Skip to main content

Advertisement

SpringerLink
Log in

Current Treatment of Mycetoma

  • Neglected Tropical Diseases (A Sanchez, Section Editor)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose of review

The purpose of this review is to update the status of treatment of actinomycetoma and eumycetoma. Specific information is presented to describe the best medical management for uncomplicated and complicated actinomycetic and fungal mycetomas.

Recent findings

Localized actinomycetoma that involves the skin without affecting underlying organs is treated with trimethoprim/sulfamethoxazole for 3 to 12 months. In extensive infections with bone or deep organ involvement and in those with no therapeutic response, amikacin can be added. Duration of treatment varies from 5 to 20 weeks and will depend on clinical response, development of adverse effects, and patient comorbidities. Other antibiotics including diaminodiphenylsulfone (DDS), amoxicillin/clavulanic acid, rifampicin, minocycline, moxifloxacin, imipenem, meropenem, and linezolid may be employed in different combinations in selected cases. If available, an antibiogram should guide antimicrobial therapy. Eumycetoma treatment includes itraconazole, voriconazole, posaconazole, and terbinafine. Surgery is indicated depending on disease extension, antifungal clinical response, and localization.

Summary

Trimethoprim/sulfamethoxazole (TMP/SMZ) is the drug of choice for actynomicetoma but amikacin can be added in complicated cases. When aminoglycosides are contraindicated, other antimicrobials can be employed; surgery is seldom indicated. In eumycetoma, itraconazole is currently the first-line therapy, and terbinafine can be added in complicated cases. Other azoles are unavailable or expensive. Experimental in vitro and in vivo studies with different antimicrobials are currently underway for actinomycetoma. In eumycetoma, a comparative double-blind randomized study with itraconazole and fosravuconazole along with surgical treatment is being carried out at the Mycetoma Research Center in Khartoum, Sudan. Clinical awareness about mycetoma among physicians will allow a prompt diagnosis and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Venkatswami S, Sankarasubramanian A, Subramanyam S. The Madura foot. Int J Low Extrem Wounds. 2012;11(1):31–42. https://doi.org/10.1177/1534734612438549.

    Article  PubMed  Google Scholar 

  2. Van de Sande WWJ. Global burden of human mycetoma: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2013;7(11):e2550. https://doi.org/10.1371/journal.pntd.0002550.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Samy AM, Van de Sande WWJ, Fahal AH, Peterson AT. Mapping the potential risk of mycetoma infection in Sudan and South Sudan using ecological niche modeling. Small PLC, editor. PLoS Negl Trop Dis. 2014;8(10):e3250. https://doi.org/10.1371/journal.pntd.0003250.

    Article  PubMed  PubMed Central  Google Scholar 

  4. López-Martínez R, Méndez-Tovar LJ, Bonifaz A, Arenas R, Mayorga J, Welsh O, et al. Actualización de la epidemiología del micetoma en México. Revisión de 3,933 casos. Gac Med Mex. 2013;149(5):586–92.

    PubMed  Google Scholar 

  5. Fahal A, Mahgoub ES, Hassan AMEL, Abdel-Rahman ME. Mycetoma in the Sudan: an update from the Mycetoma Research Centre, University of Khartoum, Sudan. PLoS Negl Trop Dis. 2015;9(3):1–19. https://doi.org/10.1371/journal.pntd.0003679.

    Article  Google Scholar 

  6. Fahal AH, Sabaa AHA. Mycetoma in children in Sudan. Trans R Soc Trop Med Hyg. 2010 Feb;104(2):117–21. https://doi.org/10.1016/j.trstmh.2009.07.016.

  7. Welsh O, Vera-Cabrera L, Salinas-Carmona MC. Mycetoma. Clin Dermatol. 2007 Mar;25(2):195–202. https://doi.org/10.1016/j.clindermatol.2006.05.

  8. Bonifaz A, Tirado-Sánchez A, Calderón L, Saúl A, Araiza J, Hernández M, et al. Mycetoma: experience of 482 cases in a single center in Mexico. Reynolds T, editor. PLoS Negl Trop Dis. 2014;8(8):e3102. https://doi.org/10.1371/journal.pntd.0003102.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fahal AH. Mycetoma: a thorn in the flesh. Trans R Soc Trop Med Hyg. 2004;98:3–11. https://doi.org/10.1016/S0035-9203(03)00009-9.

    Article  PubMed  CAS  Google Scholar 

  10. Van de Sande WWJ, Fahal AH, Goodfellow M, Mahgoub ES, Welsh O, Zijlstra EE. Merits and pitfalls of currently used diagnostic tools in mycetoma. Reynolds T, editor. PLoS Negl Trop Dis. 2014;8(7):e2918. https://doi.org/10.1371/journal.pntd.0002918.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yousif BM, Fahal AH, Shakir MY. A new technique for the diagnosis of mycetoma using fixed blocks of aspirated material. Trans R Soc Trop Med Hyg. 2010;104(1):6–9. https://doi.org/10.1016/j.trstmh.2009.06.015.

