Head and neck mycetoma: the mycetoma research centre experience

Abstract

Mycetoma is a unique neglected tropical disease which is endemic in what is known as the "mycetoma belt". The disease has many devastating impacts on patients and communities in endemic area and is characterised by massive deformity, destruction and disability. Mycetoma is commonly seen in the foot and hand and less frequent in other parts of the body. Mycetoma of the head and neck is a rarity and is associated with high morbidity and even mortality if not treated early. In this communication we report on 49 patients with head and neck mycetoma followed up at the Mycetoma Research Centre in Khartoum. Most of the reported patients had actinomycetoma and the majority were young adult males from mycetoma endemic areas in the Sudan. Most of them were students, farmers and workers. Prior to presentation the majority had long disease duration and the cause was multifactorial. Advanced disease with massive lesion, deformity and disability was the common presentation. There was no obvious history of local trauma, familial tendency or other predisposing factor identified in this group of patients. MRI and CT scan were the most accurate diagnostic tools to determine the disease extent. The treatment outcome was rather poor and characterised by low cure rate, poor outcome and high follows-up dropout. Such a gloomy outcome calls for structured and objective health education programs.

Fig 1. A: Showing massive head actinomycetoma with severe bilateral proptosis.

This patient had vision loss in the right eye, and loss of hearing in both ears due massive intra-cranial involvement. B: Skull CT scan showing massive intracranial actinomycetoma involvement with bones destruction. The patient agreed to show his photos for publication purpose.

Fig 2. Showing massive head actinomycetoma with involvement of the different parts of the skull with multiple sinuses and discharge.

The patient agreed to show her photos for publication purpose.

Fig 3. Showing massive head actinomycetoma with multiple sinuses.

The patient agreed to show his photos for publication purpose.

Fig 4. Skull X-ray showing massive thickening of the skull tables and generalised osteoblastic changes.

Fig 5. Cranial MRI showing eumycetoma involving the skin, subcutaneous tissue and destruction of the frontal bone and with well encapsulated intracranial lesion.

Fig 6. Cranial MRI showing generalised skin, subcutaneous tissue and bone involvement with massive intracranial spread.