to severe consequences including disfiguration, deformity, disability, amputation, and even death [ 8 , 9 ], as well as causing heavy economic and medical burdens to social communities [ 3 , 9 , 10 ].…”