title: Management of mycetoma: major challenge in tropical mycoses with limited international recognition.
abstract: OBJECTIVE
  The present review highlights an orphan infectious disease in alarming need of international recognition. While money is being invested to develop new broad-spectrum antimicrobial drugs to treat infection in general, improvement in the management of complicated infections such as mycetoma receives little support.
  
  
  RESULTS
  Many case presentations describe single-center experience in the management of mycetoma. Unfortunately, randomized and blinded clinical studies into the efficacy of antimicrobial treatment are desperately lacking. Response to medical treatment is usually better in actinomycetoma than eumycetoma. Eumycetoma is difficult to treat using current therapies. Surgery in combination with azole treatment is the recommended regimen for small eumycetoma lesions in the extremities. Bone involvement complicates clinical management, leaving surgical amputation as the only treatment option. Although clinical management has not received major attention recently, laboratory technology has improved in areas of molecular diagnosis and epidemiology.
  
  
  CONCLUSIONS
  Management of mycetoma and laboratory diagnosis of its etiological agents need to be improved and better implemented in endemic regions. Optimized therapeutic approaches and more detailed epidemiological data are urgently needed. It is vital to initiate multicenter collaborations on national and international levels to develop consensus clinical score sheets and state-of-the-art treatment regimens for mycetoma patients.
authors.affiliation: King Saud University, Department of Pathology & Microbiology, Riyadh, Saudi Arabia. aoahmed@gmail.com
authors.forename: Abdalla A O
authors.initials: AA
authors.lastname: Ahmed
authors.forename: Wendy W J
authors.initials: WW
authors.lastname: van de Sande
authors.forename: Ahmed
authors.initials: A
authors.lastname: Fahal
authors.forename: Irma
authors.initials: I
authors.lastname: Bakker-Woudenberg
authors.forename: Henri
authors.initials: H
authors.lastname: Verbrugh
authors.forename: Alex
authors.initials: A
authors.lastname: van  Belkum
mesh_terms: D000671:Amputation, Surgical; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D004195:Disease Models, Animal; D014943:Global Health; D006801:Humans; D008271:Mycetoma / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D013302:Streptomyces / Q000472:pathogenicity; D014330:Tropical Medicine
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents