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Rao M, Casias M, Abidi MZ. Disseminated Scedosporium infection in the early post-kidney transplant period. Transpl Infect Dis 2024; 26:e14232. [PMID: 38375929 DOI: 10.1111/tid.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 02/21/2024]
Affiliation(s)
- Madhumita Rao
- Division of Infectious Diseases, UCHealth - University of Colorado Hospital, Aurora, Colorado, USA
| | - Michael Casias
- Division of Infectious Diseases, UCHealth - University of Colorado Hospital, Aurora, Colorado, USA
| | - Maheen Z Abidi
- Division of Infectious Diseases, UCHealth - University of Colorado Hospital, Aurora, Colorado, USA
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2
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Badarol Hisham N, Abdul Rhani S, Mohd Ali R, Masri SN. Fusarium falciforme eumycetoma: a diagnostic challenge of a neglected tropical disease. BMJ Case Rep 2024; 17:e258657. [PMID: 38458767 DOI: 10.1136/bcr-2023-258657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Eumycetoma, a subcutaneous infection caused by various fungi with pathognomonic discharging grain, is rarely reported in Malaysia. This case concerns a eumycetoma infection in an immunocompetent man who presented with progressive left foot swelling complicated with pustules, sinuses and pale grain discharge for the past year after recurrent thorn pricks. Histological findings of the grain and tissue showed foci of septate fungal hyphae. Tissue culture yielded no growth. Amplification and sequencing of the rDNA internal transcribed spacer 1 (ITS1), ITS4 and large subunit regions of the tissue identified the causative agent as Fusarium falciforme, highlighting the role of molecular diagnostic method in identifying fungal species in eumycetoma. The patient was treated with surgical excision and oral itraconazole with excellent improvement. However, he presented again with recurrence after defaulting therapy. F. falciforme has been implicated in causing diseases in crops and sea turtles. Therefore, the One Health approach should be adopted to manage this emerging species.
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Affiliation(s)
- Noralwani Badarol Hisham
- Department of Medical Microbiology, Universiti Putra Malaysia Fakulti Perubatan dan Sains Kesihatan, Serdang, Selangor, Malaysia
| | | | - Razana Mohd Ali
- Pathology Department, Universiti Putra Malaysia Fakulti Perubatan dan Sains Kesihatan, Serdang, Selangor, Malaysia
| | - Siti Norbaya Masri
- Department of Medical Microbiology, Universiti Putra Malaysia Fakulti Perubatan dan Sains Kesihatan, Serdang, Selangor, Malaysia
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Liu X, Li R, Song Y, Wang A. Eumycetoma with Atypical Manifestation Caused by Fusarium: First Case Diagnosed by PCR and Next-Generation Sequencing in China. Mycopathologia 2024; 189:18. [PMID: 38407639 DOI: 10.1007/s11046-023-00813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/22/2023] [Indexed: 02/27/2024]
Affiliation(s)
- Xiao Liu
- Department of Dermatology and Venerology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China
- Department of Dermatology and Venerology, Beijing Jishuitan Hospital of Capital Medical University, Beijing, China
| | - Ruoyu Li
- Department of Dermatology and Venerology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China
| | - Yinggai Song
- Department of Dermatology and Venerology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
- Research Center for Medical Mycology, Peking University, Beijing, China.
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China.
| | - Aiping Wang
- Department of Dermatology and Venerology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
- Research Center for Medical Mycology, Peking University, Beijing, China.
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China.
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4
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Ali HO, Elkheir LYM, Fahal AH. The use of artificial intelligence to improve mycetoma management. PLoS Negl Trop Dis 2024; 18:e0011914. [PMID: 38329930 PMCID: PMC10852264 DOI: 10.1371/journal.pntd.0011914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Affiliation(s)
- Hyam Omar Ali
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- The Faculty of Mathematical Sciences, University of Khartoum, Khartoum, Sudan
| | - Lamis Yahia Mohamed Elkheir
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- The Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
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Trindade Torres M, Sousa Nunes B, Varandas L, Maltez F. Actinomycetoma by Cellulosimicrobium cellulans in a Young Man from Guinea-Bissau: Short Literature Review Regarding a Case Report. ACTA MEDICA PORT 2024; 37:46-50. [PMID: 36919988 DOI: 10.20344/amp.17356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/09/2022] [Indexed: 03/16/2023]
Abstract
Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria. Cellulosimicrobium cellulans is a gram-positive bacterium from the order Actinomycetales that rarely causes human disease. The diagnosis is based on the clinical presentation and identification of the causative microorganism. We present a short literature review regarding the case report of a young man diagnosed with actinomycetoma due to Cellulosimicrobium cellulans and who received treatment with an association of amikacin and sulfamethoxazole/ trimethoprim (Welsh regimen).
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Affiliation(s)
| | - Beatriz Sousa Nunes
- Serviço de Infeciologia Pediátrica. Hospital de Dona Estefânia. Lisboa. Portugal
| | - Luís Varandas
- Serviço de Infeciologia Pediátrica. Hospital de Dona Estefânia. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Lisboa; Instituto de Higiene e Medicina Tropical. Lisboa. Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas. Hospital de Curry Cabral. Lisboa. Portugal
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Doğan A, Ali AM, Ali MA, Abdullahi İM. Mycetoma case series in Somalia. Trop Doct 2024; 54:42-44. [PMID: 37715653 DOI: 10.1177/00494755231201664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Mycetoma is a suppurative chronic bacterial or fungal disease inoculated into the body by minor trauma which may penetrate from subcutaneous tissue to bone. Although the lower extremities are most commonly affected, rare forms can also be seen from time to time. The diagnostic triad of swelling in the affected area, multiple sinus formation, and purulent discharge with grains are typical. Definitive diagnosis is made by isolation of the causative pathogen, radiologic imaging, and histopathologic examination. Antifungal and antibacterial options are applied together with surgery. Our aim in this case series is to report and analyze 10 rare cases of mycetoma.
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Affiliation(s)
- Ahmet Doğan
- Department of İnfectious Diseases and Clinical Microbiology, Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Ahmed Mohamed Ali
- Department of İnfectious Diseases and Clinical Microbiology, Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Mukhtar Abdullahi Ali
- Department of İnfectious Diseases and Clinical Microbiology, Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - İsmail Mohamoud Abdullahi
- Department of Medical Pathology, Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
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Nyuykonge B, Siddig EE, Nyaoke BA, Zijlstra EE, Verbon A, Bakhiet SM, Fahal AH, van de Sande WWJ. Using (1,3)-β-D-glucan concentrations in serum to monitor the response of azole therapy in patients with eumycetoma caused by Madurella mycetomatis. Mycoses 2024; 67:e13664. [PMID: 37872649 DOI: 10.1111/myc.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION (1,3)-β-D-glucan is a panfungal biomarker secreted by many fungi, including Madurella mycetomatis, the main causative agent of eumycetoma. Previously we demonstrated that (1,3)-β-D-glucan was present in serum of patients with eumycetoma. However, the use of (1,3)-β-D-glucan to monitor treatment responses in patients with eumycetoma has not been evaluated. MATERIALS AND METHODS In this study, we measured (1,3)-β-D-glucan concentrations in serum with the WAKO (1,3)-β-D-glucan assay in 104 patients with eumycetoma treated with either 400 mg itraconazole daily, or 200 mg or 300 mg fosravuconazole weekly. Serial serum (1,3)-β-D-glucan concentrations were measured at seven different timepoints. Any correlation between initial and final (1,3)-β-D-glucan concentrations and clinical outcome was evaluated. RESULTS The concentration of (1,3)-β-D-glucan was obtained in a total of 654 serum samples. Before treatment, the average (1,3)-β-D-glucan concentration was 22.86 pg/mL. During the first 6 months of treatment, this concentration remained stable. (1,3)-β-D-glucan concentrations significantly dropped after surgery to 8.56 pg/mL. After treatment was stopped, there was clinical evidence of recurrence in 18 patients. Seven of these 18 patients had a (1,3)-β-D-glucan concentration above the 5.5 pg/mL cut-off value for positivity, while in the remaining 11 patients, (1,3)-β-D-glucan concentrations were below the cut-off value. This resulted in a sensitivity of 38.9% and specificity of 75.0%. A correlation between lesion size and (1,3)-β-D-glucan concentration was noted. CONCLUSION Although in general (1,3)-β-D-glucan concentrations can be measured in the serum of patients with eumycetoma during treatment, a sharp decrease in β-glucan concentration was only noted after surgery and not during or after antimicrobial treatment. (1,3)-β-D-glucan concentrations were not predictive for recurrence and seem to have no value in determining treatment response to azoles in patients with eumycetoma.
