Management of mycetomas in France

Area of Science:

• Medical Mycology
• Tropical Infectious Diseases
• Dermatology

Background:

• Mycetomas are chronic subcutaneous infections caused by fungi (eumycetes) or bacteria (actinomycetes), presenting as multi-fistulized pseudotumors.
• Eumycetoma is particularly challenging to treat and represents a significant global health issue in tropical and subtropical regions.
• While rare in France, mycetoma cases in developed countries may benefit from broader treatment options.

Purpose of the Study:

• To present the clinical presentation and management of mycetoma cases diagnosed in a developed country (France).
• To analyze treatment outcomes, particularly the efficacy of antifungal therapies in a non-endemic setting.

Main Methods:

• Retrospective study of mycetoma cases from 1995 to 2011 at Bobigny Avicenne teaching hospital.
• Analysis of clinical presentation, etiology, bone involvement, and treatment management.

Main Results:

• Six male patients (median age 31) were studied, with five from Sub-Saharan Africa and one from Sri Lanka.
• Five eumycetomas and one actinomycetoma were diagnosed, with bone involvement in five cases; one atypical intra-osseous mycetoma was noted.
• Three patients were cured (two surgically, one medically for actinomycetoma); antifungal therapy failed in all four eumycetoma cases.

Conclusions:

• Mycetoma diagnosis and management are often delayed in non-endemic areas like France due to its rarity.
• Newer broad-spectrum antifungals (triazoles, caspofungin) showed no efficacy in treating eumycetoma in this cohort.
• Surgical management appears more effective for eumycetoma, while medical treatment was successful for the single actinomycetoma case.