Mycetoma: A disease so neglected it’s not even on the WHO list of NTDs

Foot exhibiting Mycetoma infection. WHO.

Edit: On 28 May 2016, the 69th World Health Assembly approved a resolution recognizing mycetoma as a neglected tropical disease. I’d like to think this article had something to do with that, although I’m certain that’s not the reality.

Mycetoma is a badly neglected tropical disease that results in bone and flesh destruction which frequently leads to amputation and sometimes death. Caused by either bacteria or fungi, mycetoma commonly affects the foot and starts as a skin infection that spreads over time and eventually erupts into painful skin lesions while it destroys surrounding bone.

Mycetoma is so neglected it isn’t even on the WHO’s list of 17 Neglected Tropical Diseases. Mycetoma commonly affects the very poor and especially folks who work in agriculture, labor, and herding. The world has a ‘Mycetoma belt‘ that stretches roughly from the Equator to the Tropic of Cancer.

Mycetoma Belt. DNDi.

Like many neglected diseases, mycetoma can reinforce the poverty of the afflicted by negatively affecting work productivity, school attendance, and impacting the social lives of the afflicted due to the negative social stigma and social isolation of mycetoma infection.

Because mycetoma is not a notifiable disease, there are no surveillance systems that exist. However, a meta-analysis study was done in 2013 to more accurately determine the global disease burden of mycetoma. The study found that most cases were reported in Mexico, Sudan and India. The fungus Madurella mycetomatis was the most common causative agent of mycetoma around the world.

Treatment of mycetoma is a challenge. The bacterial version has a cure rate of about 90% while the fungal version has a cure rate of only 25-35%. The current treatment of the fungal version is not safe, effective or affordable. DNDi has plans to conduct a randomized control trial of an anti-fungal drug originally developed for treatment of Chagas disease. The study will be based in Sudan at the Mycetoma Research Center in Khartoum.

For more information on mycetoma, PLOS has started a collection on mycetoma that contains a lot of great information ranging from public health to clinical to basic science information. Additionally, Global Health Now did a 3-part series on mycetoma as it was chosen as the winner of the Global Health Untold Story in 2015.

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