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Affiliation(s)
- Bertrand Nyuykonge
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | | | - Borna A Nyaoke
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Sahar M Bakhiet
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - Ahmed H Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Danny CG, Manoharan K, Kumar NA, Sowbaghya PT. Unveiling a common neglected tropical disease: actinomycotic mycetoma. QJM 2023; 116:950-951. [PMID: 37354532 DOI: 10.1093/qjmed/hcad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Indexed: 06/26/2023] Open
Affiliation(s)
- C G Danny
- Department of DVL, Sree Balaji Medical College and Hospital, 7, CLC Works Road, Chromepet, Chennai, Tamil Nadu, 600044, India
| | - K Manoharan
- Department of DVL, Sree Balaji Medical College and Hospital, 7, CLC Works Road, Chromepet, Chennai, Tamil Nadu, 600044, India
| | - N A Kumar
- Department of DVL, Sree Balaji Medical College and Hospital, 7, CLC Works Road, Chromepet, Chennai, Tamil Nadu, 600044, India
| | - P T Sowbaghya
- Department of DVL, Sree Balaji Medical College and Hospital, 7, CLC Works Road, Chromepet, Chennai, Tamil Nadu, 600044, India
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Konings M, Eadie K, Strepis N, Nyuykonge B, Fahal AH, Verbon A, van de Sande WWJ. The combination of manogepix and itraconazole is synergistic and inhibits the growth of Madurella mycetomatis in vitro but not in vivo. Med Mycol 2023; 61:myad118. [PMID: 37960934 PMCID: PMC10684268 DOI: 10.1093/mmy/myad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/17/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
Mycetoma is a neglected tropical disease commonly caused by the fungus Madurella mycetomatis. Standard treatment consists of extensive treatment with itraconazole in combination with surgical excision of the infected tissue, but has a low success rate. To improve treatment outcomes, novel treatment strategies are needed. Here, we determined the potential of manogepix, a novel antifungal agent that targets the GPI-anchor biosynthesis pathway by inhibition of the GWT1 enzyme. Manogepix was evaluated by determining the minimal inhibitory concentrations (MICs) according to the CLSI-based in vitro susceptibility assay for 22 M. mycetomatis strains and by in silico protein comparison of the target protein. The synergy between manogepix and itraconazole was determined using a checkerboard assay. The efficacy of clinically relevant dosages was assessed in an in vivo grain model in Galleria mellonella larvae. MICs for manogepix ranged from <0.008 to >8 mg/l and 16/22 M. mycetomatis strains had an MIC ≥4 mg/ml. Differences in MICs were not related to differences observed in the GWT1 protein sequence. For 70% of the tested isolates, synergism was found between manogepix and itraconazole in vitro. In vivo, enhanced survival was not observed upon admission of 8.6 mg/kg manogepix, nor in combination treatment with 5.7 mg/kg itraconazole. MICs of manogepix were high, but the in vitro antifungal activity of itraconazole was enhanced in combination therapy. However, no efficacy of manogepix was found in an in vivo grain model using clinically relevant dosages. Therefore, the therapeutic potential of manogepix in mycetoma caused by M. mycetomatis seems limited.
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Affiliation(s)
- Mickey Konings
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Kimberly Eadie
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Nikolaos Strepis
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Bertrand Nyuykonge
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Ahmed H Fahal
- Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
| | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of Internal Medicine, UMC Utrecht, Utrecht, The Netherlands
| | - Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
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Singh S, Lum J, Majeed A. Effect of Mycetoma in Lung Transplant Patients - a Single Center Experience. Transplant Proc 2023; 55:2197-2202. [PMID: 37758562 DOI: 10.1016/j.transproceed.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Mycetomas are uncommon in lung transplant recipients. Prior studies have shown increased mortality associated with mycetoma in lung transplant recipients (LTR). We reviewed our center's experience in outcome of LTRs with pre -or post-transplant mycetoma. METHODS We retrospectively reviewed electronic health records of LTRs performed at our institute between January 1, 2013 to December 31, 2020. RESULTS Mycetoma was present in less than 1 percent of LTR patients (7/1086). Mean age at the time of the transplant was 65 years. Idiopathic pulmonary fibrosis (5/7), interstitial lung disease (1/7), and sarcoidosis (1/7) were underlying pulmonary diagnoses. Seventy-one percent (5/7) received single lung transplant and 29% received double lung transplant. Seventy-one percent had negative serum galactomannan vs 29% (2/7) of patients who had positive serum galactomannan (one post and one pre). Fifty-seven percent had positive bronchoalveolar aspergillus galactomannan (23% had negative). A total of 42% (3/7) were found to have mycetoma before transplant and 58% (4/7) had mycetoma post transplant. Chest computed tomography findings in all patients were consistent with mycetoma. CONCLUSIONS In our cohort of patients, mycetoma was not found to be the primary cause of death if diagnosed pre transplant. Transplant recipients with mycetoma pre transplant did not develop invasive fungal infection or mycetoma post transplant. Careful evaluation of lung transplant candidates with mycetoma is critical. Further studies are needed to determine optimal duration of antifungal therapy and to determine if surgical resection may be needed to manage post-lung transplant mycetoma.
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Affiliation(s)
- Supriya Singh
- Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Infectious Diseases, University of Tennessee Medical Center, Knoxville, Tennessee.
| | - Jessica Lum
- Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Aneela Majeed
- Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
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Ndour N, Ndiaye MT, Diop A, Ly R, Ndiaye C, Sarr M, Diouf A, Diagne F, Ly F. Fungal mycetoma and pregnancy: An association with costly and difficult management, about a case. PLoS Negl Trop Dis 2023; 17:e0011372. [PMID: 37956163 PMCID: PMC10688872 DOI: 10.1371/journal.pntd.0011372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/30/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Mycetomas are endemic diseases in tropical and sub-tropical countries of Africa, Asia and America, mainly affecting rural populations living below the poverty line. We report a particular case of a mycetoma associated with pregnancy whose evolution was good, but at the cost of significant financial expenses. This was a 39-year-old woman who developed a fungal mycetoma due to Madurella mycetomatis from the ingunocrural region. The patient had to develop several previous pregnancies on this site of mycetoma, the outcome of which was favorable. The last pregnancy was accompanied by an aggravation of the mycetoma in the form of polyfistulized inflammatory swelling of the right inguino-crural region emitting black grains. Magnetic Resonance Imaging (MRI) of the region showed invasion of the adductor muscles at the level of the root of the thigh on its antero-internal side with no sign of pelvic extension or underlying bone lesion. The patient was treated by surgery associated with antifungal treatment. The evolution was favorable for pregnancy and mycetoma.
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Affiliation(s)
- Niare Ndour
- Department of Dermatology, Hospital Institute of Social Hygiene, Dakar, Senegal
| | - Mame Tené Ndiaye
- Department of Dermatology, Albert Royer Hospital, Dakar, Senegal
| | - Assane Diop
- Department of Dermatology, Hospital Institute of Social Hygiene, Dakar, Senegal
| | - Ramatoulaye Ly
- Department of Dermatology, Hospital Institute of Social Hygiene, Dakar, Senegal
| | - Coumba Ndiaye
- Department of Dermatology, Hospital Institute of Social Hygiene, Dakar, Senegal
| | - Mamadou Sarr
- Department of Dermatology, Hospital Institute of Social Hygiene, Dakar, Senegal
| | - Astou Diouf
- Department of Dermatology, Hospital Institute of Social Hygiene, Dakar, Senegal
| | - Fatou Diagne
- Department of Dermatology, Hospital Institute of Social Hygiene, Dakar, Senegal
| | - Fatimata Ly
- Department of Dermatology, Hospital Institute of Social Hygiene, Dakar, Senegal
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França JCB, Carneiro BH, Cognialli RCR, de Queiroz-Telles F. Case report: Mycetoma caused by Gordonia soli. Rev Soc Bras Med Trop 2023; 56:e03262023. [PMID: 37792837 PMCID: PMC10550213 DOI: 10.1590/0037-8682-0326-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023] Open
Abstract
Mycetoma is a neglected tropical disease caused by fungi (eumycetoma) or bacteria (actinomycetoma), with high morbidity. Gordonia spp. are gram-positive bacteria that have previously been reported to cause mycetoma. Here, we report a case of Gordonia soli (initially misidentified as Nocardia spp.) as the etiological agent of actinomycetoma in a 64-year-old patient. After a literature search in the Cochrane Library, LILACS, SciELO, MEDLINE, PubMed, and PubMed Central databases, we concluded that this is the first case report of mycetoma caused by Gordonia soli. The current case highlights the importance of microbiological diagnosis of mycetoma and the challenges in its management.