    Article  PubMed  CAS  Google Scholar 

  12. Ahmed AO, van Leeuwen W, Fahal A, Van de Sande W, Verbrugh H, Van Belkum A. Mycetoma caused by Madurella mycetomatis: a neglected infectious burden. Lancet Infect Dis. 2004;4(9):566–74. https://doi.org/10.1016/S1473-3099(04)01131-4.

    Article  PubMed  Google Scholar 

  13. Ahmed SA, van de Sande WWJ, Stevens DA, Fahal A, van Diepeningen AD, Menken SBJ, et al. Revision of agents of black-grain eumycetoma in the order Pleosporales. Persoonia Mol Phylogeny Evol Fungi. 2014;33:141–54. https://doi.org/10.3767/003158514X684744.

    Article  CAS  Google Scholar 

  14. El Shamy ME, Fahal AH, Shakir MY, Homeida MMA. New MRI grading system for the diagnosis and management of mycetoma. Trans R Soc Trop Med Hyg. 2012;106(12):738–42. https://doi.org/10.1016/j.trstmh.2012.08.009.

    Article  PubMed  Google Scholar 

  15. Bonifaz A, González-Silva A, Albrandt-Salmerón A, Del Carmen Padilla M, Saúl A, Ponce RM. Utility of helical computed tomography to evaluate the invasion of actinomycetoma; a report of 21 cases. Br J Dermatol. 2008;158(4):698–704. https://doi.org/10.1111/j.1365-2133.2008.08435.x.

    Article  PubMed  CAS  Google Scholar 

  16. •• Ahmed AA, van de Sande W, Fahal AH. Mycetoma laboratory diagnosis: review article. PLoS Negl Trop Dis. 2017;11:e0005638. https://doi.org/10.1371/journal.pntd.0005638. Provides a panoramic view of the laboratory diagnosis of mycetoma in endemic countries.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ashley ESD, Lewis R, Lewis JS, Martin C, Andes D. Pharmacology of systemic antifungal agents. Clin Infect Dis. 2006;43(1):S28–39. https://doi.org/10.1086/504492.

    Article  Google Scholar 

  18. Yan JY, Nie XL, Tao QM, Zhan SY, De ZY. Ketoconazole associated hepatotoxicity: a systematic review and meta-analysis. Biomed Environ Sci. 2013;26(7):605–10. https://doi.org/10.3967/0895-3988.2013.07.013.

    Article  PubMed  Google Scholar 

  19. Nenoff P, Van de Sande WWJ, Fahal AH, Reinel D, Schöfer H. Eumycetoma and actinomycetoma—an update on causative agents, epidemiology, pathogenesis, diagnostics and therapy. J Eur Acad Dermatol Venereol. 2015;29(10):1873–83. https://doi.org/10.1111/jdv.13008.

    Article  PubMed  CAS  Google Scholar 

  20. Estrada-Chavez GE, Vega-Memije ME, Arenas R, Chavez-Lopez G, Estrada-castañon R, Fernandez R, et al. Eumycotic mycetoma caused by Madurella mycetomatis successfully treated with antifungals, surgery, and topical negative pressure therapy. Int J Dermatol. 2009;48(4):401–3. https://doi.org/10.1111/j.1365-4632.2009.03967.x.

    Article  PubMed  Google Scholar 

  21. Yap YG, Camm AJ. Drug induced QT prolongation and torsades de pointes. Heart. 2003;89(11):1363–72. https://doi.org/10.1007/s00508-008-0940-6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Negroni R, Tobón A, Bustamante B, Shikanai-Yasuda MA, Patino H, Restrepo A. Posaconazole treatment of refractory eumycetoma and chromoblastomycosis. Rev Inst Med Trop Sao Paulo. 2005;47(6):339–46. https://doi.org/10.1590/S0036-46652005000600006.

    Article  PubMed  Google Scholar 

  23. Oliveira F de M, Unis G, Hochhegger B, Severo LC. Scedosporium apiospermum eumycetoma successfully treated with oral voriconazole: report of a case and review of the Brazilian reports on scedosporiosis. Rev Inst Med Trop Sao Paulo. 2013;55(2):121–3. https://doi.org/10.1590/S0036-46652013000200010.

