Mycetoma is a chronic, progressively destructive infectious disease that primarily affects the skin, underlying tissues, and sometimes bones. It is caused by certain types of bacteria or fungi that enter the body through small wounds or abrasions, typically in the feet. The condition is more common in tropical and subtropical regions, where people often walk barefoot and are exposed to soil and vegetation. Despite its serious consequences, mycetoma remains a neglected disease with limited awareness, research, and resources.
Causes and Types
Mycetoma is classified into two types based on the organism causing the infection: actinomycetoma, caused by bacteria (mainly Nocardia or Actinomadura species), and eumycetoma, caused by fungi (mainly Madurella species) (World Health Organization [WHO], 2023). The fungal form is more difficult to treat and often leads to more severe complications.
The disease begins when the pathogen enters the body through a break in the skin, often after stepping on a thorn or sharp object. Over time, it forms a painless lump under the skin, which can gradually enlarge and become disfiguring. The lump may discharge grains or pus, and if not treated early, the infection can reach deeper tissues and bones.
Symptoms and Diagnosis
One of the unique features of mycetoma is the presence of grains, which are tiny colored particles discharged through sinuses in the skin. These grains contain colonies of the infecting organism and can help doctors identify whether the infection is bacterial or fungal (Fahal et al., 2021). Common symptoms include:
- Swelling at the site of infection, often the foot
- Multiple sinus tracts that discharge pus or grains
- Deformity and reduced function in the affected area
- Rarely, pain (most patients report little or no pain)
Diagnosing mycetoma can be challenging due to its slow progression and similarity to other diseases. Doctors typically use a combination of clinical examination, imaging techniques (such as X-rays or MRI), and laboratory tests including culture and histopathology to confirm the diagnosis (Zijlstra et al., 2016).
Risk Factors and Geographic Distribution
Mycetoma mostly affects young adults, particularly men, who work in farming or other outdoor occupations. It is commonly seen in what is known as the “mycetoma belt,” which includes countries in Africa, Latin America, and South Asia. Sudan, India, and Mexico are among the most affected countries (WHO, 2023). Walking barefoot in rural areas is one of the most significant risk factors for the disease.
Poor living conditions, lack of protective footwear, and limited access to health care also contribute to the high burden of mycetoma in these regions. Because it develops slowly and may be painless, people often delay seeking medical help until the disease has advanced.
Treatment and Challenges
The treatment of mycetoma depends on whether it is bacterial or fungal. Actinomycetoma is usually responsive to long-term antibiotic therapy, typically using a combination of drugs like trimethoprim-sulfamethoxazole and amikacin (van de Sande et al., 2018). In contrast, eumycetoma requires antifungal medications such as itraconazole, but these are less effective and often require surgery to remove infected tissue.
One of the biggest challenges in treating mycetoma is the need for prolonged therapy, which can last several months to years. In many cases, especially when diagnosed late, patients may need surgery or even amputation of the affected limb. Unfortunately, antifungal drugs are expensive and often unavailable in low-income settings, where the disease is most common.
Prevention and Public Health Importance
Preventing mycetoma mainly involves avoiding injury and practicing good hygiene. Wearing shoes, especially in areas where the disease is common, can significantly reduce the risk. Public health education and awareness campaigns are essential to help people recognize the early signs of the disease and seek timely treatment.
Despite its devastating effects, mycetoma has long been neglected in global health efforts. It was only recognized by the World Health Organization as a neglected tropical disease (NTD) in 2016 (WHO, 2023). There is still a significant need for more research, better diagnostic tools, affordable treatments, and government policies to tackle the burden of this disease.
Mycetoma is a serious but often overlooked disease that affects the most vulnerable populations. With early diagnosis and proper treatment, many of the severe outcomes can be prevented. However, a global effort is needed to improve awareness, accessibility of medical care, and development of effective treatment options. Ending the neglect of mycetoma is not just a medical challenge—it is a moral responsibility.
References
- Fahal, A. H., Hassan, M. A., Abdel-Rahman, M. E., Alshambaty, Y. A., Zakaria, A., & Bakhiet, S. M. (2021). Mycetoma: The spectrum of clinical presentation, diagnosis and management. PLOS Neglected Tropical Diseases, 15(2), e0008989. https://doi.org/10.1371/journal.pntd.0008989
- van de Sande, W. W. J., Fahal, A. H., Goodfellow, M., Mahgoub el, S., Welsh, O., Zijlstra, E. E., & van Belkum, A. (2018). Merits and pitfalls of currently used diagnostic tools in mycetoma. PLOS Neglected Tropical Diseases, 12(2), e0006678. https://doi.org/10.1371/journal.pntd.0006678
- World Health Organization. (2023). Mycetoma. https://www.who.int/news-room/fact-sheets/detail/mycetoma
- Zijlstra, E. E., van de Sande, W. W. J., & Welsh, O. (2016). Mycetoma: A unique neglected tropical disease. The Lancet Infectious Diseases, 16(1), 100–112. https://doi.org/10.1016/S1473-3099(15)00359-X