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13
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Enbiale W, Bekele A, Manaye N, Seife F, Kebede Z, Gebremeskel F, van Griensven J. Subcutaneous mycoses: Endemic but neglected among the Neglected Tropical Diseases in Ethiopia. PLoS Negl Trop Dis 2023; 17:e0011363. [PMID: 37756346 PMCID: PMC10561858 DOI: 10.1371/journal.pntd.0011363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/09/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Subcutaneous (deep) mycoses are a chronic infectious disease of the skin and underlying structures endemic in tropical countries. The disease has serious medical and socioeconomic consequences for patients, communities and health services in endemic areas. The inclusion of mycetoma and other subcutaneous mycoses in the list of Neglected Tropical Diseases by WHO highlights the need to assess the burden of these diseases and establish control programs where necessary. In Ethiopia no strategies can be devised because of a lack of epidemiologic information. To address this evidence gap, we performed a national rapid assessment of the geographic distribution of subcutaneous mycoses. METHODOLOGY We conducted a rapid retrospective assessment using hospital records to identify all suspected and confirmed cases of subcutaneous mycoses in 13 referral hospitals across the country between 2015 and 2022. In each hospital the logbooks were reviewed for diagnoses of subcutaneous mycosess, as diagnosed per routine practice. Descriptive analysis was done. RESULT From 13 hospitals we extracted 143 cases of subcutaneous mycoses, registered from July 2018 to September 2022. 118 (82.5%) patients were diagnosed as mycetoma, 21 (14.7%) as chromoblastomycosis and the remaining 4 (2.8%) as sporotrichosis. The mean age of patients was 35.8 years (SD = 14.5). 101 (70.6%) patients were male and 96 (67.1%) patients were farmers. 64 (44.8%) cases were from the Tigray regional state. 56 (65.9%) patients had information on diagnostic microscopic evaluation: for mycetoma histopathologic evaluation and fine needle aspiration cytology had a higher positivity rate while for chromoblastomycosis potassium hydroxide (KOH) staining had a better yield. The main clinical presentations were nodules, sinuses and infiltrative plaques on the skin. Radiologic findings of bone involvement was present in some. CONCLUSIONS Mycetoma and other subcutaneous mycoses are endemic in Ethiopia, with cases reported from almost all regions with the highest cases numbers reported from the northern part of the country. A routine program and systems should be developed to identify and document the burden of subcutaneous fungal infections in the country. Diagnosis and treatment guidelines should be developed.
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Affiliation(s)
- Wendemagegn Enbiale
- Bahir Dar University, College of Medicine and Health sciences, Bahir Dar, Ethiopia
| | - Alemayehu Bekele
- Arba Minch University Collaborative Research and Training Center for Neglected Tropical Diseases, Arba Minch, Ethiopia
| | - Nigus Manaye
- World Health Organization, country office, Addis Ababa, Ethiopia
| | | | - Zeyede Kebede
- World Health Organization, country office, Addis Ababa, Ethiopia
| | - Filmon Gebremeskel
- Mekele University, College of Medicine and Health Sciences, Mekele, Ethiopia
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Chhabra N, Sri P, Ganguly S. Linezolid: a safer and effective substitute to aminoglycoside in the treatment of actinomycetoma by Nocardia species. Int J Dermatol 2023; 62:1160-1163. [PMID: 37366290 DOI: 10.1111/ijd.16764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
Actinomycetoma is chronic, suppurative, granulomatous infection caused by bacteria and requires prolonged antibiotic therapy preferrably in combinations. Nephrotoxicity is a common side effect of aminoglycosides used in the management of actinomycetoma. We report here two cases of actinomycetoma due to Nocardia species who received linezolid as a substitute to aminoglycosides after developing nephrotoxicity.
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Affiliation(s)
- Namrata Chhabra
- Department of Dermatology, All India Institute of Medical Sciences, Raipur, 492099, Chhattisgarh, India
| | - Preethaa Sri
- Department of Dermatology, All India Institute of Medical Sciences, Raipur, 492099, Chhattisgarh, India
| | - Satyaki Ganguly
- Department of Dermatology, All India Institute of Medical Sciences, Raipur, 492099, Chhattisgarh, India
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Milani B, Dagne DA, Choi HL, Schito M, Stone HA. Diagnostic capacities and treatment practices on implantation mycoses: Results from the 2022 WHO global online survey. PLoS Negl Trop Dis 2023; 17:e0011443. [PMID: 37379338 PMCID: PMC10335693 DOI: 10.1371/journal.pntd.0011443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
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.
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Affiliation(s)
- Barbara Milani
- WHO consultant, World Health Organization, Geneva, Switzeland
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases [WHO/NTD], World Health Organization, Geneva, Switzeland
| | - Hye Lynn Choi
- Department of Control of Neglected Tropical Diseases [WHO/NTD], World Health Organization, Geneva, Switzeland
- Department of Regulation and Prequalification [WHO/RPQ], World Health Organization, Geneva, Switzeland
| | - Marco Schito
- CURE Drug Repurposing Collaboratory, Critical Path Institute, Tucson, Arizona, United States of America
| | - Heather Anne Stone
- Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, United States of America
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Affiliation(s)
- Ahmed Hassan Fahal
- Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
- * E-mail: ,
| | - Kannan Omer Ahmed
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Medani, Gezira state, Sudan
| | - Ali Awadallah Saeed
- Department of Pharmacology, Faculty of Pharmacy, The National University, Khartoum, Sudan
| | - Abdalla Omer Elkhawad
- Department of Pharmacology, Faculty of Pharmacy, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Sahar Mubarak Bakhiet
- Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
- Department of Molecular biology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
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Abd Algaffar SO, Verbon A, Khalid SA, van de Sande WWJ. Development and validation of a resazurin assay for in vitro susceptibility testing of Actinomadura madurae: a common causative agent of actinomycetoma. J Antimicrob Chemother 2022; 78:155-160. [PMID: 36315595 PMCID: PMC9780526 DOI: 10.1093/jac/dkac367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Actinomycetoma is a chronic granulomatous disease affecting skin, subcutaneous tissue, fascia, muscle and bones. With increasing resistance against commonly used treatment regimens, susceptibility testing is urgently needed. METHODS We developed an in vitro susceptibility assay for Actinomadura madurae, one of the common causative agents of actinomycetoma, employing resazurin for endpoint reading. Using this assay, reproducible MICs were determined for the most commonly used antibacterial agents for actinomycetoma treatment. The tested antibacterial agents included trimethoprim/sulfamethoxazole, amikacin, streptomycin, amoxicillin, ceftriaxone, gentamicin, ciprofloxacin, doxycycline, imipenem, linezolid, penicillin G and rifampicin. RESULTS Following the clinical breakpoints as stated by CLSI, 100% of the tested strains were susceptible to trimethoprim/sulfamethoxazole (MIC 0.03/0.59-1/19 mg/L), amikacin (MIC 0.0078-0.25 mg/L), doxycycline (MIC <0.25-1 mg/L) and linezolid (MIC <0.25-2 mg/L), 90% to ciprofloxacin (MIC <0.25-2 mg/L), 80% to ceftriaxone (MIC <0.5 to >64 mg/L) and imipenem (MIC <0.25-32 mg/L) and only 20% to amoxicillin (MIC <0.5 to >64 mg/L) and rifampicin (MIC 0.5 to >32 mg/L). CONCLUSIONS Determinations of MICs by visual readings of colour changes versus spectrophotometric readings were comparable. This convenient visual reading has the advantage of feasible implementation in endemic settings.
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Affiliation(s)
- S O Abd Algaffar
- Faculty of Pharmacy, University of Science & Technology, Omdurman, Sudan
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S A Khalid
- Faculty of Pharmacy, University of Science & Technology, Omdurman, Sudan
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Omer AT, Hasabo EA, Bashir SN, EL hag NE, Ahmed YS, Abdelgadir II, Osman AA. Head and neck mycetoma: Clinical findings, investigations, and predictors for recurrence of the disease in Sudan: A retrospective study. PLoS Negl Trop Dis 2022; 16:e0010838. [PMID: 36251632 PMCID: PMC9576061 DOI: 10.1371/journal.pntd.0010838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 09/20/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Mycetoma is a unique neglected tropical disease which is found endemic in areas known as the "mycetoma belt". Head and neck mycetoma is a rarity and it has many devastating impacts on patients and communities. In this study, we assessed clinical findings, investigations, and predictors for recurrence of head and neck mycetoma in Sudan. METHODOLOGY A retrospective study was conducted at Mycetoma Research Center in Khartoum between January 1999 and December 2020 for all patients with head and neck mycetoma. Data were analyzed using R software version 4.0.2. RESULTS We included 107 patients with head and neck mycetoma. 65.4% were young adult males from mycetoma endemic areas in Sudan, and most of them were students (33.6%). Most of patients (64.4%) had actinomycetoma. Before presenting with head and neck mycetoma, majority (75.7%) had a long duration with mycetoma, and 30.8% had a history of trauma. The commonest invaded site was the parietal region (30.8%). The lesion started gradually in most of the patients (96.3%). 53.3% of the patients had large size lesions with no sweating, regional lymph nodes involvement, or distal vein involvement. CT scan was the most accurate diagnostic tool while 8.4% of patients were diagnosed by clinical examinations only. Laboratory investigations confirmed that 24/45 (44.4%) of actinomycetoma was caused by Streptomyces somaliensis while 13/28 (46.4%) of eumycetoma was caused by Madurella mycetomatis. All patients with recurrence of head and neck mycetoma underwent surgical excision of the lesion (n = 41/41 {100%}, p < 0.001). CONCLUSION In head and neck mycetoma, the most common type was actinomycetes in Sudan. Majority had a long course of mycetoma and the commonest causative organism was Streptomyces somaliensis. The treatment outcome was poor and characterized by a low cure rate.
