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Clark JE, Kim HY, van de Sande WWJ, McMullan B, Verweij P, Alastruey-Izquierdo A, Chakrabarti A, Harrison TS, Bongomin F, Hay RJ, Oladele R, Heim J, Beyer P, Galas M, Siswanto S, Dagne DA, Roitberg F, Gigante V, Beardsley J, Sati H, Alffenaar JW, Morrissey CO. Eumycetoma causative agents: A systematic review to inform the World Health Organization priority list of fungal pathogens. Med Mycol 2024; 62:myae044. [PMID: 38935904 PMCID: PMC11210612 DOI: 10.1093/mmy/myae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/14/2023] [Accepted: 04/25/2024] [Indexed: 06/29/2024] Open
Abstract
The World Health Organization, in response to the growing burden of fungal disease, established a process to develop a fungal priority pathogens list. This systematic review aimed to evaluate the epidemiology and impact of eumycetoma. PubMed and Web of Science were searched to identify studies published between 1 January 2011 and 19 February 2021. Studies reporting on mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence during the study time frames were selected. Overall, 14 studies were eligible for inclusion. Morbidity was frequent with moderate to severe impairment of quality of life in 60.3%, amputation in up to 38.5%, and recurrent or long-term disease in 31.8%-73.5% of patients. Potential risk factors included male gender (56.6%-79.6%), younger age (11-30 years; 64%), and farming occupation (62.1%-69.7%). Mycetoma was predominantly reported in Sudan, particularly in central Sudan (37%-76.6% of cases). An annual incidence of 0.1/100 000 persons and 0.32/100 000 persons/decade was reported in the Philippines and Uganda, respectively. In Uganda, a decline in incidence from 3.37 to 0.32/100 000 persons between two consecutive 10-year periods (2000-2009 and 2010-2019) was detected. A community-based, multi-pronged prevention programme was associated with a reduction in amputation rates from 62.8% to 11.9%. With the pre-specified criteria, no studies of antifungal drug susceptibility, mortality, and hospital lengths of stay were identified. Future research should include larger cohort studies, greater drug susceptibility testing, and global surveillance to develop evidence-based treatment guidelines and to determine more accurately the incidence and trends over time.
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Affiliation(s)
- Julia E Clark
- Queensland Children’s Hospital and School of Clinical Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Hannah Yejin Kim
- Infectious Diseases Institute (Sydney ID), The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University of Rotterdam, Rotterdam, The Netherlands
| | - Brendan McMullan
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Infectious Diseases, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Paul Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | - Thomas S Harrison
- Institute for Infection and Immunity, and Clinical Academic Group in Infection and Immunity, St. George’s, University of London, and St. George’s University Hospitals NHS Foundation Trust, London, UK
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Roderick J Hay
- St Johns Institute of Dermatology, King’s College London, London, UK
- The International Foundation for Dermatology, London, UK
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Jutta Heim
- Global Antibiotics Research and Development Partnership Foundation, Geneva, Switzerland
| | - Peter Beyer
- Global Antibiotics Research and Development Partnership Foundation, Geneva, Switzerland
| | - Marcelo Galas
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Siswanto Siswanto
- South-East Asia Region Office, World Health Organization, New Delhi, India
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Felipe Roitberg
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Valeria Gigante
- AMR Division, World Health Organization, Geneva, Switzerland
| | - Justin Beardsley
- Infectious Diseases Institute (Sydney ID), The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Hatim Sati
- AMR Division, World Health Organization, Geneva, Switzerland
| | - Jan-Willem Alffenaar
- Infectious Diseases Institute (Sydney ID), The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - C Orla Morrissey
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
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Khalid SA, Abd Algaffar S, Tajuddeen N, Lombe BK, Bringmann G. Naphthylisoquinoline alkaloids: novel agents against the causative pathogens of eumycetoma and actinomycetoma- en route to broad-spectrum antimycetomal drugs. Antimicrob Agents Chemother 2024; 68:e0161223. [PMID: 38602413 PMCID: PMC11064494 DOI: 10.1128/aac.01612-23] [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] [Received: 12/06/2023] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
