A holistic approach to the mycetoma management

Abstract

Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients’ socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients’ management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families.

Mycetoma in Uganda: A neglected tropical disease

“…Due to general lack of or inaccessibility to pathological services across the country, it is also possible that many patients were clinically diagnosed with mycetoma and were/are managed empirically on a combination of antifungal and antibacterial agents. Experience from Sudan has shown that establishing a centre of excellence for mycetoma improved active case findings, diagnosis and management of the disease [21]. Mycetoma Research Centre in Sudan alone cares for over 8,800 patients, a value slightly higher than the earlier global estimate of the burden of mycetoma [5].…”

Mycetoma: The Spectrum of Clinical Presentation

“…To overcome this, early case detection, which depends on detecting the visual warning signs of the disease and treatment is the only available means to prevent the numerous and serious complications of mycetoma. The first step in early case detection is meticulous clinical examination of the suspected patients, as other diagnostics tools, including direct microscopy, culture, histopathology and molecular identification, are commonly not available in mycetoma- endemic regions [ 60 ].…”

The global distribution of actinomycetoma and eumycetoma

“…Antibiotics and antifungals effective in the treatment of mycetoma are included in the WHO Model List of Essential Medicines [20], but the long duration of treatment [8] and monitoring [16] means they may be prohibitively expensive [2]. In Sudan, for example, treatment with itraconazole can cost US$26 per day [21]. Thus, there is a clear need for new, effective diagnostics and treatments, accessible to those who need it; simple yet innovative approaches could prove fruitful [5] (for example, staining mycetoma grains with henna for histological analysis [12]).…”