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Affiliation(s)
- Alaa T. Omer
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- * E-mail:
| | | | - Sara N. Bashir
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Noha E. EL hag
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Yousra S. Ahmed
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Asma A. Osman
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Lim W, Nyuykonge B, Eadie K, Konings M, Smeets J, Fahal A, Bonifaz A, Todd M, Perry B, Samby K, Burrows J, Verbon A, van de Sande W. Screening the pandemic response box identified benzimidazole carbamates, Olorofim and ravuconazole as promising drug candidates for the treatment of eumycetoma. PLoS Negl Trop Dis 2022; 16:e0010159. [PMID: 35120131 PMCID: PMC8815882 DOI: 10.1371/journal.pntd.0010159] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/10/2022] [Indexed: 12/18/2022] Open
Abstract
Eumycetoma is a chronic subcutaneous neglected tropical disease that can be caused by more than 40 different fungal causative agents. The most common causative agents produce black grains and belong to the fungal orders Sordariales and Pleosporales. The current antifungal agents used to treat eumycetoma are itraconazole or terbinafine, however, their cure rates are low. To find novel drugs for eumycetoma, we screened 400 diverse drug-like molecules from the Pandemic Response Box against common eumycetoma causative agents as part of the Open Source Mycetoma initiative (MycetOS). 26 compounds were able to inhibit the growth of Madurella mycetomatis, Madurella pseudomycetomatis and Madurella tropicana, 26 compounds inhibited Falciformispora senegalensis and seven inhibited growth of Medicopsis romeroi in vitro. Four compounds were able to inhibit the growth of all five species of fungi tested. They are the benzimidazole carbamates fenbendazole and carbendazim, the 8-aminoquinolone derivative tafenoquine and MMV1578570. Minimal inhibitory concentrations were then determined for the compounds active against M. mycetomatis. Compounds showing potent activity in vitro were further tested in vivo. Fenbendazole, MMV1782387, ravuconazole and olorofim were able to significantly prolong Galleria mellonella larvae survival and are promising candidates to explore in mycetoma treatment and to also serve as scaffolds for medicinal chemistry optimisation in the search for novel antifungals to treat eumycetoma.
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Affiliation(s)
- Wilson Lim
- Erasmus MC, University Medical Center Rotterdam, Department of Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Bertrand Nyuykonge
- Erasmus MC, University Medical Center Rotterdam, Department of Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Kimberly Eadie
- Erasmus MC, University Medical Center Rotterdam, Department of Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Mickey Konings
- Erasmus MC, University Medical Center Rotterdam, Department of Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Juli Smeets
- Erasmus MC, University Medical Center Rotterdam, Department of Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Ahmed Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | | | - Matthew Todd
- University College London, School of Pharmacy, London, United Kingdom
| | - Benjamin Perry
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | | | - Jeremy Burrows
- Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | - Annelies Verbon
- Erasmus MC, University Medical Center Rotterdam, Department of Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Wendy van de Sande
- Erasmus MC, University Medical Center Rotterdam, Department of Microbiology and Infectious Diseases, Rotterdam, The Netherlands
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Lim W, Konings M, Parel F, Eadie K, Strepis N, Fahal A, Verbon A, van de Sande WWJ. OUP accepted manuscript. Med Mycol 2022; 60:6513817. [PMID: 35064672 PMCID: PMC9295015 DOI: 10.1093/mmy/myac003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/19/2021] [Accepted: 01/08/2022] [Indexed: 11/13/2022] Open
Abstract
Eumycetoma is a neglected tropical disease, and Madurella mycetomatis, the most common causative agent of this disease forms black grains in hosts. Melanin was discovered to be one of the constituents in grains. Melanins are hydrophobic, macromolecular pigments formed by oxidative polymerisation of phenolic or indolic compounds. M. mycetomatis was previously known to produce DHN-melanin and pyomelanin in vitro. These melanin was also discovered to decrease M. mycetomatis’s susceptibility to antifungals itraconazole and ketoconazole in vitro. These findings, however, have not been confirmed in vivo. To discover the melanin biosynthesis pathways used by M. mycetomatis in vivo and to determine if inhibiting melanin production would increase M. mycetomatis's susceptibility to itraconazole, inhibitors targeting DHN-, DOPA- and pyomelanin were used. Treatment with DHN-melanin inhibitors tricyclazole, carpropamid, fenoxanil and DOPA-melanin inhibitor glyphosate in M. mycetomatis infected Galleria mellonella larvae resulted in presence of non-melanized grains. Our finding suggested that M. mycetomatis is able to produce DOPA-melanin in vivo. Inhibiting DHN-melanin with carpropamid in combination with the antifungal itraconazole also significantly increased larvae survival. Our results suggested that combination treatment of antifungals and melanin inhibitors can be an alternative treatment strategy that can be further explored. Since the common black-grain eumycetoma causing agents uses similar melanin biosynthesis pathways, this strategy may be applied to them and other eumycetoma causative agents.
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Affiliation(s)
- Wilson Lim
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | - Mickey Konings
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | - Florianne Parel
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | - Kimberly Eadie
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | - Nikolaos Strepis
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | - Ahmed Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - Annelies Verbon
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | - Wendy W J van de Sande
- To whom correspondence should be addressed. Wendy van de Sande, Assoc Prof. Erasmus MC, University Medical Center Rotterdam, Department of Microbiology and Infectious Diseases, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel: +31 10 703 35 10; E-mail:
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Selvadurai S, Virk J. Cavernous sinus thrombosis secondary to sphenoid mycetoma following COVID-19 infection. QJM 2021; 114:594-595. [PMID: 33844020 PMCID: PMC8083338 DOI: 10.1093/qjmed/hcab075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shaun Selvadurai
- Otolaryngology Department, Whipps Cross University Hospital- Barts Health NHS Trust, London, United Kingdom
- Corresponding Author
| | - Jagdeep Virk
- Otolaryngology Department, Whipps Cross University Hospital- Barts Health NHS Trust, London, United Kingdom
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22
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Bawaskar HS, Bawaskar PH. Mycetoma. J Assoc Physicians India 2021; 69:11-12. [PMID: 34781618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Bakheet OE, Hassan MA, Fahal AH. Extensive perineal Actinomadura pelletieri actinomycetoma-induced urethral stricture: a rare complication. Trans R Soc Trop Med Hyg 2021; 115:415-419. [PMID: 33399848 DOI: 10.1093/trstmh/traa166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/15/2020] [Accepted: 11/26/2020] [Indexed: 11/14/2022] Open
Abstract
Mycetoma is a neglected tropical disease that causes tremendous suffering and misery to affected patients. In Sudanese rural communities, many patients hide their lesions, especially those located in the perineal, scrotal, inguinal and genital regions, and they regard them as sources of social stigma. We report the case of a 45-year-old male from northern Kordofan State, Sudan, who presented with multiple discharging sinuses in the perineal region. Clinical diagnosis was actinomycetoma and fine-needle aspiration cytology was consistent with Actinomadura pelletieri, confirmed by culture and biochemical analysis. To our knowledge, this is the first case of A. pelletieri with urethral complications and subsequent implications for management.
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Konings M, Eadie K, Lim W, Fahal AH, Mouton J, Tesse N, van de Sande WWJ. The synthetic synergistic cinnamon oil CIN-102 is active against Madurella mycetomatis, the most common causative agent of mycetoma. PLoS Negl Trop Dis 2021; 15:e0009488. [PMID: 34106933 PMCID: PMC8216527 DOI: 10.1371/journal.pntd.0009488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 06/21/2021] [Accepted: 05/20/2021] [Indexed: 12/01/2022] Open
Abstract
Mycetoma is a devastating neglected tropical infection of the subcutaneous tissue and most commonly caused by the fungus Madurella mycetomatis. Treatment of mycetoma consists of a combination of a long term antifungal treatment with itraconazole and surgery. However, treatment is associated with low success rates. Therefore, there is a need to identify novel treatments for mycetoma. CIN-102 is a synthetic partial copy of cinnamon oils with activity against many pathogenic bacteria and fungi. In this study we determined the in vitro activity of CIN-102 against 21 M. mycetomatis isolates and its in vivo efficacy in a M. mycetomatis infected Galleria mellonella larval model. In vitro, CIN-102 was active against M. mycetomatis with MICs ranging from 32 μg/mL to 512 μg/mL. 128 μg/mL was needed to inhibit the growth in 50% of tested isolates. In vivo, concentrations below the MIC of 40 mg/kg and 80 mg/kg CIN-102 prolonged larval survival, but higher concentrations of CIN-102 did not. Mycetoma is a tropical infection causing large tumorous lesions on mainly the foot. This infection is most commonly caused by the fungus Madurella mycetomatis. Mycetoma is treated with antifungal agents and surgery but with low success rates. In our search for novel treatments for mycetoma we determined if CIN-102, a synthetic oil that resembles cinnamon oil, would be therapeutic in mycetoma. We therefore determined the activity of this oil against the fungus in vitro. We found that CIN-102 could inhibit M. mycetomatis growth in vitro. To determine if CIN-102 was also active against the mycetoma grain in vivo, we determined the efficacy in our Galleria mellonella grain model. Interestingly, CIN-102 was found to be effective in the larvae at a low concentrations.
