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Year : 2017  |  Volume : 4  |  Issue : 4  |  Page : 289-290

The public health implications of mycetoma: A neglected tropical disease

Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India

Date of Web Publication11-Oct-2017

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cjhr.cjhr_28_17

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How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. The public health implications of mycetoma: A neglected tropical disease. CHRISMED J Health Res 2017;4:289-90

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. The public health implications of mycetoma: A neglected tropical disease. CHRISMED J Health Res [serial online] 2017 [cited 2023 Jan 30];4:289-90. Available from: https://www.cjhr.org/text.asp?2017/4/4/289/216469


Mycetoma is a chronic and disabling disease of bacterial or fungal origin, and it usually affects the skin, muscle, and bone.[1] The disease is extremely common in tropical and subtropical regions with a brief rainy season, but long dry seasons, which provides a favorable environment for the growth of thorny bushes.[1] Even though the precise global magnitude of the disease is not known, close to 8800 cases were reported in the year 2013 based on the findings of a survey.[1] The infection has been found to be endemic in tropical and subtropical regions in the “mycetoma belt,” which comprises ten nations (like Chad, Ethiopia, India, Yemen, etc.). The disease is common among rural males within the age group of 15–30 years, who walk barefoot, nevertheless no individual is exempted.[1]

In the year 2016, the disease has been categorized as one of the neglected tropical diseases.[1] This is because of the propensity of the disease to affect the poorest section of the human populations living in remote settings, chronic and painless nature of the disease, shortage of the trained healthcare staff, minimal awareness about the disease among endemic and vulnerable population groups, and shortcomings in the diagnostic and treatment front.[2],[3] In addition, because of the associated stigma, children have to drop out of their schools, while adults find it difficult to locate a job or spouse.[2] The stigma further enhances due to the associated physical disability, and the disease may eventually lead to amputation of the affected body part, in the absence of access to treatment.[3]

The diagnosis of the disease is usually clinically established with no point-of-care diagnostic test being available.[1],[3] Moreover, even with regard to treatment, the choice of drugs is extremely limited, as some of the effective drugs have been banned due to toxicity.[1],[2],[3] In addition, the duration of treatment is long, drugs are expensive, potential risk of secondary bacterial infection, and there is always a possibility of recurrence of the infection, all of which makes it quite difficult for the total cure of the disease.[2] Furthermore, the disease is not a notifiable condition, with no surveillance system, or prevention and control programs.[2],[3] Thus, due to the presence of all these factors, more often than not, patients present late in advanced stages of the disease, when amputation is the only available treatment option.[1],[2],[3]

However, owing to the massive aftereffects on the health and socioeconomic status of individuals and families and a great burden on the health-care delivery system, it is of utmost importance to address the challenges posed by the disease.[1] Even though the infection is difficult to prevent, a significant reduction in the incidence of the disease can be obtained by advising people to not to walk barefoot, especially in endemic settings.[3] Further, early detection and prompt treatment is extremely effective in reducing the associated morbidity and improving the treatment outcome of the disease.[1],[2]

The current strategy of active case finding with early diagnosis and treatment is the most suitable approach for minimizing the caseload.[1],[2] The need of the hour is to formulate a holistic public health strategy, comprising of a better surveillance system, investment in research to promote the development of cost-effective preventive approaches, diagnostic tools, and adequate management of cases even in low-resource settings.[1],[2],[3] At the same time, there is an immense need to strengthen the health system, improve supervision and monitoring activities, and conduct intensive advocacy and resource mobilization activities.[1],[3]

To conclude, to reduce the magnitude of the disease and improve the quality of life of the affected people, it is of utmost importance that policymakers should acknowledge the importance of the problem and work in collaboration to improve the existing scenario.

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Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. Mycetoma – Fact Sheet; 2017. Available from: http://www.who.int/mediacentre/factsheets/mycetoma/en/. [Last accessed on 2017 Apr 05].  Back to cited text no. 1
Burki TK. Starting from scratch-the unique neglect of mycetoma. Lancet Infect Dis 2016;16:1011-2.  Back to cited text no. 2
Zijlstra EE, van de Sande WW, Fahal AH. Mycetoma: A long journey from neglect. PLoS Negl Trop Dis 2016;10:e0004244.  Back to cited text no. 3


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