Clinical Pharmacy Program, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan.
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan.
Trans R Soc Trop Med Hyg. 2023 Jan 3;117(1):12-21. doi: 10.1093/trstmh/trac069.
Mycetoma is a chronic granulomatous inflammatory disease that affects the cutaneous and subcutaneous tissues, leading to gruesome complications if not treated early. As a neglected disease, it has received scant attention in developing curable drugs. Mycetoma treatment is still based on expert opinions in the absence of guidelines.
This descriptive, cross-sectional, hospital-based study aimed to determine and assess the disease treatment outcomes observed at Mycetoma Research Center, Sudan.
In this study, 75% of patients had eumycetoma, all of whom were treated with itraconazole and 37.4% underwent surgical excision, while 25% of the patients had actinomycetoma, 99.2% of whom were treated with a combination of cotrimoxazole and amoxicillin-clavulanate. The cure rate was 12.7% and 14.3% for patients with eumycetoma and actinomycetoma, respectively. Only 6.1% of eumycetoma patients underwent amputation. Remarkably, no patient with actinomycetoma underwent an amputation. Small lesions (OR=10.09, p<0.001) and good follow-up (OR=6.81, p=0.002) were positive predictors of complete cure. In terms of amputation, history of surgical recurrence at presentation (OR=3.67, p=0.020) and presence of grains (OR=7.13, p=0.012) were positive predictors, whereas small lesions were negative predictors (OR=0.06, p=0.009).
Treatment of mycetoma was suboptimal, with a low cure rate despite a long treatment duration. Complete cure has a significant association with small lesions and good follow-up.
足菌肿是一种慢性肉芽肿性炎症性疾病，影响皮肤和皮下组织，如果不早期治疗，会导致严重的并发症。作为一种被忽视的疾病，它在开发可治愈的药物方面几乎没有得到关注。足菌肿的治疗仍然基于专家意见，而没有指南。
本研究为描述性、横断面、基于医院的研究，旨在确定和评估苏丹足菌肿研究中心观察到的疾病治疗结果。
在这项研究中，75%的患者患有外源性真菌肿，所有患者均接受伊曲康唑治疗，37.4%的患者接受手术切除，而 25%的患者患有放线菌肿，99.2%的患者接受复方磺胺甲噁唑和阿莫西林克拉维酸治疗。外源性真菌肿和放线菌肿患者的治愈率分别为 12.7%和 14.3%。只有 6.1%的外源性真菌肿患者进行了截肢。值得注意的是，没有放线菌肿患者进行截肢。小病变（OR=10.09，p<0.001）和良好的随访（OR=6.81，p=0.002）是完全治愈的阳性预测因素。就截肢而言，就诊时手术复发史（OR=3.67，p=0.020）和存在颗粒（OR=7.13，p=0.012）是阳性预测因素，而小病变是阴性预测因素（OR=0.06，p=0.009）。
尽管治疗时间较长，但足菌肿的治疗效果并不理想，治愈率较低。完全治愈与小病变和良好的随访有显著关联。
