Eumycetoma (Fungal Mycetoma) Treatment & Management

Updated: Jun 17, 2022
  • Author: George Turiansky, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

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 1 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. [17] 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. [18, 19]

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. [20]

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. [21]

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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. [22]

In 1 case involving an adolescent male with eumycetoma osteomyelitis of the calcaneus, the treatment was surgical debridement with itraconazole 400 mg daily for 1 year. The patient had good resolution at 6 months of treatment. [23]

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