Mycetoma is a devastating neglected tropical infection of the subcutaneous tissues. It is caused by fungal and bacterial pathogens recognized as eumycetoma and actinomycetoma, respectively. Mycetoma treatment involves diagnosing the causative microorganism as a prerequisite to prescribing a proper medication. Current therapy of fungal eumycetoma causative agents, such as Madurella mycetomatis, consists of long-term antifungal medication with itraconazole followed by surgery, yet with usually unsatisfactory clinical outcomes. Actinomycetoma, on the contrary, usually responds to treatment with co-trimoxazole and amikacin. Therefore, there is a pressing need to discover novel broad-spectrum antimicrobial agents to circumvent the time-consuming and costly diagnosis. Using the resazurin assay, a series of 23 naphthylisoquinoline (NIQ) alkaloids and related naphthoquinones were subjected to in vitro screening against two fungal strains of M. mycetomatis and three bacterial strains of Actinomadura madurae and A. syzygii. Seven NIQs, mostly dimers, showed promising in vitro activities against at least one strain of the mycetoma-causative pathogens, while the naphthoquinones did not show any activity. A synthetic NIQ dimer, 8,8'''-O,O-dimethylmichellamine A (18), inhibited all tested fungal and bacterial strains (IC50 = 2.81-12.07 µg/mL). One of the dimeric NIQs, michellamine B (14), inhibited a strain of M. mycetomatis and significantly enhanced the survival rate of Galleria mellonella larvae infected with M. mycetomatis at concentrations of 1 and 4 µg/mL, without being toxic to the uninfected larvae. As a result, broad-spectrum dimeric NIQs like 14 and 18 with antimicrobial activity are considered hit compounds that could be worth further optimization to develop novel lead antimycetomal agents.
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Affiliation(s)
- Sami Ahmed Khalid
- Faculty of Pharmacy, University of Science and Technology, Omdurman, Sudan
| | | | - Nasir Tajuddeen
- Department of Chemistry, Ahmadu Bello University, Zaria, Nigeria
| | - Blaise Kimbadi Lombe
- Institute of Organic Chemistry, University of Würzburg, Würzburg, Germany
- Faculty of Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Gerhard Bringmann
- Institute of Organic Chemistry, University of Würzburg, Würzburg, Germany
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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] [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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Kim S, Shi HJ, Jeon CH, Kim SB, Yi J, Kim AR, Kim KH, Lim S. Clinical Characteristics of Nocardiosis: a Multicenter Retrospective Study in Korea. Infect Chemother 2023; 55:431-440. [PMID: 37674336 PMCID: PMC10771949 DOI: 10.3947/ic.2023.0032] [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: 03/27/2023] [Accepted: 06/21/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Nocardiosis is a rare, but potentially life-threatening condition. It is difficult to diagnose, and bacterial culture identification can be time consuming. We investigated the characteristics of nocardiosis and the suitability of the treatment approach in Korea. MATERIALS AND METHODS This retrospective study was conducted at 5 medical institutions between 2011 and 2021. We reviewed the medical records of patients with microbiologically confirmed nocardiosis. Appropriate antibiotic selection was defined as follows: (1) selecting antibiotics according to the species, (2) if the species of Nocardia was unknown, trimethoprim-sulfamethoxazole-based therapy or linezolid-based therapy was administered, and (3) selection of antibiotics using the antibiotic susceptibility test. The appropriate treatment periods for antibiotics were defined as treatment maintained from 3 to 12 months, depending on involvement of the organs. Descriptive analysis and Fisher exact test were used. Statistical significance was set at P-values of <0.05. RESULTS Thirty patients were enrolled. Of these patients, 18 (60.0%) were male. The median age was 70.5 years. Among the diagnosed patients, 12 (40.0%) had an immunocompromised status. Eight (30.0%) patients received optimal treatment for the appropriate treatment period. Appropriate dosing duration was observed in 3 of the 12 (25.0%) immunocompromised patients. There was no significant difference between the presence or absence of immunosuppression and the adequacy of treatment for nocardiosis (P = 1.000). Skin and soft tissue (14 patients) were most frequently involved in this study. Nocardia species (spp.) were isolated from culture at a median of 6.0 days. There were 7 cases with N. farcinica (23.3%). CONCLUSION We found that 60.0% of the patients with nocardiosis did not have an immunocompromised status. Further, 26.7% of the total patients received adequate treatment for nocardiosis. The reasons for suboptimal management of nocardiosis in Korea are presumed to be diagnostic difficulties, lack of awareness about nocardiosis, and difficulties in selecting antibiotics for Nocardia spp. among clinicians. The lack of antibiotic susceptibility tests for Nocardia spp. could be the source of these problems. Nocardiosis should be suspected in cases of recurrent infections with skin and soft tissue, musculoskeletal, or respiratory system involvement with or without an immunocompromised status. Clinical microbiological support is required for the diagnosis and selection of antibiotics in Korea. High clinical index of suspicion and clinical microbiological support are required for the accurate diagnosis of nocardiosis in Korea.
