Mycetoma epidemiology, diagnosis management, and outcome in three hospital centres in Senegal from 2008 to 2018

Abstract

Mycetoma is a neglected tropical disease caused by various actinomycetes or fungi. The disease is characterized by the formation of tumor like-swellings and grains. Senegal is an endemic country where mycetoma cases are under-or misdiagnosed due to the lack of capacities and knowledge among health workers and the community; and where the management of eumycetoma, burdened by a high amputation rate, is currently inadequate. This study aimed to update data on the epidemiology of mycetoma cases diagnosed in three hospital centres in Senegal over a 10 years-period. A total of 193 patients, diagnosed from 2008 to 2018, were included in the study. The most frequent presentation was eumycetoma (47.2%); followed by actinomycetoma (36.8%); it remained undetermined in 16.1% of the patients. The mean age was 38.3 years (68.4% of the patients were between 15 and 45 years-old); the male: female ratio was a 2.94; and most were farmers. One hundred fifty-six (80.8%) patients had used phytotherapy before attending the hospital. Mycetoma was mainly located to the lower limbs (91.2%). Grains were observed in 85% of the patients; including white (25.6%) and yellow (4.3%) grains. The etiological diagnosis was complex, resulting in negative direct microscopy, culture and/or histopathology findings, which explains that 16.1% remained uncharacterized. In most of cases, actinomycetoma were treated with a combination of cotrimoxazole, amoxicillin/clavulanic acid, and streptomycin; whereas eumycetoma cases were treated with terbinafine. The surgery was done in 100 (51.8%) of the patients including 9 in actinomycetoma, 78 in eumycetoma and 13 in undetermined form. The high number of uncharacterized mycetoma in this study, the delay in attending a qualified health-care facility, and the lack of available adequate antifungal drug, point out the need to strengthen mycetoma management capacities in Senegal.

In vitro susceptibility testing for black grain eumycetoma causative agents

“…Furthermore, since surgery is always a component of mycetoma treatment, direct comparison between MICs and outcomes might be complicated. However, there are a few studies in which different series of patients were treated with either ketoconazole, 68 , 69 itraconazole 6 , 70 or terbinafine. 6 , 71 Of the 571 black-grain patients with a complete data set and treated with 200–400 mg ketoconazole twice daily and surgery, only 321 (56.2%) were cured and 35 (6.1%) underwent an amputation.…”

“…However, there are a few studies in which different series of patients were treated with either ketoconazole, 68 , 69 itraconazole 6 , 70 or terbinafine. 6 , 71 Of the 571 black-grain patients with a complete data set and treated with 200–400 mg ketoconazole twice daily and surgery, only 321 (56.2%) were cured and 35 (6.1%) underwent an amputation. 68 Of the 23 black-grain mycetoma patients treated with a combination of itraconazole with the antibiotics trimethoprim–sulfamethoxazole and surgery, all were cured (100% cure rate).…”

“… 68 Of the 23 black-grain mycetoma patients treated with a combination of itraconazole with the antibiotics trimethoprim–sulfamethoxazole and surgery, all were cured (100% cure rate). 6 Of the 22 black-grain mycetoma patients treated with terbinafine for which data were available until the end of treatment, 20 (90.9%) patients were cured and 2 (9.1%) had a recurrence, 6 indicating that despite an MIC above the attainable serum level, cure was possible. A comprehensive clinical trial is needed to determine if the MIC is indicative of clinical success or failure.…”

Development and Validation of an In Vitro Resazurin-Based Susceptibility Assay against Madurella mycetomatis

“…Apparently, inhibition of ergosterol synthesis in M. mycetomatis isolates by either the azole class of antifungal agents or terbinafine offers the best mechanism by which to inhibit M. mycetomatis growth ( 5 , 6 ). Because there are currently no breakpoints established for M. mycetomatis for any of the antifungal agents tested, the absolute value of the MIC is not indicative of therapeutic success or failure ( 11 – 13 ). As reported in other studies, we found higher MICs for terbinafine ( 6 ).…”

The Activity of 2,3-Dimethylquinoxaline against Madurella mycetomatis

“…The current treatment is unsatisfactory and involves long-term antimicrobial therapy and aggressive surgical excisions [12]. Drug discovery and development often create additional challenges for being a neglected tropical disease.…”