Results of the 2017 global WHO survey on mycetoma

Overview

Mycetoma  is  a  chronic  infectious  disease  characterized  by  invasion  and  destruction of  skin  and  subcutaneous  tissue by either bacteria or fungi. The clinical presentation is a combination of a painless  subcutaneous  mass, multiple sinuses and discharge of grains. Bone invasion is  not  uncommon, and, in  some cases,  even  repeated  surgery  cannot  control  progression  of  the  disease.

The fungus Madurella mycetomatis is among the most frequent causal agents. Other common pathogens are the bacteria Streptomyces somaliensis, Actinomadura madurae, A. pelletieri, Nocardia brasiliensis and N. asteroides. The disease occurs mainly within the so-called “mycetoma belt”, between latitudes 15° south and 30° north, in hot and rather dry climates. The me-chanism of transmission is assumed to be introduction of environmental organisms through a penetrating injury into the skin and subcutaneous tissue. Mycetoma occurs mainly among rural populations with low socio-economic status, and it can be assumed that many cases progress because they are not recognized by health authorities.

Little is known about mycetoma, its pathogenesis, trans-mission or biology, and effective treatment options are limited. Action has, however, been taken to improve the situation of patients suffering from this devastating disease. In May 2016, the Sixty-ninth World Health Assembly adopted a resolution (WHA69.21) requesting WHO to include mycetoma in the list of neglected tro-pical diseases (NTDs) and to support Member States in which mycetoma is endemic to strengthen their capaci-ty to improve early detection and access to treatment, assess the burden of disease and, when necessary, estab-lish disease control measures.

To meet these requests, the department of control of NTDs at WHO headquarters, in collaboration with the relevant WHO country and regional offices, decided to conduct a global survey on mycetoma to gather prelim-inary information from Member States, to support WHO’s plan for implementation of resolution WHA69.21.