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Affiliation(s)
- Mickey Konings
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Kimberly Eadie
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Wilson Lim
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Ahmed H. Fahal
- Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
| | - Johan Mouton
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Nicolas Tesse
- Septeos, Research and experimental development on biotechnology, Paris, France
| | - Wendy W. J. van de Sande
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
- * E-mail:
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Gara S, Litaiem N, Zeglaoui F. [Eumycetoma]. Rev Prat 2021; 71:287. [PMID: 34161030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Soumaya Gara
- "Service de dermatologie, hôpital Charles-Nicolle, université Tunis El Manar, Tunis, Tunisie"
| | - Noureddine Litaiem
- "Service de dermatologie, hôpital Charles-Nicolle, université Tunis El Manar, Tunis, Tunisie"
| | - Faten Zeglaoui
- "Service de dermatologie, hôpital Charles-Nicolle, université Tunis El Manar, Tunis, Tunisie"
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26
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Vera-Cabrera L, Cardenas-de la Garza JA, Cuellar-Barboza A, Gallardo-Rocha A, Molina-Torres CA, Escalante-Fuentes W, Ocampo-Candiani J. Case Report: Coral Reef Pathogen Aspergillus sydowii Causing Black Grain Mycetoma. Am J Trop Med Hyg 2021; 104:871-873. [PMID: 33399044 PMCID: PMC7941817 DOI: 10.4269/ajtmh.20-1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/09/2020] [Indexed: 11/07/2022] Open
Abstract
Mycetoma is an infrequent subcutaneous infection caused by true fungi (eumycetoma) or aerobic actinomycetes (actinomycetoma). We report the case of a 62-year-old man with eumycetoma involving the left foot and ankle. Skin biopsy revealed black-brown grains, and in culture, a white colony fungus grew at day 8. Molecular sequencing using ITS1-ITS4 primers identified the species as Aspergillus sydowii. The patient was treated with itraconazole 200 mg twice daily and terbinafine 250 mg daily for 8 months, with complete response and no recurrence after 2.5 years of follow-up. Aspergillus sydowii is a saprotrophic fungus that rarely causes skin or nail disease. No cases of eumycetoma caused by this agent have been previously reported. As its geographic distribution continues to expand, it may increasingly be recognized as a cause of human disease.
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Affiliation(s)
- Lucio Vera-Cabrera
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Adrian Cuellar-Barboza
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Anabel Gallardo-Rocha
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Carmen Amelia Molina-Torres
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Wendy Escalante-Fuentes
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Ocampo-Candiani
- Laboratorio Interdisciplinario de Investigación Dermatológica, Servicio de Dermatología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
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Cortez de Almeida RF, Correia RES, Varón AG, de Oliveira Coelho JMC, de Oliveira AP, Lourenço MCS, Ribeiro da Silva EADS, Conceição EC, Lamas CDC, Freitas DFS. Actinomycetoma with systemic features: A warning sign for immunosuppression? PLoS Negl Trop Dis 2020; 14:e0008865. [PMID: 33270626 PMCID: PMC7714237 DOI: 10.1371/journal.pntd.0008865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Andréa Gina Varón
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Ana Paola de Oliveira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Emilyn Costa Conceição
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cristiane da Cruz Lamas
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Grande Rio University, Rio de Janeiro, Brazil
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Salinas-Carmona MC, Longoria-Lozano O, Garza-Esquivel HR, López-Ulloa J, Reyes-Carrillo J, Vázquez-Marmolejo AV. Inducible nitric oxide synthase blockade with aminoguanidine, protects mice infected with Nocardia brasiliensis from actinomycetoma development. PLoS Negl Trop Dis 2020; 14:e0008775. [PMID: 33091049 PMCID: PMC7580934 DOI: 10.1371/journal.pntd.0008775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022] Open
Abstract
Mycetoma is a chronic infectious disease that can be caused by fungi or bacteria, Madurella mycetomatis and Nocardia brasiliensis are frequent etiologic agents of this disease. Mycetoma produced by bacteria is known as actinomycetoma. In mycetoma produced by fungi (eumycetoma) and actinomycetoma, diagnosis of the disease is based on clinical findings: severe inflammation, with deformities of affected tissues, abscesses, fistulae, sinuses and discharge of purulent material that contains micro colonies of the etiologic agent. Microscopic examination of infected tissue is similar regardless of the offending microbe; hallmark of infected tissue is severe inflammation with abundant neutrophils around micro colonies and granuloma formation with macrophages, lymphocytes, dendritic and foamy cells. Even though medical treatment is available for mycetoma patients, amputation, or surgical intervention is frequently needed. The pathogenesis of actinomycetoma is little known, most information was obtained from experimental animal models infected with bacteria. In other experimental mice infections with different microbes, it was demonstrated that nitric oxide is responsible for the intracellular killing of Mycobacterium tuberculosis by activated macrophages. Nitric oxide is a free radical with potent stimulatory and suppressive effects in innate and adaptive immunity. The unstable nitric oxide molecule is produced by action of nitric oxide synthases on L-arginine. There are three nitric oxide synthases expressed in different cells and tissues, two are constitutively expressed one in neurons, and the other in endothelial cells and one that is inducible in macrophages. Aminoguanidine is a competitive inhibitor of inducible nitric oxide synthase. Its administration in experimental animals may favor or harm them. We used aminoguanidine in mice infected with Nocardia brasiliensis, and demonstrated that all treated animals were protected from actinomycetoma development. Anti N. brasiliensis antibodies and T cell proliferation were not affected, but inflammation was reduced.
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Affiliation(s)
- Mario C. Salinas-Carmona
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, Servicio de Inmunología, Monterrey, Nuevo Leon, Mexico
- * E-mail:
| | - Ossian Longoria-Lozano
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, Servicio de Inmunología, Monterrey, Nuevo Leon, Mexico
| | - Humberto R. Garza-Esquivel
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, Servicio de Inmunología, Monterrey, Nuevo Leon, Mexico
| | - Juan López-Ulloa
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, Servicio de Inmunología, Monterrey, Nuevo Leon, Mexico
| | - Jorge Reyes-Carrillo
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, Servicio de Inmunología, Monterrey, Nuevo Leon, Mexico
| | - Anna Velia Vázquez-Marmolejo
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, Servicio de Inmunología, Monterrey, Nuevo Leon, Mexico
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Singh G, Agarwal R, Khullar S, Xess I, Sharma VK, Goyal A. Recalcitrant eumycetoma of the foot: Financial burden a major barrier on the road of recovery. PLoS Negl Trop Dis 2020; 14:e0008356. [PMID: 32760057 PMCID: PMC7410166 DOI: 10.1371/journal.pntd.0008356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Reshu Agarwal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Khullar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
- * E-mail:
| | - Vinod Kumar Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Cárdenas-de la Garza JA, Welsh O, Cuéllar-Barboza A, Suarez-Sánchez KP, De la Cruz-Valadez E, Cruz-Gómez LG, Gallardo-Rocha A, Ocampo-Candiani J, Vera-Cabrera L. Clinical characteristics and treatment of actinomycetoma in northeast Mexico: A case series. PLoS Negl Trop Dis 2020; 14:e0008123. [PMID: 32097417 PMCID: PMC7059949 DOI: 10.1371/journal.pntd.0008123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/06/2020] [Accepted: 02/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological agent. Mycetoma may be caused by true fungi (eumycetoma) or filamentous aerobic bacteria (actinomycetoma). Mycetoma is more frequent in the so-called mycetoma belt (latitude 15° south and 30° north around the Tropic of Cancer), especially in Sudan, Nigeria, Somalia, India, Mexico, and Venezuela. The introduction of new antibiotics with fewer side effects, broader susceptibility profiles, and different administration routes has made information on actinomycetoma treatment and outcomes necessary. The objective of this report was to provide an update on clinical, therapeutic, and outcome data for patients with actinomycetoma attending a reference center in northeast Mexico. Methodology/principal findings This was a retrospective, cross-sectional, descriptive study of 31 patients (male to female ratio 3.4:1) diagnosed with actinomycetoma by direct grain examination, histopathology, culture, or serology from January 2009 to September 2018. Most lesions were caused by Nocardia brasiliensis (83.9%) followed by Actinomadura madurae (12.9%) and Actinomadura pelletieri (3.2%). About 50% of patients had bone involvement, and the right leg was the most commonly affected region in 38.7% of cases. Farmers/agriculture workers were most commonly affected, representing 41.9% of patients. The most commonly used treatment regimen was the Welsh regimen (35.5% of cases), a combination of trimethoprim/sulfamethoxazole (TMP/SMX) plus amikacin, which had a 90% cure rate, followed by TMP/SMX plus amoxicillin/clavulanic acid in 19.4% of cases with a cure rate of 100%. In our setting, 28 (90.3%) patients were completely cured and three (9.7%) were lost to follow-up. Four patients required multiple antibiotic regimens due to recurrences and adverse effects. Conclusions/significance In our sample, actinomycetoma was predominantly caused by N. brasiliensis. Most cases responded well to therapy with a combination of TMP/SMX with amikacin or TMP/SMX and amoxicillin/clavulanic acid. Four patients required multiple antibiotics and intrahospital care. Mycetoma is a chronic skin disease that can invade bone or underlying organs. Inadequate treatment may lead to long-lasting disability. Information about treatment is scarce. We report the outcomes of 31 patients with a diagnosis of bacterial actinomycetoma attending a tertiary care hospital in northeast Mexico. Most cases were treated with a combination of antibiotics including TMP/SMX plus amikacin or TMP/SMX plus amoxicillin/clavulanic acid. Cure was achieved in 90% of patients and only one required surgery.
