Diagnostic capacities and treatment practices on implantation mycoses: Results from the 2022 WHO global online survey

Between January and March 2022, WHO conducted a global online survey to collect data on diagnostic capacities and treatment practices in different settings for four implantation mycoses: eumycetoma, actinomycetoma, cutaneous sporotrichosis and chromoblastomycosis. The survey investigated the type of diagnostic methods available in countries at various health system levels (tertiary, secondary, primary level) and the medicines used to treat implantation mycoses, with a view to understanding the level of drug repurposing for treatment of these diseases. 142 respondents from 47 countries, including all continents, contributed data: 60% were from middle-income countries, with 59% working at the tertiary level of the health system and 30% at the secondary level. The results presented in this article provide information on the current diagnostic capacity and treatment trends for both pharmacological and non-pharmacological interventions. In addition, the survey provides insight on refractory case rates, as well as other challenges, such as availability and affordability of medicines, especially in middle-income countries. Although the study has limitations, the survey-collected data confirms that drug repurposing is occurring for all four surveyed implantation mycoses. The implementation of an openly accessible global and/or a national treatment registry for implantation mycoses could contribute to address the gaps in epidemiological information and collect valuable observational data to inform treatment guidelines and clinical research. Author summaryIn June 2022, the World Health Organization (WHO) launched a framework for integrated control and management of skin-related neglected tropical diseases. The framework describes how mycetoma, chromoblastomycosis and other (deep) implantation mycoses including sporotrichosis should be addressed and integrated in the primary health care settings. Between January and March 2022, WHO conducted a global online survey to collect information on the medicines used to treat implantation mycoses worldwide. The survey was designed as part of a WHO collaborative project with the United States Food and Drug Administration to identify priority disease areas for pilot testing in CURE ID, a web-based application to help clinicians share their experiences in managing difficult-to-treat infectious diseases and thereby inform clinical research needs to support drug repurposing. The survey also explored the type of diagnostic methods employed in countries within different health care settings (tertiary, secondary, primary level) and the medicines used to treat implantation mycoses, to obtain a better understanding of the practices in diagnostic services and level of drug repurposing for treatment of these diseases.