Management of chromoblastomycosis and sporotrichosis in Madagascar

Deep cutaneous mycoses such as chromomycosis, sporotrichosis, and mycetomas are a group of fungal diseases that are not well known, neglected, and underdiagnosed in Madagascar. Madagascar is one of the world’s major centers of chromomycosis with an estimated prevalence of 1/200,000 inhabitants in 1994. The challenge was to start from the diagnosis and management of a few cases to the implementation of a pilot study on these deep-seated mycoses conducted since 2012 in our country in order to estimate their prevalence and identify their epidemiological and mycological characteristics. The preliminary results published allowed us to identify fonsecaea nubica as one of the major fungi responsible for chromomycosis in Madagascar. The prevalence was estimated at 1.47/100,000 in the north of the country. Sporotrichosis due to Sporothrix schenkii is prevalent in the central hihgland. A study on mycetoma is under development. Particular clinical characteristics have been identified in the Malagasy population, allowing a new classification of cases different from that used elsewhere in the world. The objectives of the project also included the preventive and therapeutic aspects and a study on global management is currently underway. Global recognition was obtained with the integration of Madagascar into the Global Action Fund for Fungal Infection (GAFFI), as well as active collaborations developed with international scientific communities. The prospects and challenges are to integrate deep mycoses into the framework of a national program within the Ministry of Health, to develop a management model adapted to the realities of our country, and to obtain long-term technical and financial support from the national authorities and international bodies.

Keywords: chromoblastomycosis, sporotrichosis, mycetoma, epidemiology, perspectives