Chest CT scan showing numerous multiple lung nodules with multiple dot-in sign characteristic for mycetoma.

<p>Chest CT scan showing numerous multiple lung nodules with multiple dot-in sign characteristic for mycetoma.</p

Chest X-ray showing multiple bilateral lungs patches with the differential diagnosis of secondaries, miliary tuberculosis, or mycetoma infiltrations.

<p>Chest X-ray showing multiple bilateral lungs patches with the differential diagnosis of secondaries, miliary tuberculosis, or mycetoma infiltrations.</p

X-ray of the patient’s right knee joint region showing massive soft tissue mass and condylar notch widening with massive effusion.

<p>X-ray of the patient’s right knee joint region showing massive soft tissue mass and condylar notch widening with massive effusion.</p

Showing massive knee eumycetoma with multiple active sinuses, discharge, and black grains.

<p>Showing massive knee eumycetoma with multiple active sinuses, discharge, and black grains.</p

The thigh mass ultrasound examination showing multiple massive cystic masses with hyper-reflective echoes in line with eumycetoma.

<p>The thigh mass ultrasound examination showing multiple massive cystic masses with hyper-reflective echoes in line with eumycetoma.</p

The knee region MRI showing extensive enhancing solid mass with nodule components, infiltrating the muscular components of anterior and posterior lower thigh with intra-articular extension and bony cortical defect at lateral femoral condyle.

<p>The knee region MRI showing extensive enhancing solid mass with nodule components, infiltrating the muscular components of anterior and posterior lower thigh with intra-articular extension and bony cortical defect at lateral femoral condyle.</p

A holistic approach to the mycetoma management

<div><p>Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients’ socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients’ management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families.</p></div

The villagers attending health education session, watching video films on mycetoma awareness.

<p>The villagers attending health education session, watching video films on mycetoma awareness.</p

Community leaders, villagers and health and medical staff training material.

<p>Community leaders, villagers and health and medical staff training material.</p