A holistic approach to the mycetoma management

Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients’ socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients’ management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families.Author summary: Mycetoma enjoys all the neglected tropical diseases (NTDs) characteristics. It frequently affects the poorest of the poor in poor communities in remote regions. The affected population are of low socio-economic status, of low visibility and low political and social voice and hence they are neglected. The disease is considered as a social stigma in particularly among females and children thus they tend to hide it for prolong period and when they are compelled to seek medical care the condition is then at a late stage. The mycetoma patients have many financial constraints that hinder them from seeking medical and health care. In the remote mycetoma endemic areas, the health and medical facilities are meagre, and it is difficult for the patients to reach the regional health centres and thus the majority of patients present with late advanced disease. To overcome these treatment difficulties, the MRC had adopted this holistic management approach to decentralised the patient's care, improve the disease awareness and advocacy, provide free medical and surgical treatment locally at the village level, and to improve the affected villages environmental and hygienic conditions. In this communication, the MRC is reporting on this unique experience, discussing the advantages and difficulties faced it and suggesting recommendations to improve it to be adopted worldwide. Reviewing the medical literature revealed, no report on such management approached for mycetoma patients and thus it worth reporting it.