Mycetoma management and clinical outcomes: the Mycetoma Research Center experience

Mycetoma is a chronic granulomatous inflammatory disease that affects the cutaneous and subcutaneous tissues, leading to gruesome complications if not treated early. As a neglected disease, it has received scant attention in developing curable drugs. Mycetoma treatment is still based on expert opini...

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Published in:Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 117; no. 1; p. 12
Main Authors: Musa, Esraa Abdelgadir, Abdoon, Iman Hassan, Bakhiet, Sahar Mubarak, Osman, Bashier, Abdalla, Safa A, Fahal, Ahmed Hassan
Format: Journal Article
Language:English
Published: England 03.01.2023
Subjects:
Chronic Disease
Cross-Sectional Studies
Humans
Mycetoma - drug therapy
Mycetoma - surgery
Sudan - epidemiology
Treatment Outcome
Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
Sudan
treatment
amputation, disease management
eumycetoma
mycetoma
Sudan
ISSN:1878-3503, 1878-3503
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Summary:Mycetoma is a chronic granulomatous inflammatory disease that affects the cutaneous and subcutaneous tissues, leading to gruesome complications if not treated early. As a neglected disease, it has received scant attention in developing curable drugs. Mycetoma treatment is still based on expert opinions in the absence of guidelines. This descriptive, cross-sectional, hospital-based study aimed to determine and assess the disease treatment outcomes observed at Mycetoma Research Center, Sudan. In this study, 75% of patients had eumycetoma, all of whom were treated with itraconazole and 37.4% underwent surgical excision, while 25% of the patients had actinomycetoma, 99.2% of whom were treated with a combination of cotrimoxazole and amoxicillin-clavulanate. The cure rate was 12.7% and 14.3% for patients with eumycetoma and actinomycetoma, respectively. Only 6.1% of eumycetoma patients underwent amputation. Remarkably, no patient with actinomycetoma underwent an amputation. Small lesions (OR=10.09, p<0.001) and good follow-up (OR=6.81, p=0.002) were positive predictors of complete cure. In terms of amputation, history of surgical recurrence at presentation (OR=3.67, p=0.020) and presence of grains (OR=7.13, p=0.012) were positive predictors, whereas small lesions were negative predictors (OR=0.06, p=0.009). Treatment of mycetoma was suboptimal, with a low cure rate despite a long treatment duration. Complete cure has a significant association with small lesions and good follow-up.
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ISSN:1878-3503
1878-3503
DOI:10.1093/trstmh/trac069