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Challenges, current research, and a potential new treatment for the neglected tropical disease mycetoma

Of all the neglected tropical diseases mycetoma is among the least well known and studied. It affects some of the poorest segments of remote populations with the slow and chronic development of a subcutaneous mass usually found on the foot. The disease burden of mycetoma is unknown, as is the method of transmission, and as yet there is no point-of-care diagnostic test.

Mycetoma can be caused by either bacterial or fungal infections. Bacterial infections can usually be cleared by antibiotics with a cure rate of >90% however fungal infections are far more severe. The current treatment involves a 12 month course of the antifungal intraconazole, followed by surgery on the infected area. This treatment only has a 26% cure rate, with 55% of patients unable to afford the complete antifungal course. Recurrence of the fungal infection is common and can lead to amputation of the infected area.

In 2013 the Mycetoma Consortium was founded in order to increase public and scientific awareness of the disease. They have put forward a proposal to add mycetoma to the World Health Organization’s prioritized neglected tropical diseases, as well as organizing symposia at key congresses and submitting a series of papers advocating for further research in the field.

Professor Eduard Zijlstra, from the Rotterdam Centre for Tropical Medicine, says: “We endeavour to have mycetoma included in the group of 17 NTDs as listed by the WHO. This would be a crucial step in the recognition of mycetoma as a Neglected Tropical Disease by the scientific community, policy makers and donors.”

It is recognized that there are several key areas in mycetoma research that need to be urgently addressed. In particular a clearer understanding of the burden of the disease and the route of transmission. This would help to identify simple protection measures to help prevent the spread of the disease. Identifying suitable tests to identify the disease in the field and monitor ongoing treatment would also be beneficial. Finally, very little research has been done on the risks and impact of co-infection of mycetoma with other tropical or bacterial diseases that may compromise the patient response to the disease.

PLOS Neglected Tropical Diseases has released a Mycetoma Collection gathering together the most up-to-date research on the diagnosis, treatment, histopathology, genetics, risk assessment and phylogenetics of the disease, including important case studies and meta-analysis. The collection will be released along with an editorial highlighting the challenges of the disease and exploring the potential of the new antifungal treatment fosravuconazole currently undergoing clinical trials.