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Affiliation(s)
- Jesús Alberto Cárdenas-de la Garza
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Oliverio Welsh
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adrián Cuéllar-Barboza
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Karina Paola Suarez-Sánchez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Estephania De la Cruz-Valadez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Luis Gerardo Cruz-Gómez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Anabel Gallardo-Rocha
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Ocampo-Candiani
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Lucio Vera-Cabrera
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
- * E-mail:
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Gameraddin M, Gareeballah A, Mokhtar S, M Abuzaid M, Alhazmi F, Ali Hamad H. Characterization of Foot Mycetoma Using Sonography and Color Doppler Imaging. Pak J Biol Sci 2020; 23:968-972. [PMID: 32700845 DOI: 10.3923/pjbs.2020.968.972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Mycetoma of the foot, commonly referred to as Madura foot, is a chronic granulomatous infection, which impacts vascularization of the affected region. This study aimed to evaluate foot mycetoma using Doppler and sonography techniques to identify the principle sonographic features and blood flow patterns associated with the condition. MATERIALS AND METHODS This was a cross-sectional prospective single-center study conducted at the Mycetoma Research Center (MCR) in Khartoum State, Sudan. Sixty patients with Madura foot were examined using a Duplex ultrasound machine with a 7-10 MHZ linear probe. Data was analyzed using SPSS software. The distribution of demographic data was evaluated by simple descriptive statistics. Statistical tests was performed using Student's independent t-tests to compare different forms of mycetoma and Chi-square tests to examine differences in blood flow patterns between fungal (eumycetoma) and bacterial (actinomycetoma) forms of the infection. RESULTS The presence of multiple cavities and aggregated grains were more common in eumycetoma than in actinomycetoma. The echotexture was significantly more heterogeneous in eumycetoma than in actinomycetoma (p = 0.03). Eumycetoma had higher vascularity than actinomycetoma. CONCLUSION Mycetoma has characteristic sonographic features and patterns of vascularity, which are essential to differentiate between the fungal and bacterial forms of mycetoma.
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Tazi S, Konzi KME, Chachi EM, Lyagoubi M, Aoufi S. Epidemiological profile of eumycetomas in Rabat, Morocco, over 40 years. J Mycol Med 2019; 29:356-360. [PMID: 31587988 DOI: 10.1016/j.mycmed.2019.100902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 11/20/2022]
Abstract
Eumycetomas are chronic subcutaneous pseudo-tumoral infections, endemic in arid tropical areas, which are caused by exogenous fungi that produce grains in vivo. The objective of our work is to establish their epidemiological, clinical and mycological profile in our Moroccan context. Therefore, we conducted a retrospective study, extending from 1975 to 2019, compiling all cases of eumycetomas that were diagnosed in the parasitology-mycology laboratory of the Ibn Sina University Hospital of Rabat. The diagnosis, based on the swabbing of exudates and eventual grains or the study of biopsies, included the direct examination of 30% KOH mounts, the realization of appositions colored by May-Grünwald-Giemsa and the incubation on 3 Sabouraud media at 27° and 37°C. In 44 years, 12 cases of eumycetoma have been diagnosed, with a male to female ratio of 5:1 and a mean age of 44.8 years. The lesions, evolving from 1 to 30 years, were podal in 10 cases, popliteal and gluteal in one case each, with osteolysis in 3 patients. The collected grains were black in 9 cases, white in 2 others. Direct examination was unanimously positive, revealing entangled hyphae, whilst culture isolated Madurella sp. in 9 cases, Trichophyton rubrum, Acremonium sp. in one case each and remained sterile in the last case. The treatment was medical in 8 cases, medico-surgical in 3 others, with loss of sight of most patients.
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Affiliation(s)
- S Tazi
- Central laboratory of parasitology-mycology, Ibn Sina University Hospital, Rabat. Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco.
| | - K M-E Konzi
- Central laboratory of parasitology-mycology, Ibn Sina University Hospital, Rabat. Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - E M Chachi
- Central laboratory of parasitology-mycology, Ibn Sina University Hospital, Rabat. Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - M Lyagoubi
- Central laboratory of parasitology-mycology, Ibn Sina University Hospital, Rabat. Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - S Aoufi
- Central laboratory of parasitology-mycology, Ibn Sina University Hospital, Rabat. Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
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Uno K, Hishiya N, Matsuda M, Kai Y, Amano M, Nakamura A, Tohjyo T, Kawaguchi T, Nakano R, Yano H, Kasahara K, Mikasa K. Case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae tracheobronchial mycetoma. J Infect Chemother 2019; 25:1065-1069. [PMID: 31227382 DOI: 10.1016/j.jiac.2019.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022]
Abstract
Cunninghamella is a member of the class Zygomycetes. Cunninghamella species include ubiquitous filamentous fungi; infections caused by Cunninghamella species are less frequent but have higher mortality rates than infections caused by Mucorales group members such as Rhizopus and Mucor. Herein, we reported a rare fatal case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae tracheobronchial mycetoma. A 73-year-old female with a history of right-sided breast cancer who had undergone mastectomy 11 years previously and had no recurrence presented to our emergency department with a 1-week history of left-sided back pain. Chest X-ray revealed left lung atelectasis; bronchoscopy revealed an endobronchial mass lesion in the left main bronchus. Pathological examination revealed fungal mycetoma but malignant lesions were not detected. Endobronchial and lung mycetoma caused by Cunninghamella bertholletiae were initially diagnosed; liposomal amphotericin B was administered, but her condition deteriorated. Rigid endoscopy showed growth of hemorrhagic tissue occupying the left main bronchus just under the carina. Pathological examination of the shaved lesion revealed metastasis from breast cancer covered with abundant necrotic tissue. No mold was observed in the necrotic tissue; this was probably due to liposomal amphotericin B treatment. To our knowledge, this is the first case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae mycetoma. Distinguishing endobronchial metastases from breast cancer and atypical presentations of Cunninghamella endobronchial mycetomas can be very difficult. Repeated bronchoscopies maybe helpful in establishing an accurate diagnosis when clinical prognosis does not match the initial diagnosis.
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Affiliation(s)
- Kenji Uno
- Department of Infectious Diseases, Minami-Nara General Medical Center, Fukugami 8-1, Oyodocho, Yoshino-gun, Nara, Japan.
| | - Naokuni Hishiya
- Department of Infectious Diseases, Minami-Nara General Medical Center, Fukugami 8-1, Oyodocho, Yoshino-gun, Nara, Japan
| | - Masayuki Matsuda
- Department of Respiratory Medicine, Minami-Nara General Medical Center, Fukugami 8-1, Oyodocho, Yoshino-gun, Nara, Japan
| | - Yoshiro Kai
- Department of Respiratory Medicine, Minami-Nara General Medical Center, Fukugami 8-1, Oyodocho, Yoshino-gun, Nara, Japan
| | - Masayuki Amano
- Department of General Medicine, Minami-Nara General Medical Center, Fukugami 8-1, Oyodocho, Yoshino-gun, Nara, Japan
| | - Atsuhiro Nakamura
- Department of Respiratory Medicine, Nara Prefectural Seiwa Medical Center, Mimuro1-14-16, Sango-cho, Ikoma-gun, Nara, Japan
| | - Takashi Tohjyo
- Department of Thoracic Surgery, Saiseikai Chuwa Hospital, Abe323, Sakurai City, Nara, Japan
| | - Takeshi Kawaguchi
- Department of Thoracic Surgery, Nara Medical University, Shijyo-cho 840, Kashihara City, Nara, Japan
| | - Ryuichi Nakano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Shijyo-cho 840, Kashihara City, Nara, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Shijyo-cho 840, Kashihara City, Nara, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Keiichi Mikasa
- Center for Infectious Diseases, Nara Medical University, Nara, Japan
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Fida M, Saraceno R, Gjylametaj N, Dervishi O, Barbullushi A, Kellici S, Vasili E. Eumycetoma pedis in an Albanian farmer. Cutis 2018; 102:E13-E15. [PMID: 30566558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Monika Fida
- Department of Dermatology, University of Medicine, Tirana, Albania
| | - Rosita Saraceno
- Department of Dermatology, University of Rome Tor Vergata, Italy
| | | | - Orjana Dervishi
- Laboratory Department, University of Medicine, Tirana, Albania
| | | | - Suela Kellici
- Faculty of Pharmacy, University of Medicine, Tirana, Albania
| | - Ermira Vasili
- Department of Dermatology, University of Medicine, Tirana, Albania
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Fasciana T, Colomba C, Cervo A, Di Carlo P, Scarlata F, Mascarella C, Giammanco A, Cascio A. Madura foot: an imported case of a non-common diagnosis. Infez Med 2018; 26:167-170. [PMID: 29932092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mycetoma (or "madura foot") is characterized by deformation, cutaneous lesions, infection of tissues extending from the cutaneous layer to the underlying fascia, and an indolent course. A number of fungal or bacterial agents that are introduced through traumatic inoculation can be responsible for the disease, but Actinomadura madurae is among the most common agents of mycetoma occurring worldwide. We report a case of madura foot caused by A. madurae in an immunocompetent young Somali man who was admitted with a diagnosis of skin and soft tissue infection of the left foot with osteomyelitis. The present report emphasizes the importance of the knowledge of this infection, which is sporadic but problematic to treat and, above all, difficult to diagnose. Moreover, a multidisciplinary approach with involvement of an infectious diseases specialist with experience in tropical diseases and a microbiology unit performing rapid molecular diagnostic tests is required for early diagnosis and an optimal antibiotic therapy.
