The recognition of Mycetoma: much needed attention finally given to long neglected tropical disease (NTD)

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Image: Woman in the West Indies with mycetoma caused by a fungal organism
CDC/ Dr. Lucille K. Georg

From Harpur Schwartz, an economics/global health student from Connecticut College, USA,  interning with Cabi’s Global Health team.

While tuning in to the live broadcast of the Sixty-ninth World Health Assembly taking place at the World Health Organization (WHO) headquarters in Geneva, Switzerland, mycetoma reached the discussion floor. At the risk of sounding naïve, I’m going to tell you that I had never heard of mycetoma – although a quick google search revealed images resembling elephantiasis. As a student studying global health, I was a little disappointed with myself; I mean I have at least heard of the other neglected tropical diseases (NTDs). But if mycetoma was unfamiliar to me, how many other people had never heard of this disease? I have provided answers to some basic questions I had about mycetoma in case you too are unfamiliar with this disease…

What is mycetoma?

The World health Organization describes mycetoma as, “… a chronic, progressively destructive morbid inflammatory disease usually of the foot but any part of the body can be affected”. This disease is caused by a bacterial (actinomycetoma) or fungal (eumycetoma) infection where the organism enters the body through a minor trauma or a penetrating injury (i.e. commonly a thorn prick). It is believed that the infection enters the body after this pricking occurs, but there are no concrete studies determining transmission. A good video on it can be found here in Global Health Now's Spotlight on Mycetoma by Amy Maxmen.

Is there a cure?

In terms of treatment, curing actinomycetoma using antibiotics has about a 90% success rate. The use of antifungals to treat eumycetoma has a success rate of about 35%, but in 2016 a new antifungal agent, fosravuconazole, will be the subject of the First Clinical Trial in Mycetoma conducted by Drugs for Neglected Diseases Institute (DNDi). Because the disease takes a slow, relatively pain-free progression, mycetoma is at its most advanced stages once it is diagnosed. It is at these later stages when amputation becomes necessary.

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Climate change – will it affect spread of vector borne diseases?

Climate change is going to mean mosquito-borne diseases
spread north out of the tropics right? That seems to be the story the news media are giving us. But it is really the case? Do we really need to start thinking about buying bednets to protect against mozzy bites?




Aedes mosquito(CDC)As editor of Global Health database I was invited to the ISNTD Bites
seminar in London, at the Natural History Museum where the issue was hotly debated. The session on climate change and disease vectors showed that
while biology of disease vectors like mosquitoes and sandflies is affected by temperature there are several other
factors that influence spread of disease vectors and the diseases they carry that may mean they don’t spread in the way straight climate maps predict.
Among these are land use, urbanisation and global trade. In fact, the
entomologists at the seminar were arguing that climate change issues are
distracting researchers from looking more into factors that are having drastic effects on the spread of disease vectors
and disease right now.

 

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Neglected tropical diseases: the future is multidisciplinary and ‘one health’

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A new society has been born – the International Society for Neglected Tropical Diseases. The society’s reason for existence is to provide a space where people from different disciplines can meet and develop new ways to control neglected tropical diseases (NTDs). I went to their inaugural conference. The talks were many and varied as was the audience: there were experts in anthropology, communication and education, microbiology and molecular biology, health workers in the field, and last but not least – veterinarians.

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