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Affiliation(s)
- Seulki Kim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hye Jin Shi
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Cheon-Hoo Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - A Reum Kim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kye-Hyung Kim
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
| | - Seungjin Lim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
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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] [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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Musa EA, Abdoon IH, Bakhiet SM, Osman B, Abdalla SA, Fahal AH. Mycetoma management and clinical outcomes: the Mycetoma Research Center experience. Trans R Soc Trop Med Hyg 2023; 117:12-21. [PMID: 35903002 DOI: 10.1093/trstmh/trac069] [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: 05/08/2022] [Revised: 06/12/2022] [Accepted: 07/18/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Mycetoma is a chronic granulomatous inflammatory disease that affects the cutaneous and subcutaneous tissues, leading to gruesome complications if not treated early. As a neglected disease, it has received scant attention in developing curable drugs. Mycetoma treatment is still based on expert opinions in the absence of guidelines. METHODS This descriptive, cross-sectional, hospital-based study aimed to determine and assess the disease treatment outcomes observed at Mycetoma Research Center, Sudan. RESULTS In this study, 75% of patients had eumycetoma, all of whom were treated with itraconazole and 37.4% underwent surgical excision, while 25% of the patients had actinomycetoma, 99.2% of whom were treated with a combination of cotrimoxazole and amoxicillin-clavulanate. The cure rate was 12.7% and 14.3% for patients with eumycetoma and actinomycetoma, respectively. Only 6.1% of eumycetoma patients underwent amputation. Remarkably, no patient with actinomycetoma underwent an amputation. Small lesions (OR=10.09, p<0.001) and good follow-up (OR=6.81, p=0.002) were positive predictors of complete cure. In terms of amputation, history of surgical recurrence at presentation (OR=3.67, p=0.020) and presence of grains (OR=7.13, p=0.012) were positive predictors, whereas small lesions were negative predictors (OR=0.06, p=0.009). CONCLUSIONS Treatment of mycetoma was suboptimal, with a low cure rate despite a long treatment duration. Complete cure has a significant association with small lesions and good follow-up.
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Affiliation(s)
- Esraa Abdelgadir Musa
- Clinical Pharmacy Program, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan
| | - Iman Hassan Abdoon
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan
| | | | - Bashier Osman
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan
| | - Safa A Abdalla
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, 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] [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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Comment on "Orbital Actinomycetoma with cranial extension: A rare case report". Int J Surg Case Rep 2022; 96:107352. [PMID: 35772262 PMCID: PMC9253358 DOI: 10.1016/j.ijscr.2022.107352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
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Lim W, Verbon A, van de Sande W. Identifying novel drugs with new modes of action for neglected tropical fungal skin diseases (fungal skinNTDs) using an Open Source Drug discovery approach. Expert Opin Drug Discov 2022; 17:641-659. [PMID: 35612364 DOI: 10.1080/17460441.2022.2080195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The three fungal skin neglected tropical diseases (NTD) mycetoma, chromoblastomycosis and sporotrichosis currently lack prioritization and support to establish drug discovery programs in search for novel treatment options. This has made the efforts to identify novel drugs for these skinNTDs fragmented. AREAS COVERED To help escalate the discovery of novel drugs to treat these fungal skinNTDs, the authors have prepared an overview of the compounds with activity against fungal skinNTDs by analyzing data from individual drug discovery studies including those performed on the Medicines for Malaria Venture (MMV) open access boxes. EXPERT OPINION The authors were unable to identify studies in which causative agents of all three skinNTDs were included, indicating that an integrated approach is currently lacking. From the currently available data, the azoles and iodoquinol were the only compounds with activity against causative agents from the three different fungal skinNTDs. Fungal melanin inhibition enhanced the activity of antifungal agents. For mycetoma, the fenarimols, aminothiazoles and benzimidazole carbamates are currently being investigated in the MycetOS initiative. To come to a more integrated approach to identify drugs active against all three fungal skinNTDs, compounds made in the MycetOS initiative could also be explored for chromoblastomycosis and sporotrichosis.
