LAUSR

Mycetoma is a WHO recognised neglected tropical disease that is a subcutaneous chronic granulomatous progressively morbid inflammatory disease [1]. It frequently affects young adults and children in remote rural areas. It most commonly affects field laborers and herdsmen who are in direct contact with the soil. Hence, the most common site of infection is the foot, and the hand ranks second. Less frequently, other parts of the body may also be infected [2]. The disease can either be caused by true fungi, so called eumycetoma, or by certain bacteria, so called actinomycetoma, and the common causative organisms are Madurella mycetomatis and Nocardia brasiliensis, respectively [3,4]. These organisms are thought to be present in the soil, thorns, or animal dunk, and they are probably implanted into the host subcutaneous tissue through a breach in the skin as a result of minor trauma [5]. Mycetoma, irrespective of the aetiological agent, presents as a slowly progressive, painless, subcutaneous swelling. Multiple secondary nodules then evolve that may suppurate and drain through multiple sinuses tracts. The sinuses usually discharge grains containing colonies of the causative organism, and they are considered as a unique characteristic of the disease (Fig 1) [6,7]. The disease then spreads to involve the skin, subcutaneous tissue, deep structures, and bone, resulting in destruction, deformity, loss of function, and, occasionally, mortality [7]. Actinomycetoma is relatively more responsive to medical treatment, which depends on the site, the severity of the disease, and the causative organisms, with a cure rate of up to 90% [8]. In contrast, treatment of eumycetoma is challenging and problematic, of which most cases do not respond to medical therapy alone and require alongside surgical intervention. In general, the treatment outcome of eumycetoma is suboptimal and unsatisfactory in many patients [9,10]. This Review highlights the currently available treatment options for eumycetoma caused by M. mycetomatis and their shortcomings, possible factors contributing to treatment failure, and prospects for achieving better treatment outcomes.