Mycetoma management and clinical outcomes: the Mycetoma Research Center experience

Abstract

Background Mycetoma is a chronic granulomatous inflammatory disease that affects the cutaneous and subcutaneous tissues, leading to gruesome complications if not treated early. As a neglected disease, it has received scant attention in developing curable drugs. Mycetoma treatment is still based on expert opinions in the absence of guidelines. Methods This descriptive, cross-sectional, hospital-based study aimed to determine and assess the disease treatment outcomes observed at Mycetoma Research Center, Sudan. Results In this study, 75% of patients had eumycetoma, all of whom were treated with itraconazole and 37.4% underwent surgical excision, while 25% of the patients had actinomycetoma, 99.2% of whom were treated with a combination of cotrimoxazole and amoxicillin-clavulanate. The cure rate was 12.7% and 14.3% for patients with eumycetoma and actinomycetoma, respectively. Only 6.1% of eumycetoma patients underwent amputation. Remarkably, no patient with actinomycetoma underwent an amputation. Small lesions (OR=10.09, p<0.001) and good follow-up (OR=6.81, p=0.002) were positive predictors of complete cure. In terms of amputation, history of surgical recurrence at presentation (OR=3.67, p=0.020) and presence of grains (OR=7.13, p=0.012) were positive predictors, whereas small lesions were negative predictors (OR=0.06, p=0.009). Conclusions Treatment of mycetoma was suboptimal, with a low cure rate despite a long treatment duration. Complete cure has a significant association with small lesions and good follow-up.

Actinomycetoma Treated with Oral Trimethoprim + Sulfamethoxazole and Amoxicillin with Clavulanic Acid: A Case Report

“…The oldest description of this disease dates back to the ancient Indian Sanskrit text Atharva Veda in which reference is made to padavalmikam, meaning "anthill foot" (5) In modern times , Mycetoma was first reported in 1842 by Dr. John Gill in Madurai, India in Army medical reports and it was Colebrook in 1844 who described it as Madura foot which was what the disease was known as in those areas. This was later termed as mycetoma by Vandyke carter in 1860.It was Rustomjee in 1860 who described the two variants of disease , with black & yellow granules respectively.…”

“…Patient was started on oral Sulfamethoxazole 800mg with Trimethoprim 160mg two tablets daily for 4months with oral Amoxicillin with clavulanic acid 1gm twice daily for 4months. (5) Other IV antibiotics like rifampicin, amikacin, linezolid and Traditional welsh regimen was not given as patient had altered renal parameters and uncontrolled T2DM with high risk of nephrotoxicity & ototoxicity. Patient showed excellent response with healing of all sinuses after two months of therapy.…”

Public Health Research Priorities for Fungal Diseases: A Multidisciplinary Approach to Save Lives

“…Lateral flow antigen assays, a serologic diagnostic test to differentiate actinomycetoma from eumycetoma, or modifications to molecular techniques to make them more readily available at health outposts could transform mycetoma diagnostics [ 97 ]. Treatment for mycetoma is often long and unsuccessful; side effects from the frequently used itraconazole impact patient adherence [ 98 ]. Research into shorter, safer, more effective treatments and regimens is necessary to reduce the morbidity caused by mycetoma.…”

The use of artificial intelligence to improve mycetoma management

“…The available diagnostic tests are invasive, time-consuming, of low sensitivity and specificity, and there is no point of care [15][16][17]. Furthermore, the available treatment of mycetoma is suboptimal, characterised by a low cure rate and high recurrence and follow-up rates, and the disease remains with patients for a while, if not for life [18,19].Artificial intelligence (AI) continues evolving swiftly, with ongoing research and development in various domains. It can potentially bring about significant advancements in science, technology, and society.…”

“…The available diagnostic tests are invasive, time-consuming, of low sensitivity and specificity, and there is no point of care [15][16][17]. Furthermore, the available treatment of mycetoma is suboptimal, characterised by a low cure rate and high recurrence and follow-up rates, and the disease remains with patients for a while, if not for life [18,19].…”