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Affiliation(s)
- Wilson Lim
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annelies Verbon
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wendy van de Sande
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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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: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [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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Abstract
Sialic acids are present in humans and other metazoans, playing essential roles in physiological and pathological processes. Commensal and pathogenic bacteria have evolved the capacity to utilize sialic acids as nutrient and energy sources. However, in some actinobacteria, sialic acid catabolism (SAC) is associated with free-living populations. To unravel the distribution and evolutionary history of SAC in the phylum Actinobacteria, we analyzed the presence and diversity of the putative SAC gene cluster (nan) in 7,180 high-quality, nonredundant actinobacterial genomes that covered 1,969 species. The results showed that ∼13% of actinobacterial species had the potential to utilize sialic acids, with 45 species capable of anhydro-SAC, all except two of them through the canonical pathway. These species belonged to 20 orders and 81 genera, with ∼36% of them from four genera, Actinomyces, Bifidobacterium, Corynebacterium, and Streptomyces. Moreover, ∼40% of the nan-positive species are free living. Phylogenetic analysis of the key nan genes, nanA, nanK, and nanE, revealed a strong signal of horizontal gene transfer (HGT), accompanied with vertical inheritance and gene loss. This evolutionary pattern led to high diversity and differential distribution of nan among actinobacterial taxa and might cause the cluster to spread to some free-living species while losing in some host-associated species. The evolution of SAC in actinobacteria probably represents the evolution of certain kinds of noncore bacterial functions for environmental adaptation and lifestyle switch, in which HGT plays a dominant role. IMPORTANCE Sialic acids play essential roles in the physiology of humans and other metazoan animals, and microbial sialic acid catabolism (SAC) is one of the processes critical for pathogenesis. To date, microbial SAC is studied mainly in commensals and pathogens, while its distribution in free-living microbes and evolutionary pathway remain largely unexplored. Here, by examining all actinobacterial genomes available, we demonstrate that putative SAC is present in a small proportion of actinobacterial species, of which, however, ∼40% are free-living species. We also reveal remarkable difference in the distribution of SAC among actinobacterial taxa and high diversity of the putative SAC gene clusters. HGT plays a significant role in the evolution of SAC, accompanied with vertical inheritance and gene loss. Our results provide a comprehensive and systematic picture of the distribution and evolutionary history of SAC in actinobacteria, expanding the current knowledge on bacterial adaptation and diversification.
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Lim W, Eadie K, Konings M, Rijnders B, Fahal AH, Oliver JD, Birch M, Verbon A, van de Sande W. Madurella mycetomatis, the main causative agent of eumycetoma, is highly susceptible to olorofim. J Antimicrob Chemother 2021; 75:936-941. [PMID: 31904836 PMCID: PMC7069493 DOI: 10.1093/jac/dkz529] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives Eumycetoma is currently treated with a combination of itraconazole therapy and surgery, with limited success. Recently, olorofim, the lead candidate of the orotomides, a novel class of antifungal agents, entered a Phase II trial for the treatment of invasive fungal infections. Here we determined the activity of olorofim against Madurella mycetomatis, the main causative agent of eumycetoma. Methods Activity of olorofim against M. mycetomatis was determined by in silico comparison of the target gene, dihydroorotate dehydrogenase (DHODH), and in vitro susceptibility testing. We also investigated the in vitro interaction between olorofim and itraconazole against M. mycetomatis. Results M. mycetomatis and Aspergillus fumigatus share six out of seven predicted binding residues in their DHODH DNA sequence, predicting susceptibility to olorofim. Olorofim demonstrated excellent potency against M. mycetomatis in vivo with MICs ranging from 0.004 to 0.125 mg/L and an MIC90 of 0.063 mg/L. Olorofim MICs were mostly one dilution step lower than the itraconazole MICs. In vitro interaction studies demonstrated that olorofim and itraconazole work indifferently when combined. Conclusions We demonstrated olorofim has potent in vitro activity against M. mycetomatis and should be further evaluated in vivo as a treatment option for this disease.
