Table 1.
Prevalence of mycetoma as reported in Sudanese villages.*
Figure 1.
Possible hypothesis for mycetoma infection route.
At the moment, many questions still remain about the various steps in the development of mycetoma. First, it is not known where the causative agents reside. What is the natural habitat of these agents? Both soil and dung have been implicated, but other niches could also be involved. Second, how is the causative agent introduced into the subcutaneous tissue? Is it via a thorn prick as implicated for years, or are vectors, such as insects, involved? When the causative agent is introduced in the subcutaneous tissue, will it always cause mycetoma, or does the host play a role as well? Do immune status, genetic background, or co-infections play a role in the development of mycetoma or even the extent of the infection?