Your Guide to
Neglected Tropical Diseases

Mycetoma is a chronic, slowly progressing infectious disease that begins in the tissues beneath the skin and can spread to affect the skin, deeper tissues, muscles, and bone. The disease can be caused by more than 70 different types of bacteria or fungi found in soil and water. Mycetoma appears as a painless swelling with multiple openings called sinuses that discharge sand-like particles known as “grains” containing the infectious organism.

Over time, if untreated, the disease spreads through tissues and destroys bone, causing severe deformity, loss of function, and disability. Because mycetoma progresses slowly and painlessly, and medical facilities are scarce in affected areas, many people seek care only when the disease is advanced, sometimes requiring amputation as the only treatment option. Secondary bacterial infections are common and can lead to severe systemic infections if not treated.

Mycetoma transmission occurs when bacteria or fungi from soil or water enter the body through minor wounds or penetrating injuries to the skin, commonly from thorn pricks, wood splinters, or stone cuts. The disease cannot spread from person to person.

Mycetoma is significantly more common among people who habitually walk barefoot and among rural residents engaged in outdoor manual labor such as agriculture and livestock farming. There are two types of causative agents, fungi and bacteria, and the disease is widespread in tropical and subtropical regions characterized by a short rainy season and a long dry season. The fact that these are dry environments where thorny shrubs thrive may also increase the risk of being pricked by thorns. In addition to such environmental conditions, outdoor work and walking barefoot are the main risk factors for mycetoma infection.

Geographic scope:

• Endemic in tropical and subtropical regions of Africa, Asia, Europe, and Latin America.
• Sudan reports the highest number of cases worldwide.
• Other heavily affected countries include Mexico, India, Venezuela, Chad, Ethiopia, Mauritania, Senegal, Somalia, and Yemen.
• Cases have been reported in 102 countries worldwide, though many outside the traditional mycetoma belt are underdiagnosed.

Population affected:

• Although approximately 19,500 cases have been reported in the literature between 1876 and 2019, given the low diagnostic capacity, this is considered to be only the tip of the iceberg.
• Mycetoma is not a notifiable disease (designated infectious disease) in many countries, and surveillance systems are inadequate; it is therefore estimated that the actual number of cases far exceeds the number reported.

Treatment depends on whether the infection is caused by bacteria or fungi. Bacterial mycetoma can be cured with antibiotics in up to 90% of cases when caught early and treated with combination therapy, though outcomes vary significantly depending on how early treatment begins and whether combination therapy is available. Treatment takes months to years.

Fungal mycetoma is more difficult to cure and typically requires both antifungal medications and surgery. Surgery removes diseased tissue and may range from removal of small areas to amputation in severe cases. Treatment is lengthy, expensive, and often unavailable in endemic areas. Patients need long-term follow-up to watch for the disease returning.

Prevention focuses on avoiding skin injuries. Wearing closed-toe shoes and protective clothing helps prevent wounds; cleaning and treating any wounds promptly may also reduce infection risk. Early detection and treatment before serious damage occurs can prevent disability and improve outcomes.