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Affiliation(s)
- Wilson Lim
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Kimberly Eadie
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Mickey Konings
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bart Rijnders
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Ahmed H Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | | | | | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Wendy van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
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Musa HH, Musa TH, Musa IH, Musa IH. Global scientific research progress in mycetoma: a bibliometric analysis. Trans R Soc Trop Med Hyg 2021; 115:1414-1426. [PMID: 33982760 DOI: 10.1093/trstmh/trab072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mycetoma is a neglected tropical disease that attracts little attention in regard to research and publications and hence this study was undertaken to determine the trends and global scientific research output in mycetoma-related fields. METHODS Mycetoma data were retrieved from the Web of Science (WoS) and Scopus databases. The MeSH Browser was used to extract relevant keywords. Biblioshiny software (R-studio cloud), VOSviewer v. 1.6.6 and SPSS software were used for data management. RESULTS Research trends on mycetoma increased globally from 1999 to 2020. The results were 404 documents (4444 citations) in WoS and 513 documents (5709 citations) in Scopus, and the average number of citations per article was 11 in WoS and 11.13 in Scopus. There was a significant association between the total number of citations and the total citations per year in both WoS (r=0.833, p<0.0001) and Scopus (r=0.926, p<0.0001). Sudan, India, the Netherlands and Mexico were the top-ranking productive countries for mycetoma publications in WoS, while India, the USA and Mexico were the top-ranking countries in Scopus. Articles on mycetoma were mainly published in PLoS Neglected Tropical Diseases, the International Journal of Dermatology and the Journal of Clinical Microbiology. A. H. Fahal from the Mycetoma Research Centre, University of Khartoum, Sudan, had the highest number of citations in mycetoma research during 1999-2020, followed by W. W. J. van de Sande from the Erasmus Medical Centre, University of Rotterdam, the Netherlands, during 2003-2020. CONCLUSION The analysis provides insight into a global overview of Mycetoma research. In addition, the analysis holds a better understanding of the development trends that have emerged in Mycetoma over the past 21 years, which can also offer a scientific reference for future research.
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Affiliation(s)
- Hassan H Musa
- Biomedical Research Institute, Darfur College, Nyala, Sudan.,Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, University of Khartoum, Sudan
| | - Taha H Musa
- Biomedical Research Institute, Darfur College, Nyala, Sudan.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Ibrahim H Musa
- Biomedical Research Institute, Darfur College, Nyala, Sudan.,Department of Software Engineering, School of Computer Science and Engineering, Southeast University, Nanjing, China
| | - Idriss H Musa
- Biomedical Research Institute, Darfur College, Nyala, Sudan.,Department of Surgery, School of Medicine, Darfur College, Nyala, Sudan
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Patra S, Senthilnathan G, Ramam M, Arava S, Bhari N. Linezolid: A novel treatment option for the treatment of a non-responsive case of actinomycotic mycetoma. Indian J Dermatol Venereol Leprol 2021; 87:455. [PMID: 33871213 DOI: 10.25259/ijdvl_125_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Suman Patra
- Department of Dermatology and Venereology All India Institute of Medical Sciences, New Delhi, India
| | - Gridharan Senthilnathan
- Department of Dermatology and Venereology All India Institute of Medical Sciences, New Delhi, India
| | - M Ramam
- Department of Dermatology and Venereology All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology All India Institute of Medical Sciences, New Delhi, India
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Lafont E, Conan PL, Rodriguez-Nava V, Lebeaux D. Invasive Nocardiosis: Disease Presentation, Diagnosis and Treatment - Old Questions, New Answers? Infect Drug Resist 2020; 13:4601-4613. [PMID: 33376366 PMCID: PMC7764858 DOI: 10.2147/idr.s249761] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022] Open
Abstract
Nocardia spp. is an environmental filamentous Gram-positive bacterium that may cause infections in humans and, despite recent progress, many challenges remain regarding the management of nocardiosis. This review aims at describing most recently published data regarding the diagnosis, treatment and follow-up of patients with invasive nocardiosis. As nocardiosis mainly affects patients with cell-mediated immunity defects, a comprehensive workup is mandatory in case of invasive nocardiosis occurring in ”apparently healthy patients”. Indeed, invasive nocardiosis might reveal an unknown primary immunodeficiency or the presence of anti-GM-CSF autoantibodies. Even if the diagnosis of nocardiosis mostly relies on direct examination and bacterial culture, a genus-specific PCR may be used for the detection of Nocardia, when directly performed on a clinical sample. Brain imaging should always be performed, even in the absence of neurological symptoms. Cotrimoxazole (trimethoprim/sulfamethoxazole), linezolid, parenteral cephalosporins, carbapenems and amikacin may be used as initial antibiotics to treat nocardiosis. Cotrimoxazole or linezolid can be used as monotherapy in selected patients without brain involvement. Although treatment duration has historically been set to at least 6 months in the absence of central nervous system involvement, shorter durations (<120 days) seem to be associated with a favourable outcome.
