Mycetoma Intiative in Sudan
- Mycetoma is a morbid, destructive disfiguring chronic inflammatory disease with many adverse impacts on patients, communities and health authorities.
- Mycetoma has a worldwide distribution but that is extremely uneven. It prevails in what is known as the mycetoma belt.
- No age is exempted but mycetoma commonly affects young adults between 15-30 years of age and these are the earning members of the society especially in developing countries.
- Mycetoma is seen more conventionally in young students, cultivators, field labourers and in herdsmen and most of them are of low socio-economic status.
- As it is neglected diseases, the true incidence and prevalence of mycetoma world-wide are not precisely known and most of the reported mycetoma data are related, in most reports, to hospital patients with advanced disease. This is attributed to the nature of mycetoma which is usually painless, slowly progressive and the late presentation of the majority of patients.
- The Sudan is consider the mycetoma homeland with a prevalence of 8.5/1000 population in one endemic village. At the mycetoma research Centre, University of Khartoum, a WHO Collaborating Centre in mycetoma more than 7500 patients are registered.
- In the affected areas, the massive lack of health education, poor health and medical facilities and financial constraints contribute to the late presentation with massive disease in the majority of patients.
- The diagnostic tests are expensive, not sensitive nor specific and not available in endemic regions.
- The antifungal treatment duration for mycetoma is long (mean duration of 18 months), and this is associated with many medical, socio-economic adverse impacts on patients and health authorities.
- The current treatment outcome is suboptimal, characterised by low cure rate (25.8%), high recurrence (27%) and amputation rates (10%).
- Patients’ compliance to the available treatment is poor and high dropout is a common phenomenon due to its ineffectiveness, high cost, long duration and side effects.
- Currently, FDA & EMEA have restricted the use of ketoconazole, the current mycetoma drug of choice, due to its hepatic toxicity and the only available antifungals are Itraconazole and Voriconazole.
- The average cost of antifungal is 6540 US$ per year per patients, that proved to be expensive for patients and health authorities in endemic areas. The mean annual income in the Sudan is 1800 US$.
- Being a neglected medical and health problem, there are no preventive or control measurements or programs for Mycetoma across the world currently.