Mycetoma
GMJ News knowledge hub · last reviewed August 2026 · Georgian Medical Journal
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Mycetoma — a chronic granulomatous infection of skin, subcutaneous tissue, fascia and bone caused by fungi (eumycetoma) or bacteria (actinomycetoma) — is a WHO Neglected Tropical Disease added to the NTD list in 2016, causing progressive, deforming, often amputation-requiring destruction of affected limbs, predominantly in the “mycetoma belt” stretching from Sudan through sub-Saharan Africa to South Asia and Latin America (WHO). Sudan accounts for approximately 70% of global mycetoma cases, predominantly caused by Madurella mycetomatis (eumycetoma). Treatment: itraconazole + surgery for eumycetoma; trimethoprim-sulfamethoxazole (+ amikacin for severe) for actinomycetoma. WHO targets 75% reduction in disability by 2030.
Key messages
WHO NTD since 2016 — Sudan carries 70% of burden
Mycetoma was added to the WHO Neglected Tropical Diseases list in 2016. Sudan accounts for approximately 70% of global mycetoma cases — with the Gezira state being the highest-burden area in the world (WHO).
Two types — fungal (eumycetoma) and bacterial (actinomycetoma)
Mycetoma is caused by either fungi (eumycetoma — Madurella mycetomatis most common, black grains) or bacteria (actinomycetoma — Nocardia, Actinomadura, Streptomyces — pale/white/yellow grains). The distinction determines treatment.
Painless progressive destruction
Mycetoma presents as a painless, slowly progressive swelling — typically of the foot (Madura foot), hand or knee — that forms sinuses (tracks to the surface) discharging coloured granules (the grains). Untreated, it progressively destroys skin, subcutaneous tissue, fascia and bone.
Amputation in approximately 30% of untreated cases
Without effective treatment, mycetoma causes progressive bone destruction and leads to amputation in approximately 30% of cases. Even with treatment, functional disability is common.
Itraconazole for eumycetoma, TMP-SMX for actinomycetoma
Treatment: eumycetoma — itraconazole (prolonged courses, often 12-24+ months, combined with surgery); actinomycetoma — trimethoprim-sulfamethoxazole (first-line, alone or with amikacin for 3-6+ months, then TMP-SMX maintenance). Response rates are modest and recurrence is common.
WHO 2030 target — 75% reduction in disability
WHO targets 75% reduction in mycetoma-related disability by 2030 through improved case detection, standardised treatment, access to medicines and research into new therapies.
Key statistics
Mycetoma — global endemic distribution and relative burden
Source: WHO. The "mycetoma belt" runs from Sudan/Somalia through West Africa, India and Mexico/Venezuela.
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NTDsLeprosy (NTD skin disease)Buruli ulcer (NTD skin)DisabilityAntifungal resistanceWASH
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