Symptoms, transmission, and current treatments for mycetoma
What is mycetoma?
Mycetoma is a chronic slow-growing infection which comes in either bacterial (actinomycetoma) or fungal (eumycetoma) form. This highly neglected disease is not well understood or widely studied. Infection begins most often in the foot, probably after a cut allows the bacteria or fungus to enter from the soil or animal dung, and it can spread to other parts of the body. It slowly, progressively, and initially painlessly, destroys subcutaneous tissues. Mycetoma affects skin, muscle and bone, causing severe disability.
The current treatments for fungal mycetoma is difficult to administer making adherence low, and amputation is common when infection is severe or treatment fails. But even so, there is a high chance of recurrence. Disfigurement and disability can lead to stigma and social discrimination, placing a heavy burden on communities and health services in affected areas. Children and young adults are particularly at risk.
What is the impact of mycetoma?
- basic epidemiological information is lacking and the overall global burden is unknown
- occurs most often in the so-called ‘mycetoma belt’ between latitudes 15° S and 30° N
- the ‘mycetoma belt’ is characterized by a hot, dry climate with a short, heavy rainy season
- approximately 40% of mycetoma cases worldwide are fungal
- fungal mycetoma has a cure rate of only 80% with current treatments if patients take the full course of treatment but can be as low as 35% due to difficulty in treatment.
What are current treatments for mycetoma?
Fungal mycetoma is treated with antifungal drugs and then removal of the remaining infected area. Amputation is common.
Antifungal drugs used to treat mycetoma are:
- only 25-35% effective in the field and 80% effective if patients take the full course of treatment
- administered for 12 months
- unsafe with many side effects
- too expensive for people with the disease
- not available in areas where the disease is found
There is a >90% cure rate for bacterial mycetoma using a combination of antibiotics.
What new treatments for mycetoma are needed?
There is a desperate need for an effective, safe, affordable, and shorter-term treatment for fungal mycetoma that can be used in rural areas.
What mycetoma treatments are we working on?
We aim to develop an effective, safe, affordable, and simpler treatment.
Find out about our work developing treatments for mycetoma
How do you get mycetoma?
- infection enters the body through cuts or a penetrating injury, commonly thorn pricks
- manual workers and people who walk barefoot are most at risk
- mycetoma cannot be transmitted from person to person
What are the symptoms of mycetoma?
Mycetoma usually progresses slowly.
- starts with a painless lump under the skin
- progresses to open infection discharging small ‘grains’ containing fungal spores
- causes swollen, disfigured body parts – most commonly hands and feet, back, and buttocks
- deteriorates into a chronic condition as mycetoma spreads to the skin, deep tissue and bone, resulting in destruction, deformity, and loss of function
Bacterial infection is also common, which may cause increased pain, disability, and fatal septicaemia if untreated.
Many people with mycetoma become depressed and need psychological support.
How is mycetoma diagnosed?
Mycetoma can be identified by directly examining discharged ‘grains’ of fungal spores under a microscope, but further tests are needed to confirm the diagnosis. There are no simple diagnostic tests to use in villages, requiring patients to travel to referral hospitals for diagnosis, which may include biopsy and x-ray or ultrasound. The earlier the infection is detected, the better the chance there is of curing it, so a simple, effective diagnostic test is urgently needed.
Last updated: November 2023
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