Abstract
Mycetoma is a neglected tropical disease caused by various actinomycetes or fungi. The disease is characterized by the formation of tumor like-swellings and grains. Senegal is an endemic country where mycetoma cases are under-or misdiagnosed due to the lack of capacities and knowledge among health workers and the community; and where the management of eumycetoma, burdened by a high amputation rate, is currently inadequate. This study aimed to update data on the epidemiology of mycetoma cases diagnosed in three hospital centres in Senegal over a 10 years-period. A total of 193 patients, diagnosed from 2008 to 2018, were included in the study. The most frequent presentation was eumycetoma (47.2%); followed by actinomycetoma (36.8%); it remained undetermined in 16.1% of the patients. The mean age was 38.3 years (68.4% of the patients were between 15 and 45 years-old); the male: female ratio was a 2.94; and most were farmers. One hundred fifty-six (80.8%) patients had used phytotherapy before attending the hospital. Mycetoma was mainly located to the lower limbs (91.2%). Grains were observed in 85% of the patients; including white (25.6%) and yellow (4.3%) grains. The etiological diagnosis was complex, resulting in negative direct microscopy, culture and/or histopathology findings, which explains that 16.1% remained uncharacterized. In most of cases, actinomycetoma were treated with a combination of cotrimoxazole, amoxicillin/clavulanic acid, and streptomycin; whereas eumycetoma cases were treated with terbinafine. The surgery was done in 100 (51.8%) of the patients including 9 in actinomycetoma, 78 in eumycetoma and 13 in undetermined form. The high number of uncharacterized mycetoma in this study, the delay in attending a qualified health-care facility, and the lack of available adequate antifungal drug, point out the need to strengthen mycetoma management capacities in Senegal.
Highlights
Mycetoma is a tropical chronic granulomatous disease, with the formation of tumor-like soft tissue swelling and the formation of grains [1]
Actinomycetoma are commonly caused by Streptomyces somaliensis and Nocardia spp. while Madurella mycetomatis is the commonest agent in eumycetoma [4,5,6]
This study aims to provide updated data on the epidemiology, clinical presentation, laboratory diagnosis, and treatment of mycetoma, based on the patients who had consulted in three health care facilities located in two regions of Senegal
Summary
Mycetoma is a tropical chronic granulomatous disease, with the formation of tumor-like soft tissue swelling and the formation of grains [1]. This disease usually results from small traumatic implantation of causative agent in subcutaneous tissue mainly located to the foot [2]. The involved infectious agents are either aerobic filamentous actinomycetes, causing actinomycetoma, or filamentous fungi, causing eumycetoma. The treatment of mycetoma cases depends on whether the causative agent is an actinomycete or a fungus. Whereas actinomycetoma are usually adequately treated with antibacterials, eumycetoma show usually a relatively poor response to available antifungal drugs. The surgical treatments ranges from broad surgical excision to limb amputation [7,8]
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