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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 PMCID: PMC10928750 DOI: 10.1136/bcr-2023-258657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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Gabani MH, Ahmed AA, Hassan AA, Abdalla MA, Mustafa SA, Alobaid TA, Khatir AA, Mohammed RM, Awad NI, Abdellateef TA, Hassan A, Ahmed ES, Ali MZ, Fahal AH. The nutritional status of mycetoma affected patients seen at the Mycetoma Research Center, Sudan. PLoS Negl Trop Dis 2024; 18:e0011726. [PMID: 38166142 PMCID: PMC10786388 DOI: 10.1371/journal.pntd.0011726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/12/2024] [Accepted: 12/18/2023] [Indexed: 01/04/2024] Open
Abstract
Nutrition plays a critical and crucial role in addressing neglected tropical diseases (NTDs) and their complications, as they often contribute to malnutrition, which can worsen the impact of these conditions. Therefore, it is necessary to investigate the nutritional status of mycetoma patients, which has not been explored previously. This descriptive cross-sectional hospital-based study was conducted at the Mycetoma Research Center (MRC), University of Khartoum, Sudan. The study included 179 confirmed mycetoma patients and an equal number of age- and sex-matched normal controls. The nutritional status of the mycetoma patients was assessed and compared with that of the control group. The majority of the patients were young adults with varying educational levels, predominantly from Central Sudan. The foot was the most commonly affected part; most patients had lesions more than 10 cm in diameter. The Body Mass Index (BMI) was calculated for both study groups, revealing that 43.5% of the patients and 53.6% of controls had a normal BMI. Furthermore, 36% of patients were underweight, contrasting with only 11% in the control group. Correlation analyses indicated no significant associations between BMI and age groups, educational levels, daily meals, food quantity, and appetite in the study population (p > 0.05). Similarly, no significant differences were observed in BMI concerning disease duration and affected sites (p = 0.0577). The Kruskal-Wallis test did not reveal significant differences in BMI means among the groups. The study revealed that most participants consumed three meals daily, and the control group showed a more robust appetite and consumed more food than the patient group (p = 0.005). Nevertheless, there were no significant differences in the consumption of different food types between the patient and control groups and among different BMI categories (p = 0.025 and 0.040, respectively).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Abeer Hassan
- Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
| | | | - Mohammed Zain Ali
- The School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
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Siddig EE, Ahmed A, Eltigani HF, Bakhiet SM, van de Sande WWJ, Fahal AH. The First Case of Fusarium falciforme Eumycetoma in Sudan and an Extensive Literature Review about Treatment Worldwide. J Fungi (Basel) 2023; 9:730. [PMID: 37504719 PMCID: PMC10381130 DOI: 10.3390/jof9070730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/21/2023] [Accepted: 05/17/2023] [Indexed: 07/29/2023] Open
Abstract
Eumycetoma is an infectious disease caused by various fungal pathogens. The disease is characterised by black and pale-yellowish grain discharge. In this communication, we report a case of eumycetoma with a pale grain foot-eumycetoma caused by Fusarium falciforme. The patient presented at the outpatient clinic of the Mycetoma Research Centre in Sudan. The causative agent was initially misidentified as Aspergillus nidulans based on its seemingly similar histopathological appearance. However, sequencing the internally transcribed spacer region of the extracted grain confirmed infection with Fusarium falciforme. Although the patient received Itraconazole and underwent surgical excision, the disease was recurrent. To our knowledge, this is the first report on Fusarium falciforme causing eumycetoma in Sudan, indicating the expansion of the geographical distribution of this pathogen. This calls for raising the awareness of healthcare providers and improving the diagnostic and surveillance systems in at-risk areas to improve the case management and reduce the threat of further spread. Considering the potential impacts of F. falciforme infection including threatening the global health, food security, and ecosystem balance, as well as loss of biodiversity and negative socioeconomic changes in endemic countries, we recommend the implementation of an integrated transdisciplinary One Health strategy for the prevention and control of emerging infectious diseases including F. falciforme.
