Mycetoma and the environment

Mycetoma is a chronic, incapacitating, destructive inflammatory disease with many serious damaging impacts. Currently, there is no control or prevention program as many of its epidemiological characteristics, such as the causative organisms’ ecological niche, natural habitat, primary reservoir, transmission mode, geographical distribution, incidence, and prevalence, remain unclear. This may be due to a lack of research interest, as mycetoma is still a neglected disease and the scarcity of accurate molecular diagnostic techniques in disease-endemic regions for accurate causative microorganisms identification and mapping. With this background, this study set out to address this knowledge gap by considering the mycetoma environmental occurrence predictors. The medical literature obtained data showed a close association between mycetoma occurrence and its environment. The causative microorganisms are available in the environment in active or dormant forms. Animal dung may be a natural niche and reservoir for these organisms, and thorns may facilitate the subcutaneous inoculation. Some environmental factors, such as the soil type and consistency, temperature, water sources, aridity index, and thorny trees, may be risk factors. The population in endemic areas socioeconomic, hygiene, and health education status are contributory factors for mycetoma. The individual’s genetic and immunological backgrounds may determine the disease’s susceptibility and resistance. Environmental conditions and personal hygiene improvement are mandatory to reduce disease occurrence. Mycetoma spatial mapping can detect disease cluster areas and then develop public health strategies for early case detection and management to reduce the disease burden. More research interests and facilities are needed to understand disease pathogenesis and appropriate patient management better.Author summary: Mycetoma has been known for centuries, and the earliest report was from the Madras Presidency, India, in 1842 by Gill. Despite that, there is still a knowledge gap in its basic epidemiological characteristics. With this background, this study set out to study the association between mycetoma and its environment to predict its occurrence. All the available medical literature was reviewed to address the study aim. Most of the reports confirmed the presence of the causative organisms of this neglected disease in its surrounding environment. Most are in infective forms, and some are dormant, such as M. mycetomatis. Certain environmental factors govern the mycetoma occurrence, including the distance from the water source, the thorny tree, the soil type, and others. The animals’ dung may be the natural niche and reservoir for some of these organisms, and sharp objects such as thorns and other skin injury mechanisms may facilitate subcutaneous tissue inoculation. Furthermore, the population’s socioeconomic status and the hygiene standard can contribute to its occurrence. All these predictors should be considered in planning patients’ treatment and disease prevention and control.