Eumycetoma (Fungal Mycetoma) Treatment & Management

Updated: Oct 19, 2017
  • Author: George Turiansky, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Treatment of eumycetoma remains problematic. Historically, the treatment of eumycetoma has included surgical treatment, medical treatment, or both. Combined surgical and medical treatment appears to be the management option of choice.

Antifungal therapy has variable results.

The sensitivity of organisms to antifungal drugs in vitro is not necessarily correlated with the in vivo response.

Amphotericin B has minimal or no effect on eumycetoma organisms.

Anecdotal reports of successful treatment with griseofulvin and dapsone exist.

In one study, a case of eumycetoma due to M grisea initially responded to fluconazole 400 mg/d but worsened after the patient stopped the treatment. In the same report, 2 other cases due to M mycetomatis and P boydii had either slight improvement or only transient clinical improvement with fluconazole 200-400 mg/d for 3 months. These cases were classified as nonresponsive.

Azole antifungal agents such as ketoconazole have some effectiveness. Mahgoub and Gumaa demonstrated that ketoconazole is effective in the treatment of eumycetoma caused by M mycetomatis. [12] They treated 13 patients with oral ketoconazole 200-400 mg/d; 5 patients were cured, and 4 patients improved. The median treatment duration was 12.9 months, with a treatment range of 3-36 months. Cures were noted with the higher dosages of ketoconazole.

Itraconazole is variably effective in the treatment of eumycetoma due to various organisms. [13, 14]

One case of eumycetoma due to M mycetomatis without bony involvement was successfully treated with oral voriconazole at 600 mg/d, with a 4-year disease free follow-up. [15]

A study by N'Diaye et al showed that high-dose terbinafine (500 mg bid) for 24-48 weeks was generally well tolerated. In the investigators' overall opinion at the end of the study, of 20 eumycetoma patients who completed the study, 5 patients were clinically cured and 11 were clinically improved. [16]

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Surgical Care

Treatment in the past has included amputation of the affected limb or other radical surgery. Although surgical treatment alone results in recurrence rates as high as 80%, surgical resection with a wide surgical margin of uninfected tissue may be useful in early, small lesions without bony involvement. Surgical debulking together with oral antifungal treatment may be necessary with chronic extensive lesions. A 2017 review of 13 eumycetoma cases with or without bony involvement showed promising results with surgical treatment combined with itraconazole monotherapy or with itraconazole combined with amphotericin or fluconazole, with a variable recurrence rate in some. [17]

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Long-Term Monitoring

A prolonged follow-up period is necessary to monitor for disease recurrence.

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