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KHARTOUM – There seemed little to worry about: Sudanese farmer Khadija Ahmad was planting onions when he stepped on a thorn through his sandal and cut off his foot.
But the thorn brought with it a carnivorous infection, a bacterial and fungal disease called mycetoma, which runs through the body and causes severe deformities.
For Ahmad, a 45-year-old woman from El Fasher in the war-torn Darfur region of western Sudan, the first thing she knew something was wrong was when her foot swelled up.
“At first I didn’t have any pain, just a lump,” he said. “We thought it would happen.”
Mycetoma, listed as a neglected tropical disease by the United Nations World Health Organization (WHO), is all too common in Sudan.
“I waited nine years before coming,” Ahmad said, as a doctor examined her at the Mycetoma Research Center (MRC) in the capital Khartoum.
“When I arrived, it was too late,” she said, holding her prosthetic leg in her arms. “He had to be amputated.”
Now he has to take medicine for life.
Slow and cunning
The Sudanese have another name for the disease; the “silent death”.
Although few cases are fatal, mycetoma destroys the lives of its victims.
Many of those infected are young farmers walking barefoot in the fields, says the WHO.
For workers who depend on manual labor to survive, crippling infections act as a life sentence.
Mycetoma, caused by bacteria or fungi and usually entering the body through cuts, is a progressively destructive infectious disease of body tissue that affects the skin, muscles, and even bones.
It is often characterized by swollen feet, but can also cause grotesque barnacle-shaped growths and club-shaped hands.
“The disease grows slowly and cunningly within the body for many years,” said Ahmad Hassan Fahal, founder of the MRC clinic.
It can manifest anywhere on the body, not just where the entry cut was made.
“The organism enters the skin and then grows,” Fahal said.
“Disability is very common; nearly 60 percent of people who get the disease end up with deformed limbs.”
It thrives in the humid heat of tropical climates.
Sudan is particularly affected by mycetoma, but it is endemic in a geographic “belt” of some 40 countries ranging from neighboring Ethiopia and Chad to India, Mexico and Venezuela.
“In Sudan, we also call it ‘silent death’, because it creates different problems (disability, deformity and difficulties) and it can kill the patient,” Fahal said.
“People lose their limbs and cannot work.”
Since MRC was founded in 1991, it has treated 9,000 patients for free from all over Sudan.
For a fifth of those who make it to the center, the only option left is amputation.
However, those who make it to the center are “the lucky ones,” Fahal said.
“Most of the people are in the villages in remote areas and cannot come here,” he said. “They are the poorest of the poor.”
Drug development
At MRC’s modern hospital, 30 medical specialists treat 400 patients a week, including patients from other nations affected by mycetoma.
But MRC’s focus is on its state-of-the-art laboratory, a unique global research center dedicated to the disease.
In a treatment room, Walid Nour Al Dayem, 22, lies with his left foot wrapped in bandages.
“A year ago, I was cutting the wheat crop when I stepped on a thorn,” said Dayem, who comes from the farming village of Managil, in the central state of Gezira.
“At the time, I didn’t feel much, but then it got worse.”
The local hospital told him to seek help from MRC.
“Now I’m waiting for my fate to be decided,” he said grumpily.
Doctors took samples from Dayem’s leg to see if his case is a bacterial or fungal infection, or both.
In the case of mycetoma, either is possible, complicating the MRC’s long search for drugs.
Antibiotics help against bacterial infections, but not fungal infections.
“The difficulty in finding a cure for this disease is because it is made of two different things, bacteria and fungi,” Fahal said.
“Until now, no one has been able to create a drug for the two of them together.”
But the researchers are working with Japanese and Swiss scientists on a new drug.
“Hopefully, next year or next, we will have a result,” he said with a wide smile.
