Eumycetoma: pathogenesis, current treatments, and the search for new drugs.

Eumycetoma is a neglected tropical disease which can be caused by 69 different fungal species. In 2024, eumycetoma was listed as a high priority fungal infection on the fungal priority list of the World Health Organization. Eumycetoma is characterized by chronic subcutaneous swelling, the formation of grains, and progressive tissue destruction. If left untreated, it can lead to severe complications such as bone destruction and permanent disability. Current antifungal treatments, such as itraconazole and terbinafine, are lengthy and often ineffective without surgical intervention. The search for novel treatments is challenging due to limited interest and return of investment. Drug repurposing has emerged as a promising strategy for discovering new effective therapies against eumycetoma. Additionally, the MycetOS initiative focuses on developing novel antifungal compounds that are tested in vitro and in vivo. KEY POINTS: Pathogenesis involves the formation of grains to protect the fungus New treatments are needed for eumycetoma to reduce recurrence and amputation rates Drug repurposing and MycetOS are key strategies for developing new treatments.