Fig 1.
Global distribution of reported mycetoma cases (interactive map).
Total reported mycetoma cases per the dataset compiled by Van de Sande and Fahal in 2024 [18]. The interactive HTML version of the map allows visualization of all cases, or only eumycetoma or actinomycetoma cases (S1 Fig). There, hovering over a country displays its name, its total number of reported cases, and the number attributed to fungal and bacterial etiologies. The map was made using R v4.3.1 with the leaflet package (version 2.2.2) [24]. The underlying map is OpenStreetMaps and the polygons are based on NaturalEarthData.
Table 1.
Common mycetoma causative agents. Overview of the 5 most common actinomycetoma and eumycetoma causative agents. The table specifies whether the species causes actinomycetoma (bacterial) or eumycetoma (fungal), the typical grain color and approximate size (in millimeters), and whether the organism is the predominant causative agent of actino- or eumycetoma in each world region. An asterisk (*) indicates that the genus is specified, but the species is not.
Fig 2.
Mycetoma Activity and Severity Clinical Scale infographic.
Column 1 depicts the mycetoma disease severity scale, and column 2 depicts the mycetoma disease activity scale. Each item is scored from 0 to 3 points. Severity and activity scores are recorded at initial patient presentation and at all follow-up appointments. Scores are expressed as X out of 24 points for disease severity and X out of 10 points for disease activity, with higher scores indicating more severe or active disease. Within column 1, section 1A shows objective clinical features, 1B patient reported outcomes, and 1C findings from additional investigations. A condensed explanation of the individual items is provided as follows: 1A.1: Reappearance of disease at the same site within 3 months. 1A.2: Disease duration. 1A.3: Lesion extent and localization, score 0 • single lesion confined to one anatomical site; score 1 • single lesion spanning two adjacent anatomical sites; score 2 • two or more lesions in different anatomical sites; score 3 • spread of lesion into internal organs or body cavities. 1A.4: Largest lesion diameter (cm) measured from the surface. 1A.5: Anatomical sites involved; score 0 • arms or legs; score 1 • hands, feet, torso, or pelvic region; score 2 • head or neck. 1A.6: Number of open or discharging sinus tracts. 1A.7: Local lympodenopathy, defined as infection of the lymph nodes draining the infection site. 1A.8: Impact on function of the affected joint or limb (not relevant if no joint or limb is affected), score 0 • no impact or not relevant; score 1 • impaired function and/or movement; score 2 • complete loss of function or movement. 1A.9: Pregnancy. 1A.10: Immunosuppression. 1B.1: Patient-reported pain severity using a visual pain scale from 0 (no pain) to 10 (worst imaginable pain), score 0 • absent to mild pain graded 0-3; score 1 • moderate pain, graded 4-6; score 2 • severe pain, graded 7-10. 1B.2: Ability to perform daily living activities independently, score 0 • independent; score 1 • independent with difficulty; score 2 • dependent on others. 1C.1: Evidence of bone involvement on imaging (X-ray, CT or MRI). 1C.2: Contraindications to certain drug regimens, (e.g., abnormal liver function, drug interactions, renal insufficiency, adrenal insufficiency, or anemia). 2A.1: Change in mycetoma size of ≥10%, score 0 • reduction; score 1 • no change larger than 10%; score 2 • enlargement. 2A.2: Active inflammation, present if the skin overlying the lesion feels warmer compared to surrounding skin and/or increased sweating at the lesion site. 2A.3: Change in the number of open or discharging sinus tracts, score 0 • reduction or all closed; score 1 • no change or first assessment; score 2 • increase. 2A.4: Presence of grains in sinus tract discharge. 2B.1: Change in pain severity. 2B.2: Frequency of sinus tract discharge over the last week, score 0 • no discharge; score 1 • intermittent discharge; score 2 • continuous discharge. This infographic was developed based on the Mycetoma Activity and Severity Scale (MASS) [59]. Created in BioRender. Hoekstra, M. (2026) https://BioRender.com/d8uzwr9.