Eumycetoma Medical Treatment: Past, Current Practice, Latest Advances and Perspectives

Abstract

Mycetoma is a neglected tropical disease that is associated with poor communities and socioeconomically impaired individuals in the tropical and sub-tropical areas. Interestingly, the disease is caused by either bacteria (actinomycetoma) or fungus (eumycetoma). The latter form of the disease, eumycetoma, is the most common type in Africa. Eumycetoma is characterized by a prolonged disease duration and low cure rate. The effective case management of eumycetoma largely depends on the accurate diagnosis and identification of the causative agent to the species level and evaluating its susceptibility to the available drugs. This review summarizes the currently available and used antifungal agents for the treatment of eumycetoma and discusses optimizing the newly developed antifungals as a potential second line for eumycetoma treatment.

Eumycetoma with pulmonary dissemination an unusual complication: Case series and literature review

“…A medical literature search revealed only 3 reports on the pulmonary mycetoma spread, and, interestingly, all of them were of knee eumycetoma origin [ 9 , 10 ]. Distant spread is not a frequent characteristic of eumycetoma, whereas, in actinomycetoma, that is common [ 11 ].…”

Clinical Manifestations of Human Exposure to Fungi

“…Caused by more than 30 fungal species, it is characterized by lengthy disease duration and low recovery rate. Case management relies on an accurate diagnosis by adequately identifying the causative agent and evaluating its susceptibility to the available drugs [ 191 ]. The most common etiological agents of eumycetoma include Madurella mycetomatis (>70% of the cases), Microsporum grisea , Pseudallescheria boydii , Leptosphaeria senegalensis , C. lunata , Scedosporium apiospermum , Neotestudina rosatii , Acremonium spp., and Fusarium spp.…”

“…Eumycetoma treatment includes the use of oral antifungal medication (i.e., itraconazole, ketoconazole, lanoconazole, luliconazole, posaconazole, ravuconazole, voriconazole). Nevertheless, more complex and incontrollable cases may require surgery and amputation [ 191 , 192 , 193 ]. Several phytotherapeutic alternatives, such as Acacia nubica , Nigella sativa , Boswellia papyrifera , Melaleuca alternifolia , Moringa oleifera , Zingiber officinalis , Piper nigrum , Eugenia caryophillus , and Cinnamomum verum , have been suggested, with positive effects on the treatment of this disease [ 194 ].…”

Using a Madurella mycetomatis‐specific PCR on grains obtained via non‐invasive fine‐needle aspirated material is more accurate than cytology

“…Furthermore, differences in susceptibility towards several standard drugs are recorded 2 . Therefore, accurate identification of the causative agent is crucial for proper case management 3,4 …”