What is Mycetoma?

Mycetoma (also known as Madura foot / maduromycosis / maduramycosis) is a slow-growing bacterial or fungal infection. It has two different forms:

  • Actinomycetoma – a bacterial infection with a >90% cure rate using antibiotics
  • Eumycetoma – a fungal infection with a 35% cure rate with antifungals and surgery

Approximately 40% of mycetoma cases worldwide are eumycotic.

Impact

The absence of surveillance systems and remoteness of affected populations means that basic epidemiological information is lacking. Mycetoma can be devastating, developing into a chronic infection of the skin tissues and, if left untreated, eventually resulting in amputation. Children and young adults are particularly at risk. Disfigurement and disability can lead to stigma and social discrimination.

Geography

Mycetoma is endemic in tropical and subtropical regions, in particular across a swathe of Central Africa (including Chad, Ethiopia, Mauritania, Sudan, Senegal and Somalia), as well as in Mexico, India and Yemen. The ‘mycetoma belt’ is characterized by a hot, dry climate with a short, heavy rainy season.

Transmission

There are currently no comprehensive studies available in order to have a definitive theory about the route of transmission. The infection may come from the soil or animal dung, and it is thought that it enters the body after the skin has been pricked (e.g. by a thorn).

Symptoms

Most commonly feet become very swollen and disfigured. This slow-growing disease causes little pain and consequently people delay seeking treatment until the disease has reached the later stages, when amputation is often necessary. Reversal of the symptoms is rare, and if untreated, it will gradually deteriorate into a serious chronic condition, which can be fatal.

Patient treatment needs

Actinomycetoma (bacterial form) has a 90% cure rate while the eumycetoma (fungal form) cure rate is only 25-35%. The current treatment for eumycetoma consists of antifungals, most often followed by removal of the remaining mass, again followed by antifungals as recurrence is very common. Often amputation is needed in the absence of other treatment options. The current treatment is neither safe, nor effective, nor affordable. The median treatment duration is 12 months, and with a cost of approximately 30 USD per month, it is beyond the means of many local people. An effective, safe, affordable and shorter-term curative treatment, which is appropriate for rural settings is desperately needed.

Research

There is little research on this very neglected disease, but PLOS has released a collection on Mycetoma.

Fact sheet

mycetoma_factsheet_ar_2015_cover

DNDi Mycetoma Fact Sheet