Chromoblastomycosis

More than half of Neglected Tropical Diseases present with skin problems, and this includes 3 that are fungal – Mycetoma, Chromoblastomycosis and Sporotrichosis. On June 8^th the World Health Organization launched its strategic framework for the integrated approach to these.

The strategic framework is designed to assist endemic countries in reducing the morbidity, disability and psychosocial impacts of skin NTDs and other skin conditions. It takes a people-centred approach by identifying areas, key partners and resources for integration as well as systems to embed interventions within national programmes and facilitate country ownership.

Prior to the launch, an international survey was done to assess the capacity for diagnosis and access to therapies of implantation and subcutaneous mycoses. 142 professionals responded, 59% from tertiary or national level facilities in all continents. Different means of establishing the diagnosis is reflected in the table below. Bacterial culture for actinomycetoma was available to 67% of respondents, while fungal culture for eumycetoma was available to 85%.

Therapies for eumycetoma included surgery (81%), along with various antifungal drugs shown in the table below, including itraconazole (85%) and terbinafine (48%). One respondent indicated that “Itraconazole and terbinafine are often unavailable and expensive. Because of this, patients are often started on or switched to available and less expensive antifungals; ketoconazole or fluconazole, even though these drugs are not recommended for treatment of eumycetoma [and ineffective].” Ketoconazole was recommended for global discontinuation by leading regulatory authorities and the WHO in 2013.