Mycetoma: A Long Journey from Neglect
Abstract
Even in the tropical medicine community, mentioning mycetoma often raises eyebrows and requires further explanation. This condition has all the ingredients of neglect: it affects the poorest segment of the population in remote areas, the course of the disease is slow and chronic, and health services in the endemic areas do not have trained staff, adequate diagnostic tools, or treatment. There is uncertainty about the route of transmission, which contributes to lack of effective national control programs. The associated stigma has severe socioeconomic consequences: children drop out of school and their peer group, and young adults cannot finish their training or find a job or a partner. Patients are affected psychologically because of the lack of health services, the physical disability, and the lack of prospects, as the outcome of treatment is poor and often leads to amputation of the affected part [1].
Although mycetoma affects many countries in each part of the (sub)tropics, the disease burden is not well-known [2]. Mycetoma may be caused by bacteria (actinomycetoma), in particular Nocardia spp., or by fungi (eumycetoma), of which Madurella mycetomatis is the most common. It is thought that the microorganisms enter the skin through a thorn prick or other breach of the skin, after which the typical subcutaneous mass develops, usually on the foot. Swelling, sinus formation, and discharge of grains are considered characteristic of the disease. Although the foot is most…
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