Mycetoma: Neglected But Not Unnoticed

Mycetoma has existed for hundreds of years. The evidence lies in the ancient Indian religious text Atharva Veda, the clinical characteristics of mycetoma were described as "Padavalmika" or "anthill foot". The "Madura foot" or Mycetoma was first specifically described in 1842 in the historic southern Indian city of Madura (later Madurai).

Mycetoma typically manifests as a triad of painless subcutaneous swelling that resembles a tumour, many sinuses and fistulas and grains in pus. Pathologically, mycetoma is a chronic granulomatous infection of the subcutaneous layer caused by bacteria (actinomycetoma) or fungi (eumycetoma) found in soil and water. Through a breach in the skin's protective layer, bacterial and fungal pathogens enter subcutaneous tissue where they locally multiply and incubate before manifesting as clinical symptoms. If left untreated, the pathogens can enter muscles and bones through lymphatics or muscular fascial areas, resulting in disfigurement, deformity, incapacity, amputation, and even death. They can also place a significant financial and medical burden on social communities.

Both eumycetoma and actinomycetoma have unequal prevalence rates throughout the world. Actinomycetoma is more common in humid and hot areas, whereas Eumycetoma is confined to drier areas. Due to their residence in isolated rural locations with insufficient access to medical services, such as highly qualified medical staff, diagnostic facilities and treatment alternatives, the majority of the patients have not gotten adequate care. As a result, the World Health Organization classifies mycetoma as a "neglected tropical disease".

A multifaceted approach is necessary for an accurate mycetoma diagnosis such as comprehensive physical exam, extensive clinical history and diagnostic tests. It is important to distinguish mycetoma from other infectious diseases as well as benign and malignant lesions that are not contagious.  Long-term antifungal (eumycetoma) or antibacterial (actinomycetoma) therapy is an option for treatment, as is a combination of local surgical excision and antifungal and antibacterial therapy for more severe instances.

Therefore, it is essential to raise the awareness of clinicians about this tropical disease and update their knowledge of the long journey mycetoma has taken from being ignored to being recognized.