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Affiliation(s)
- Teresa Fasciana
- Department of Sciences for Health Promotion and Mother and Child care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Claudia Colomba
- Department of Sciences for Health Promotion and Mother and Child care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Adriana Cervo
- Department of Sciences for Health Promotion and Mother and Child care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Paola Di Carlo
- Department of Sciences for Health Promotion and Mother and Child care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco Scarlata
- Department of Sciences for Health Promotion and Mother and Child care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Chiara Mascarella
- Department of Sciences for Health Promotion and Mother and Child care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Anna Giammanco
- Department of Sciences for Health Promotion and Mother and Child care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Antonio Cascio
- Department of Sciences for Health Promotion and Mother and Child care "G. D'Alessandro", University of Palermo, Palermo, Italy
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Lim W, Melse Y, Konings M, Phat Duong H, Eadie K, Laleu B, Perry B, Todd MH, Ioset JR, van de Sande WWJ. Addressing the most neglected diseases through an open research model: The discovery of fenarimols as novel drug candidates for eumycetoma. PLoS Negl Trop Dis 2018; 12:e0006437. [PMID: 29698504 PMCID: PMC5940239 DOI: 10.1371/journal.pntd.0006437] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/08/2018] [Accepted: 04/06/2018] [Indexed: 01/28/2023] Open
Abstract
Eumycetoma is a chronic infectious disease characterized by a large subcutaneous mass, often caused by the fungus Madurella mycetomatis. A combination of surgery and prolonged medication is needed to treat this infection with a success rate of only 30%. There is, therefore, an urgent need to find more effective drugs for the treatment of this disease. In this study, we screened 800 diverse drug-like molecules and identified 215 molecules that were active in vitro. Minimal inhibitory concentrations were determined for the 13 most active compounds. One of the most potent compounds, a fenarimol analogue for which a large analogue library is available, led to the screening of an additional 35 compounds for their in vitro activity against M. mycetomatis hyphae, rendering four further hit compounds. To assess the in vivo potency of these hit compounds, a Galleria mellonella larvae model infected with M. mycetomatis was used. Several of the compounds identified in vitro demonstrated promising efficacy in vivo in terms of prolonged larval survival and/or reduced fungal burden. The results presented in this paper are the starting point of an Open Source Mycetoma (MycetOS) approach in which members of the global scientific community are invited to participate and contribute as equal partners. We hope that this initiative, coupled with the promising new hits we have reported, will lead to progress in drug discovery for this most neglected of neglected tropical diseases.
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Affiliation(s)
- Wilson Lim
- Erasmus MC, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Youri Melse
- Erasmus MC, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Mickey Konings
- Erasmus MC, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Hung Phat Duong
- School of Chemistry, The University of Sydney, Sydney, Australia
| | - Kimberly Eadie
- Erasmus MC, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Benoît Laleu
- Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | - Benjamin Perry
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
| | - Matthew H. Todd
- School of Chemistry, The University of Sydney, Sydney, Australia
| | | | - Wendy W. J. van de Sande
- Erasmus MC, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
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Bonifaz A, Del Carmen Padilla M, Vázquez-González D, Hernández MA, Saldaña M, Hernández-Castro R, Tirado-Sánchez A. Abdominal actinomycetoma with double aetiology due to Nocardia brasiliensis and Actinomadura madurae. Eur J Dermatol 2018; 28:96-97. [PMID: 29165305 DOI: 10.1684/ejd.2017.3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Alexandro Bonifaz
- Dermatology Service and Mycology Department, Hospital General de México "Dr. Eduardo Liceaga"
| | | | | | - Marco A Hernández
- Dermatology Service and Mycology Department, Hospital General de México "Dr. Eduardo Liceaga"
| | - Mariana Saldaña
- Dermatology Service and Mycology Department, Hospital General de México "Dr. Eduardo Liceaga"
| | | | - Andrés Tirado-Sánchez
- Dermatology Service and Mycology Department, Hospital General de México "Dr. Eduardo Liceaga"
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Affiliation(s)
| | - Ahmed Hassan Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- * E-mail:
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Bonifaz A, Espinosa-Díaz S, Argáez J, Hernández-Castro R, Xicohtencatl-Cortes J, Tirado-Sánchez A. Actinomycetoma due to Nocardia brasiliensis with extension to the ovaries. Eur J Obstet Gynecol Reprod Biol 2017; 211:224-225. [PMID: 28259373 DOI: 10.1016/j.ejogrb.2017.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Jesús Argáez
- Gynecology Service, Hospital General de México "Eduardo Liceaga", Mexico
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Abstract
Mycetoma are chronic subcutaneous infections, endemic in dry tropical regions. It can be caused either by actinomycetes or by fungi, presenting as filamentous grains in vivo. The foot is the most common localization. The main complication is osseous involvement. Patients are rural workers living in areas situated far from medical centers. Too often, they reach well-equipped hospitals with advanced mutilating lesions. Early case detection is the first condition for good therapeutic results. Clinical presentations of actinomycetoma and eumycetoma are similar, only biological diagnosis can distinguish the two etiological forms. This distinction is essential as medical therapy for each is radically different. Precise identification of the causal agent is required for targeted treatment but it can only be realized in rare specialized laboratories. For actinomycetoma, standard therapy is trimethoprim-sulphamethoxazole (STX). Duration of treatment period is one-year minimum. In case of poor response to STX or high risk of dissemination, a combination with amikacin gave high cure rate. Other options as amoxicillin-clavulanate are available. Medical cure of actinomycetoma is generally obtained with antibiotic treatments and surgical indications are exceptional. Disappointing results were observed using antifungal in the treatment of eumycetoma and medical therapy must be completed with surgical excision. Itraconazole is now the most used drug, new triazoles are on evaluation.
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Affiliation(s)
- M Develoux
- Service de parasitologie-mycologie, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Veraldi S, Grancini A, Venegoni L, Merlo V, Guanziroli E, Menicanit C, Nazzaro G, Tortorano A. Mycetoma Caused by Aspergillus nidulans. Acta Derm Venereol 2016; 96:118-9. [PMID: 26014969 DOI: 10.2340/00015555-2144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Stefano Veraldi
- Department of Pathophysiology and Transplantation, University of Milan, I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, via Pace 9, IT-20122 Milan, Italy
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Fahal A, Mahgoub ELS, Hassan AMEL, Abdel-Rahman ME. Mycetoma in the Sudan: an update from the Mycetoma Research Centre, University of Khartoum, Sudan. PLoS Negl Trop Dis 2015; 9:e0003679. [PMID: 25816316 PMCID: PMC4376889 DOI: 10.1371/journal.pntd.0003679] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/05/2015] [Indexed: 11/25/2022] Open
Abstract
This communication reports on the Mycetoma Research Centre of the University of Khartoum, Sudan experience on 6,792 patients seen during the period 1991–2014.The patients were predominately young (64% under 30 years old) males (76%). The majority (68%) were from the Sudan mycetoma belt and 28% were students. Madurella mycetomatis eumycetoma was the most common type (70%). In 66% of the patients the duration of the disease was less than five years, and 81% gave a history of sinuses discharging mostly black grains (78%). History of trauma at the mycetoma site was reported in 20%. Local pain was reported in 27% of the patients, and only 12% had a family history of mycetoma. The study showed that 57% of the patients had previous surgical excisions and recurrence, and only 4% received previous medical treatment for mycetoma. Other concomitant medical diseases were reported in 4% of the patients. The foot (76%) and hand (8%) were the most commonly affected sites. Less frequently affected sites were the leg and knee (7%), thigh (2%), buttock (2%) and arm and forearm (1%). Rare sites included the chest wall, head and neck, back, abdominal wall, perineum, oral cavity, tongue and eye. Multiple sites mycetoma was recorded in 135 (2%) of cases. At presentation, 37% of patients had massive lesions, 79% had sinuses, 8% had local hyper-hydrosis at the mycetoma lesion, 11% had regional lymphadenopathy, while 6% had dilated tortuous veins proximal to the mycetoma lesions. The diagnosis of mycetoma was established by combined imaging techniques and cytological, histopathological, serological tests and grain culture. Patients with actinomycetoma received a combination of antimicrobial agents, while eumycetoma patients received antifungal agents combined with various surgical excisions. Surgical excisions in the form of wide local excision, debridement or amputation were done in 807 patients, and of them 248 patients (30.7%) had postoperative recurrence. Different types of amputations were done in 120 patients (1.7%). Many researchers consider the Sudan as the mycetoma homeland. The first report on mycetoma was at the turn of the eighteenth century, and since then many documents on mycetoma have been reported. However, there is no recent report on mycetoma in the country. In 1977 Mahgoub published data on mycetoma in Sudan, but no more data were published until the MRC was established. The present study reports on 6,792 patients with mycetoma seen and managed at the MRC in a period of 23 years. This is the largest reported number of cases on the disease at national and international levels. The clinical presentations of the reported patients were in line with the previous reports on mycetoma from the Sudan and elsewhere. Still, many patients presented late with advanced disease and enormous disabilities and deformities. Some of them had a fatal outcome due to several complications. Despite advances in the diagnosis and treatment of this disease, outcome is still unsatisfactory. There is a need for more research to develop effective treatment of mycetoma and field friendly diagnostic techniques. Adequate preventive and control measures to reduce the disease morbidity and mortality are needed.
