Mycetoma: a clinical dilemma in resource limited settings

Abstract

BackgroundMycetoma is a chronic mutilating disease of the skin and the underlying tissues caused by fungi or bacteria. Although recently included in the list of neglected tropical diseases by the World Health Organization, strategic control and preventive measures are yet to be outlined. Thus, it continues to pose huge public health threat in many tropical and sub-tropical countries. If not detected and managed early, it results into gruesome deformity of the limbs. Its low report and lack of familiarity may predispose patients to misdiagnosis and delayed treatment initiation. More so in situation where diagnostic tools are limited or unavailable, little or no option is left but to clinically diagnose these patients. Therefore, an overview of clinical course of mycetoma, a suggested diagnostic algorithm and proposed use of materials that cover the exposed susceptible parts of the body during labour may assist in the prevention and improvement of its management. Furthermore, early reporting which should be encouraged through formal and informal education and sensitization is strongly suggested.Main textAn overview of the clinical presentation of mycetoma in the early and late phases, clues to distinguish eumycetoma from actinomycetoma in the field and the laboratory, differential diagnosis and a suggested diagnostic algorithm that may be useful in making diagnosis amidst the differential diagnosis of mycetoma is given. Additionally, a proposed preventive measures which may be helpful in the community is also provided. Since treatment is currently based on expert opinion, we encourage active research to establish treatment guideline for it.ConclusionSince delay in visiting health facility results into gruesome complication, early presentation, recognition and initiation of appropriate choice of regimen is helpful in reducing complications. The clinical overview of mycetoma and the suggested algorithm may enhance suspicion and possibly increase recognition of mycetoma in the community and further guide in differentiation of eumycetoma from actinomycetoma. There is an urgent need for research funding for mycetoma, a disease plagued by severe physical disabilities and social stigma leading to isolation.Electronic supplementary materialThe online version of this article (10.1186/s12941-018-0287-4) contains supplementary material, which is available to authorized users.

Epidemiological profile and spectrum of neglected tropical disease eumycetoma from Delhi, North India

“…Abbas et al ., evaluated the disabling consequences of mycetoma and clear areas for intervention and further research were assessed [33]. Inclusion of mycetoma in 2016 to WHO's official list of neglected tropical disease, is a crucial step for national and global responses for addressing mycetoma, although strategic control and preventive measures are yet to be outlined [32]. …”

Madurella real-time PCR, a novel approach for eumycetoma diagnosis

“…Both positive and negative biopsies were cultured on Sabouraud's Glucose Agar (SGA) and the identity of the isolates was established by ITS sequencing. These clinical samples were retrospectively collected and in a context of a blind test set they were assigned with numerical code numbers (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The assessor of the qPCR assay was not aware of the identity of DNA samples (for both DNA samples derived from pure cultures and those obtained from clinical samples).…”

“…In the presence of classical clinical features, i. e. sinuses in the skin and grain discharge, mycetoma can easily be recognized from other skin diseases, while proper diagnosis with identification of the etiologic agent requires a combination of diagnostic tools. Imaging, cytology, and histology are used to confirm the clinical diagnosis and to establish the extent and the nature of the agent, which is either a bacterium (actinomycetoma) or a fungus (eumycetoma) [4,5]. However, due to the insufficient specificity, these methods do not allow conclusive diagnosis for which accurate identification of the causative pathogen is required [4].…”

Role of surgery in the management of mycetoma foot

“…The affected area will become edematous, hyperpigmented and once the bone is involved it will lead to deformity. 8 Most commonly foot is involved but actinomycetoma can occur in cervicothoracic region, abdominal wall and perineum. The classic clinical trial of mycetoma is painless soft tissue swelling, draining sinuses and extrusion of grains.…”

“…Bone involvement was noted in 50% of the patients as described due to the natural pathogenesis of the disease which can spread deeply into fascial planes and can involve bone. 8 If not diagnosed early, it can lead to permanent deformity due to extensive bone involvement. All studied patients had diagnosis confirmed with histopathological and microbiological examination of tissues either following biopsy or debridement.…”