New insights into a disfiguring fungal disease, eumycetoma

Human mycetoma is a mutilating disease of the cutaneous and subcutaneous tissues with a potential to invade deeper structures like muscles and bones. The disease commonly affects the limbs, and in tropical areas, where mycetoma is endemic it is a major cause of disability. The distinctive and unique clinical feature of this infection is the presence of subcutaneous granules which are oozed via fistulas on the skin; the grains are micro-colonies of the causative agent. When this agent is a fungus the disease is known as eumycetoma, while the bacterial type is known as actinomycetoma. Eumycetoma is more troublesome in terms of diagnosis and treatment, and in many cases the infection ends up with amputation. The diagnosis primarily relies on the identification of the causative agent, which may be difficult because eumycetoma can be caused by large number of fungal species that have thus far poorly been characterized. Therefore, the first part of the thesis is devoted to description and classification of the common agents of the disease in the kingdom of fungi. After taxonomic characterization of the species, further reliable criteria for identification of these species were selected. In the second part of the thesis the focus is on development and evaluation of rapid and simple identification tools aiming to improve diagnosis in endemic areas. In an effort to improve the challenging treatment of the disease, the third part of the thesis is focused on antifungal susceptibility of the causative agents and on new treatment options.