    Article  Google Scholar 

  24. Kloezen W, Meis JF, Curfs-Breuker I, Fahal AH, van de Sande WWJ. In vitro antifungal activity of isavuconazole against Madurella mycetomatis. Antimicrob Agents Chemother. 2012;56(11):6054–6. https://doi.org/10.1128/AAC.01170-12.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Ahmed SA, Kloezen W, Duncanson F, Zijlstra EE, de Hoog GS, Fahal AH, et al. Madurella mycetomatis is highly susceptible to ravuconazole. Wanke B, editor. PLoS Negl Trop Dis. 2014;8(6):e2942. https://doi.org/10.1371/journal.pntd.0002942.

    Article  PubMed  PubMed Central  Google Scholar 

  26. • Suleiman SH, Wadaella ES, Fahal AH. The surgical treatment of mycetoma. PLoS Negl Trop Dis. 2016;10(6):1–9. https://doi.org/10.1371/journal.pntd.0004690. Mycetoma is seldomly surgically treated in actinomycetoma but frequently in eumycetoma. The indications for surgical procedures in these cases are specifically delineated.

    Article  CAS  Google Scholar 

  27. Vera-Cabrera L, Ortiz-Lopez R, Elizondo-Gonzalez R, Perez-Maya AA, Ocampo-Candiani J. Complete genome sequence of Nocardia brasiliensis HUJEG-1. J Bacteriol. 2012;194:2761–2. https://doi.org/10.1128/JB.00210-12.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Welsh O, Vera-Cabrera L, Welsh E, Salinas MC. Actinomycetoma and advances in its treatment. Clin Dermatol. 2012;30:372–81. https://doi.org/10.1016/j.clindermatol.2011.06.027.

    Article  PubMed  Google Scholar 

  29. •• Welsh O, Al-Abdely HM, Salinas-Carmona MC, Fahal AH. Mycetoma medical therapy. PLoS Negl Trop Dis. 2014;8(10):e3218. https://doi.org/10.1371/journal.pntd.0003218. Current medical managment of mycetoma is delineated in this article.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. •• Zijlstra EE, Van de Sande WWJ, Welsh O, Mahgoub ES, Goodfellow M, Fahal AH. Mycetoma: a unique neglected tropical disease. Lancet Infect Dis. 2016;16(1):100–12. https://doi.org/10.1016/S1473-3099(15)00359-X. This is an article that exposes the reader to most of the mycetoma features and the fact that this disease was included in the list of Negelted Tropical Diseases of the World Health Organization. It gives information about diagnosis and treatment of actinomycetoma and eumycetoma.

    Article  PubMed  Google Scholar 

  31. Welsh O, Vera-Cabrera L, Salinas-Carmona MC. Current treatment for nocardia infections. Expert Opin Pharmacother. 2013;14(17):2387–98. https://doi.org/10.1517/14656566.2013.842553.

    Article  PubMed  CAS  Google Scholar 

  32. Zein HAM, Fahal AH, Mahgoub ES, Hassan TAE, Abdel-Rahman ME. Predictors of cure, amputation and follow-up dropout among patients with mycetoma seen at the Mycetoma Research Centre, University of Khartoum, Sudan. Trans R Soc Trop Med Hyg. 2012;106(11):639–44. https://doi.org/10.1016/j.trstmh.2012.07.003.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospital Universitario “Dr. Jose Eleuterio Gonzalez” y Facultad de Medicina, Dermatology Department, Servicio de Dermatología, Universidad Autonoma de Nuevo Leon, Ave Madero y Gonzalitos s/n, Colonia Mitras Centro, 64460, Monterrey, Mexico

    Oliverio Welsh MD, DrSc, Mario Cesar Salinas-Carmona MD, PhD, Jesus Alberto Cardenas-De la Garza MD, Irene Montserrat Rodriguez-Escamilla MD & Emmanuel Sanchez-Meza MD

Authors
  1. Oliverio Welsh MD, DrSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mario Cesar Salinas-Carmona MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jesus Alberto Cardenas-De la Garza MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Irene Montserrat Rodriguez-Escamilla MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emmanuel Sanchez-Meza MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oliverio Welsh MD, DrSc.

Ethics declarations

Conflict of Interest

Oliverio Welsh declares that he has no conflict of interest. Mario Cesar Salinas-Carmona declares that he has no conflict of interest. Jesus Alberto Cardenas-De la Garza declares that he has no conflict of interest. Irene Montserrat Rodriguez-Escamilla declares that she has no conflict of interest. Emmanuel Sanchez-Meza declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Neglected Tropical Diseases

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Welsh, O., Salinas-Carmona, M.C., la Garza, J.A.CD. et al. Current Treatment of Mycetoma. Curr Treat Options Infect Dis 10, 389–396 (2018). https://doi.org/10.1007/s40506-018-0171-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40506-018-0171-y

Keywords

Search

Navigation