Genetic Variability, Antigenicity and Antifungal Susceptibility of Madurella Mycetomatis

Mycetoma is a chronic, granulomatous, progressive inflammatory disease, characterized by a subcutaneous mass, tumefaction and the formation of sinus tracts. The sinuses discharge seropurulent material and fungal or bacterial grains. This disease, which can be caused by both bacteria and fungi, is encountered all over the world but is endemic in the so-called “mycetoma-belt”, between 30 oN and 15 oS of the equator. Sudan is one of the countries in which mycetoma has a high incidence. In this country the most common causative agent is the fungus Madurella mycetomatis. Although mycetoma was already described in 1842, still relatively little is known about this disease. Diagnostic assays and treatment are still suboptimal. Current diagnostic assays are time-consuming and not very reliable. Treatment, especially in eumycetoma, is difficult and usually involves both surgery and medical treatment. Adequate antifungal treatment may take years and is usually started without even knowing if the causative agent is actually susceptible to the chemotherapeutic agent applied. Scope of the thesis To understand the difficulties in diagnosing and treating mycetoma we first review this disease in chapter 2. The current knowledge about this disease, its prevelance, the diagnostic assays used, and the treatment given to the patients are highlighted. As will become clear in this chapter little is known about the disease. In the remaining of this thesis we will focus on 1)Genetic variation of M. mycetomatis and its human host and 2)Antigenicity of M. mycetomatis.

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