Global Burden of Human Mycetoma: A Systematic Review and Meta-analysis

Abstract

Mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. This disease has been reported from countries between 30°N and 15°S since 1840 but the exact burden of disease is not known. It is currently unknown what the incidence, prevalence and the number of reported cases per year per country is. In order to estimate what the global burden of mycetoma is, a meta-analysis was performed. In total 50 studies were included, which resulted in a total of 8763 mycetoma cases. Most cases were found in men between 11 and 40 years of age. The foot was most commonly affected. Most cases were reported from Mexico, Sudan and India. Madurella mycetomatis was the most prevalent causative agent world-wide, followed by Actinomadura madurae, Streptomyces somaliensis, Actinomadura pelletieri, Nocardia brasiliensis and Nocardia asteroides. Although this study represents a first indication of the global burden on mycetoma, the actual burden is probably much higher. In this study only cases reported to literature could be used and most of these cases were found by searching archives from a single hospital in a single city of that country. By erecting (inter)national surveillance programs a more accurate estimation of the global burden on mycetoma can be obtained. Mycetoma is a chronic infection resulting in large masses of the subcutaneous tissue of mainly the foot. It can be caused by bacteria or fungi. Treatment for most mycetoma cases is poor and amputations are common. Although this disease was already described almost 200 years ago, it is currently not known how many people over the globe actually suffer from this disease and which countries are mostly affected. These data are useful because they can be used to concentrate medical help in places where it is really needed and to focus to search on new medication on the most common causative agents. Since mycetoma is not a reportable disease, a meta-analysis was performed based from reports in literature, in order to estimate what the global burden of mycetoma is. In total 8763 mycetoma cases were analysed. It appeared that most cases were reported from Mexico, Sudan and India and that the fungus Madurella mycetomatis was the most prevalent causative agent world-wide. Although this study represents a first indication of the global burden on mycetoma, the actual burden is probably much higher. By erecting (inter)national surveillance programs a more accurate estimation of the global burden on mycetoma can be obtained.