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Management of mycetoma: major challenge in tropical mycoses with limited international recognition

Ahmed, Abdalla AOa; van de Sande, Wendy WJb; Fahal, Ahmedc; Bakker-Woudenberg, Irmab; Verbrugh, Henrib; Belkum, Alex vanb

Current Opinion in Infectious Diseases: April 2007 - Volume 20 - Issue 2 - p 146–151
doi: 10.1097/QCO.0b013e32803d38fe
Skin and soft tissue infections

Purpose of review The present review highlights an orphan infectious disease in alarming need of international recognition. While money is being invested to develop new broad-spectrum antimicrobial drugs to treat infection in general, improvement in the management of complicated infections such as mycetoma receives little support.

Recent findings Many case presentations describe single-center experience in the management of mycetoma. Unfortunately, randomized and blinded clinical studies into the efficacy of antimicrobial treatment are desperately lacking. Response to medical treatment is usually better in actinomycetoma than eumycetoma. Eumycetoma is difficult to treat using current therapies. Surgery in combination with azole treatment is the recommended regimen for small eumycetoma lesions in the extremities. Bone involvement complicates clinical management, leaving surgical amputation as the only treatment option. Although clinical management has not received major attention recently, laboratory technology has improved in areas of molecular diagnosis and epidemiology.

Summary Management of mycetoma and laboratory diagnosis of its etiological agents need to be improved and better implemented in endemic regions. Optimized therapeutic approaches and more detailed epidemiological data are urgently needed. It is vital to initiate multicenter collaborations on national and international levels to develop consensus clinical score sheets and state-of-the-art treatment regimens for mycetoma patients.

aKing Saud University, Department of Pathology & Microbiology, Riyadh, Saudi Arabia

bErasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology & Infectious Diseases, Rotterdam, The Netherlands

cMycetoma Research Centre, University of Khartoum, Sudan

Correspondence to Abdalla A.O. Ahmed, King Saud University, Department of Pathology & Microbiology, PO Box 2925, Riyadh 11461, Saudi Arabia Tel: +966 14671636; fax: +966 14672462; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.