Mycetomas: an epidemiological, etiological, clinical, laboratory and therapeutic review

Abstract

Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue, characterized by a symptomatic triad: tumor, fistulas and grains. It can be caused by fungi (eumycetoma) and bacteria (actinomycetoma), with similar clinical features. Diagnosis is based on the clinical presentation and identification of the etiological agents in the tissue, by mycological/bacteriological, histopathological and immunohistochemical tests. It is important to specify the fungal or bacterial etiology, because the treatments are different. An approach that involves early diagnosis, the use of systemic antibiotics or antifungal agents, including surgical removal of lesions, is the basis for the treatment of these diseases. In this review, the most commonly used diagnostic methods and treatments will be discussed. Also, we will review the history of the disease through epidemiological and etiological aspects.

The global distribution of actinomycetoma and eumycetoma

“…Even in Sudan, home to the only Mycetoma Research Centre (MRC) in the world, the 10,608 reported cases [14] are likely to be an underestimate [13]: While van de Sande's 2013 study calculated prevalence as 1.81 per 100,000 population (most cases coming from the MRC located in the capital Khartoum), a study in rural Sudan found it to be as high as 6.2 per 1,000 [13]. As mycetoma is associated with rural agricultural practices [8] and use of local herbal remedies [12], it may be that many cases do not present to large healthcare facilities, from where reports are likely to be published.…”

“…Sometimes taking years to manifest [15], infection involves swellings [16], usually on the feet [13]. The resulting sinuses exude "grains" of fungal or bacterial matter [8]. For diagnosis, the clinical triad of a subcutaneous mass, grains, and sinuses is often used [16], supplemented by imaging and laboratory techniques [2].…”

“…In practice, many endemic regions simply do not have the financial resources to carry out these necessary tests [16]. Eumycetoma has been reported more in Africa, actinomycetoma more often in South and Central America [8]. To treat, clinicians need to distinguish between the bacterial and fungal form of mycetoma [6]; cure of both is possible [16].…”

Molecular identification of Actinomadura madurae isolated from a patient originally from Algeria; observations from a case report

“…Despite multiple cases reported worldwide, the incidence and prevalence of the disease remain underestimated [ 2 ]. Mycetoma is more prevalent in people between 20 and 40 years old, with a low socioeconomic level, and is more common in men rather than women (3:1) [ 3 ]. Mycetoma occurs mostly in the lower extremities of the body, particularly in the feet but other parts of the body can also be involved [ 4 ].…”

“…It is usually characterized by single or multi-fistulized pseudotumor and the emission of grains. The grains can vary in size, color, and consistency, depending on the etiological species [ 3 ].…”