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Affiliation(s)
- Emmanuel Edwar Siddig
- The Mycetoma Research Center, University of Khartoum, Khartoum 11111, Sudan
- ErasmusMC, Department of Medical Microbiology and Infectious Diseases, University Medical Center Rotterdam, 3000 Rotterdam, The Netherlands
- Unit of Applied Medical Sciences, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum 11115, Sudan
| | - Ayman Ahmed
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, CH-4123 Basel, Switzerland
- Faculty of Sciences, University of Basel, CH-4003 Basel, Switzerland
- Institute of Endemic Diseases, Faculty of Medicine, University of Khartoum, Khartoum 11111, Sudan
| | | | | | - Wendy W J van de Sande
- ErasmusMC, Department of Medical Microbiology and Infectious Diseases, University Medical Center Rotterdam, 3000 Rotterdam, The Netherlands
| | - Ahmed Hassan Fahal
- The Mycetoma Research Center, University of Khartoum, Khartoum 11111, Sudan
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Siddig EE, Ahmed A, Hassan OB, Bakhiet SM, Verbon A, Fahal AH, van de Sande WWJ. Using a Madurella mycetomatis-specific PCR on grains obtained via non-invasive fine-needle aspirated material is more accurate than cytology. Mycoses 2023; 66:477-482. [PMID: 36740735 DOI: 10.1111/myc.13572] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/01/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Eumycetoma is a chronic subcutaneous inflammatory fungal infection most often caused by the fungus Madurella mycetomatis. Using a species-specific PCR on DNA directly isolated from grains is currently the most reliable method for species identification. However, so far, PCR has been performed on grains obtained through deep-seated surgical biopsies, which are invasive procedures. Grains can also be obtained via ultrasound-guided fine-needle aspiration (US-FNA). Here we determined the diagnostic performance of species-specific PCRs performed on samples obtained through US-FNA. METHODS From 63 patients, US-FNA was performed to obtain eumycetoma grains; 34 patients also underwent a deep-seated biopsy. From the grains, DNA was isolated, and one pan-fungal and two M. mycetomatis-specific PCRs were performed. The sensitivity and specificity were determined. RESULTS Of the 63 patients who underwent US-FNA, 78% (49/63) had evidence of eumycetoma based on cytology and 93.7% (59/63) based on species-specific PCRs. In the 34 patients for whom surgical biopsies were performed as well, 31 patients had a positive PCR for M. mycetomatis when DNA was isolated from the deep-seated biopsy, and 30 had a positive PCR when DNA was obtained from the US-FNA material. This resulted in a 96.8% sensitivity, and 100% specificity with 97.1% diagnostic accuracy for PCR performed on US-FNA. CONCLUSION PCR performed on the US-FNA material has a similar sensitivity and specificity as PCR performed on deep-seated biopsies. Therefore, when using PCR, a deep-seated biopsy may not be necessary to obtain grains.
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Affiliation(s)
- Emmanuel Edwar Siddig
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan.,Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Ayman Ahmed
- Swiss Tropical and Public Health Institute (Swiss TPH), Allschwil, Switzerland.,Faculty of Science, University of Basel, Basel, Switzerland
| | | | - Sahar Mubarak Bakhiet
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan.,Institute of Endemic Disease, University of Khartoum, Khartoum, Sudan
| | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Epidemiologic Aspects of Mycetoma in Africa. J Fungi (Basel) 2022; 8:jof8121258. [PMID: 36547591 PMCID: PMC9781793 DOI: 10.3390/jof8121258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/09/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022] Open
Abstract
Mycetoma is a chronic, disabling infection caused by fungi or actinomycetes that affects the disadvantaged rural populations of arid tropical regions. The identification of etiological agents is long, difficult, and often imprecise or unsuccessful. Recently developed molecular methods can be used to identify causal agents at the species level. However, diagnosis can only be implemented in specialized laboratories. For these reasons, the distribution of causal agents in endemic African countries remains approximate. It is known that the pathogenic organisms of mycetoma are present in the environment, introduced as a result of injuries or trauma. There are still unknowns concerning the natural habitats of agents and the mode of infection. A potential association between mycetoma and acacia was uncovered in Sudan, allowing the elaboration of a risk map of the country. A new hypothesis for the mode of contamination involves the intervention of an intermediate host. The first surveys in Sudanese endemic villages gave a higher prevalence than the previous estimates, indicating that the prevalence of mycetoma in endemic African countries has previously been underestimated.
