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Mycetoma, chromoblastomycosis and other deep mycoses

    Overview

    Mycetoma is a chronic, progressively destructive morbid inflammatory disease usually of the foot but any part of the body can be affected. Infection is most probably acquired by traumatic inoculation of certain fungi or ‎bacteria into the subcutaneous tissue. Mycetoma was described in the modern literature in 1694 but was first reported in the mid-19th century in the Indian town of Madura, and hence was initially called Madura foot.

    Mycetoma commonly affects young adults, particularly males aged between 20 and 40 years, mostly in developing countries. People of low socioeconomic status and manual workers such as agriculturalists, labourers and herdsmen are the worst affected.

    Mycetoma has numerous adverse medical, health and socioeconomic impacts on patients, communities and health authorities.

    As mycetoma is a badly neglected disease, accurate data on its incidence and prevalence are not available.

    Symptoms

    Mycetoma is characterized by a triad of painless ‎subcutaneous mass, multiple sinuses and discharge ‎containing grains. It usually ‎spreads to involve the skin, deep structures and bone resulting in ‎destruction, ‎deformity and loss of function, which may be fatal. ‎Mycetoma commonly ‎involves the extremities, back and gluteal region.‎

    Given its slow progression, painless nature, massive lack of health education and scarcity of medical and health facilities in endemic areas, many patients present late with advanced infection where amputation may be the only available treatment. Secondary bacterial infection is common, and lesions may cause increased pain and disability and fatal septicaemia (severe infections involving the entire human system) if untreated. Infection is not transmitted from human to human.

     

    Treatment

     

    The treatment depends on the causative organisms for the bacterial causes; it is a long term antibiotics combination whereas for the fungal type, treatment requires combined antifungals drugs and surgery. The treatment is unsatisfactory, has many side effects, is expensive and not available in most endemic areas.

    Mycetoma is not a notifiable disease (a disease required by law to be reported) and no surveillance systems exist. There no preventable or control programmes for mycetoma yet. Preventing infection is difficult, but people living in or travelling to endemic areas should be advised not to walk barefooted.

     

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    Working Groups

    Following the Skin NTD Meeting held in Geneva, Switzerland from 27-31 March 2023, WHO is proposing to establish different INFORMAL WORKING GROUPS to help follow up of the main outcomes and keep the momentum.

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    Publications

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    Report of the first WHO global meeting on skin-related neglected tropical diseases: Geneva, Switzerland, 27–31 March 2023
    The World Health Organization (WHO) held its inaugural global meeting on skin-related neglected tropical diseases (skin NTDs) on 27–31 March 2023, convening...
    Report of a WHO meeting on skin-related neglected tropical diseases in West Africa, Geneva, 3-5 October 2022

    In order to contribute to improving the promotion and implementation of the integrated approach for control and management of skin-related neglected tropical...

    Results of the 2022 global WHO online survey on diagnostic capacities and treatment practices for implantation (‎deep)‎ mycoses

    In June 2022, the World Health Organization (WHO) launched a framework for integrated control and management of skin-related neglected tropical diseases...