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Affiliation(s)
- Ahmed Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- * E-mail: ,
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Füeßl HS. [Freed from actinomycetoma and wheelchair]. MMW Fortschr Med 2015; 157:38. [PMID: 25743978 DOI: 10.1007/s15006-015-2768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Baha H, Khadir K, Hali F, Benchikhi H, Zeghwagh A, Zerouali K, Belabbes H, El Mdaghri N, Soussi MA, Marnissi F, Kadioui F. [Actinomycosic mycetoma of the foot in Morocco due to Actinomycetes viscosus]. J Mycol Med 2015; 25:76-80. [PMID: 25649200 DOI: 10.1016/j.mycmed.2014.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/17/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022]
Abstract
We present the case of an actinomycotic mycetoma of the foot due to Actinomycetes viscosus. It evolved for nine years on the foot of a 26-year-old patient from a rural environment: Douar Inezgane (city in southern Morocco). Bacteriological study of the skin and grains confirmed the diagnosis. It showed positive bacilli on direct examination and on Gram staining and in positive culture. Histological study showed a polymorphous granulomatous inflammation without signs of malignancy with actinomycotic grains. Then we retained the diagnosis of primary cutaneous actinomycosis without visceral locations. The treatment was based on antibiotics: penicillin G by intravenous infusion for five weeks, relayed orally by amoxicillin associated with trimethoprim-sulfamethoxazole for long periods. After six months of treatment, we observed a favorable outcome with reduction of the swelling, nodules, lymphadenopathy, fistula's number and extension of time of issue of grains. The current follow up is 15 months. The primary cutaneous actinomycosis is still relevant in Morocco.
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Affiliation(s)
- H Baha
- Dermatology, Ibn Rochd CHU, route 1029, immeuble 28, numéro 6 Sidi-maarouf, Casablanca, Ain Chock 20270, Maroc.
| | - K Khadir
- Dermatology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
| | - F Hali
- Dermatology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
| | - H Benchikhi
- Dermatology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
| | - A Zeghwagh
- Microbiology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
| | - K Zerouali
- Microbiology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
| | - H Belabbes
- Microbiology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
| | - N El Mdaghri
- Microbiology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
| | - M A Soussi
- Parasito-mycology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
| | - F Marnissi
- Anatomopathology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
| | - F Kadioui
- Parasito-mycology department of UHC Ibn Rushd of Casablanca, Casablanca, Maroc
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Abstract
Medical treatment of mycetoma depends on its fungal or bacterial etiology. Clinically, these entities share similar features that can confuse diagnosis, causing a lack of therapeutic response due to inappropriate treatment. This review evaluates the response to available antimicrobial agents in actinomycetoma and the current status of antifungal drugs for treatment of eumycetoma.
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Affiliation(s)
- Oliverio Welsh
- Department of Dermatology, Dr. Jose E. Gonzalez University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
- * E-mail:
| | - Hail Mater Al-Abdely
- Section of Infectious Diseases, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mario Cesar Salinas-Carmona
- Department of Immunology, Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Buonfrate D, Gobbi F, Angheben A, Marocco S, Farina C, Van Den Ende J, Bisoffi Z. Autochthonous cases of mycetoma in Europe: report of two cases and review of literature. PLoS One 2014; 9:e100590. [PMID: 24963778 PMCID: PMC4070928 DOI: 10.1371/journal.pone.0100590] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/17/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mycetoma is a chronic granulomatous infection involving cutaneous and subcutaneous tissues. It is endemic in tropical and subtropical areas, but sporadic cases have been reported also in countries of temperate climate. The purpose of this paper is to review the cases of mycetoma in European subjects (and presumably acquired in Europe), to give an insight in the main factors associated with this condition, and to describe two previously unpublished cases observed at our Centre. METHODS AND FINDINGS PubMed was systematically searched for case reports and case series of mycetoma in Europeans reported between 1980 and 2014, using specific search strategies. Two further cases diagnosed by the authors are described. Forty-two cases were collected. Eleven cases were caused by Scedosporium apiospermium, mainly in immunosuppressed patients from Bulgaria, Germany, the Netherlands, Portugal, Slovenia, Spain and the United Kingdom. Excluding all patients with immunosuppression, 29 cases remain. Most of them were reported from Bulgaria and in Albanian patients (all diagnosed outside Albania). In the Bulgarian case series many different micro-organisms, both bacteria and fungi, were isolated, while all the 5 cases from Albania were caused by Actinomadura spp. Other countries reporting cases were Greece, Italy and Turkey. In general, Actinomadura spp is the most frequent causative agent isolated, followed by Nocardia spp and Madurella mycetomatis. The foot was the most reported site involved. Most patients were medically treated, but unfortunately a long-term follow up (at least one year) was available only in a few cases. CONCLUSIONS Our review and our own cases suggest that Europeans without travel history can be affected by Madura foot. The lack of a surveillance system is likely to cause an underreporting of cases. Moreover, the unfamiliarity of Western doctors with this peculiar infection may cause a mismanagement, including unnecessary amputations.
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Affiliation(s)
- Dora Buonfrate
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
- * E-mail:
| | - Federico Gobbi
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Andrea Angheben
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Stefania Marocco
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Claudio Farina
- Microbiology Institute, AO Papa Giovanni XXIII, Bergamo, Italy
| | - Jef Van Den Ende
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Zeno Bisoffi
- Center for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
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Mhmoud NA, Fahal AH, Mahgoub ES, van de Sande WWJ. The combination of amoxicillin-clavulanic acid and ketoconazole in the treatment of Madurella mycetomatis eumycetoma and Staphylococcus aureus co-infection. PLoS Negl Trop Dis 2014; 8:e2959. [PMID: 24945499 PMCID: PMC4063734 DOI: 10.1371/journal.pntd.0002959] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 05/07/2014] [Indexed: 11/19/2022] Open
Abstract
Eumycetoma is a chronic progressive disabling and destructive inflammatory disease which is commonly caused by the fungus Madurella mycetomatis. It is characterized by the formation of multiple discharging sinuses. It is usually treated by antifungal agents but it is assumed that the therapeutic efficiency of these agents is reduced by the co-existence of Staphylococcus aureus co-infection developing in these sinuses. This prospective study was conducted to investigate the safety, efficacy and clinical outcome of combined antibiotic and antifungal therapy in eumycetoma patients with superimposed Staphylococcus aureus infection. The study enrolled 337 patients with confirmed M. mycetomatis eumycetoma and S. aureus co-infection. Patients were allocated into three groups; 142 patients received amoxicillin-clavulanic acid and ketoconazole, 93 patients received ciprofloxacin and ketoconazole and 102 patients received ketoconazole only. The study showed that, patients who received amoxicillin-clavulanic acid and ketoconazole treatment had an overall better clinical outcome compared to those who had combined ciprofloxacin and ketoconazole or to those who received ketoconazole only. In this study, 60.6% of the combined amoxicillin-clavulanic acid/ketoconazole group showed complete or partial clinical response to treatment compared to 30.1% in the ciprofloxacin/ketoconazole group and 36.3% in the ketoconazole only group. The study also showed that 64.5% of the patients in the ciprofloxacin/ketoconazole group and 59.8% in the ketoconazole only group had progressive disease and poor outcome. This study showed that the combination of amoxicillin-clavulanic acid and ketoconazole treatment is safe and offers good clinical outcome and it is therefore recommended to treat eumycetoma patients with Staphylococcus aureus co-infection.
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Affiliation(s)
- Najwa A. Mhmoud
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | | | | | - Wendy W. J. van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre Rotterdam, The Netherlands
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