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Mycetoma, chromoblastomycosis and other deep fungal infections: diagnostic and treatment approach. Curr Opin Infect Dis 2022; 35:379-383. [PMID: 35942857 DOI: 10.1097/qco.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW to review recent advances in the epidemiology, diagnosis, and treatment of deep fungal infections. RECENT FINDINGS Mycetoma and chromoblastomycosis are the only deep fungal infections incorporated in the list of neglected tropical diseases. These infections start in the skin but progress to deep tissues if not recognized early. A wide array of fungal pathogens are the causative agents. Molecular methods allow for early and accurate identification of the pathogens, but are unfortunately not available in endemic areas. Treatment options are mostly based upon clinical experience rather than on well-designed clinical trials. SUMMARY Deep fungal infections of the skin and soft tissues are rare conditions of wide world distribution but mostly reported from tropical countries. Urgent need for affordable and easily accessible molecular methods and well-conducted studies to allow for accurate diagnosis and to provide evidence to guide proper therapy are urgently needed.
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Siddig EE, El Had Bakhait O, El Nour Bahar M, Siddig Ahmed E, Bakhiet SM, Motasim Ali M, Babekir Abdallah O, Ahmed Hassan R, Verbon A, van de Sande WWJ, Fahal AH. Ultrasound-guided Fine Needle Aspiration Cytology significantly improved mycetoma diagnosis. J Eur Acad Dermatol Venereol 2022; 36:1845-1850. [PMID: 35748131 PMCID: PMC9543342 DOI: 10.1111/jdv.18363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
Background Ultrasound (US)‐guided fine‐needle aspiration cytology (US‐FNAC) has improved the diagnosis of many malignancies, infections and other diseases as it is safe, simple, quick and accurate. In mycetoma, it is assumed that this technique may have a better diagnostic yield than the conventional FNAC as it can accurately identify the optimal site for the aspiration. Objective To compare the diagnostic yield of conventional FNAC with US‐FNAC. Methods This descriptive cross‐sectional hospital‐based study included 80 patients with clinically suspected mycetoma. Results Of the 80 patients included, 35 proved to have actinomycetoma, and 37 had eumycetoma based on surgical biopsies, histopathological examination and the culture of grains. Eight patients appeared to have no mycetoma. For actinomycetoma diagnosis, the US‐guided FNAC improved sensitivity to 97% and negative predictive value (NPV) to 83% compared to the conventional FNAC, which had 63% sensitivity; and NPV of 28%. No improvement was found for specificity. For eumycetoma, the conventional FNAC had 86.5% sensitivity, 100% specificity, 100% PPV and 37.5% NPV. The US‐FNAC for the diagnosis of eumycetoma had 100% sensitivity and specificity. Conclusions and relevance The obtained results showed that US‐FNAC is better than the conventional FNAC with lower false‐negative results. It can accurately distinguish between the two types of mycetoma, allowing rapid initiation of proper treatment. The technique can be used in rural areas with low resources and for epidemiological surveys as a quick screening tool for patients suspected of mycetoma.
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Affiliation(s)
- Emmanuel Edwar Siddig
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan.,ErasmusMC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.,Department of Histopathology and Cytology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | | | | | | | - Sahar Mubarak Bakhiet
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan.,Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | | | | | - Annelies Verbon
- ErasmusMC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Wendy W J van de Sande
- ErasmusMC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
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Maubon D, Garnaud C, Ramarozatovo LS, Fahafahantsoa RR, Cornet M, Rasamoelina T. Molecular Diagnosis of Two Major Implantation Mycoses: Chromoblastomycosis and Sporotrichosis. J Fungi (Basel) 2022; 8:jof8040382. [PMID: 35448613 PMCID: PMC9027143 DOI: 10.3390/jof8040382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Chromoblastomycosis and sporotrichosis are the two main implantation mycoses that are now recognized as fungal neglected tropical diseases (NTDs). Their laboratory diagnosis mainly relies on direct microscopy, histopathology, and identification of the fungus by culture. However, to be appropriately used, these techniques require mycological expertise that is not widely available and may be absent in peripheral health care facilities in endemic areas. In addition, they lack sensitivity and specificity, and the culture for isolation and identification can have a long time-to-results period. Molecular methods, including matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), have been developed in well-equipped reference laboratories. They greatly improve the rapidity and accuracy of diagnosis; in particular, for species identification. Recently, PCR and sequencing have paved the way for more user-friendly point-of-care tests, such as those based on LAMP or RCA technologies, which can be used in basic healthcare settings and even in field consultations.
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Affiliation(s)
- Danièle Maubon
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
| | - Cécile Garnaud
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
| | | | | | - Muriel Cornet
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
- Correspondence:
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