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Affiliation(s)
- Emmanuel Lafont
- Department of Infectious Diseases and Tropical Medicine, Université de Paris, Necker-Enfants Malades University Hospital, Centre d'Infectiologie Necker-Pasteur, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Pierre-Louis Conan
- Service de Maladies Infectieuses et Tropicales, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | - Véronica Rodriguez-Nava
- Research Group on Bacterial Opportunistic Pathogens and Environment UMR5557 Écologie Microbienne, French Observatory of Nocardiosis, Université de Lyon 1, CNRS, VetAgro Sup, Lyon, France
| | - David Lebeaux
- Université de Paris, Paris 75006, France.,Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris 75015, France
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Elkheir LYM, Haroun R, Mohamed MA, Fahal AH. Madurella mycetomatis causing eumycetoma medical treatment: The challenges and prospects. PLoS Negl Trop Dis 2020; 14:e0008307. [PMID: 32853199 PMCID: PMC7452721 DOI: 10.1371/journal.pntd.0008307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lamis Y. M. Elkheir
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Rayan Haroun
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Magdi Awadalla Mohamed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Jouf, KSA
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Al-Kathiri L, Al-Najjar T, Al-Asmaili A. Successful Treatment of Recalcitrant Actinomycetoma of Gluteal Area with Combined Medical Treatment and Surgical Excision with Graft Reconstruction. Oman Med J 2020; 35:e111. [PMID: 32308989 PMCID: PMC7157440 DOI: 10.5001/omj.2020.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 12/25/2018] [Indexed: 11/17/2022] Open
Abstract
Mycetoma, formerly known as Madura foot, is a chronic, localized, gradually increasing in size, granulomatous exogenous infection of the skin and subcutaneous tissue with risks of bone and visceral involvement. It is unevenly found worldwide but it is endemic in tropical and subtropical countries. Two groups of mycetoma exist with similar clinical presentation; eumycetoma due to true fungi, and actinomycetoma due to aerobic bacteria from actinomycomycetes species. Mycetoma is difficult to treat and can lead to serious sequelae including disability, deformity and even death, so early diagnosis and treatment can elicit good results. The diagnosis is made based on a clinical picture of a triad of painless tumefaction, draining sinuses and granules of the causative micro-organism along with direct microscopic examination and histological study. It is very important to distinguish between actinomycetoma and eumycetoma for selecting the therapy. Actinomycetomas generally respond well to antimicrobials compared with eumycetomas, which respond poorly and need a combination of medical and surgical therapy. Bone involvement makes treatment more difficult, keeping surgical amputation as the only choice of treatment. Despite the possibility of a cure with medical treatment alone, treatment failure may occur even with long-term therapy, which necessitates adding surgical intervention to achieve cure. We report a case of gluteal actinomycetoma in an Omani man, treated successfully by combined medical treatment and surgical excision with graft reconstruction after failure of different regimens of antimicrobials.
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18
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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] [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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Eaton KJ, Gulbrandsen MT, Obeid RA, Shehzad P, Skinner SE. Twenty-year cervicothoracic Nocardia mycetoma with advanced thoracic cavity infiltration. JAAD Case Rep 2019; 5:697-700. [PMID: 31440560 PMCID: PMC6698446 DOI: 10.1016/j.jdcr.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gonzalez-Benavides N, Vera-Cabrera L, Sanchez-Meza E, Ocampo-Candiani J, Welsh O. Diaminodiphenyl-sulphone: in vitro activity alone and in combination with other antimicrobials against 30 strains of Nocardia brasiliensis. J Eur Acad Dermatol Venereol 2019; 33:e395-e396. [PMID: 31063602 DOI: 10.1111/jdv.15660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Gonzalez-Benavides
- Department of Dermatology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - L Vera-Cabrera
- Department of Dermatology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - E Sanchez-Meza
- Department of Dermatology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - J Ocampo-Candiani
- Department of Dermatology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - O Welsh
- Department of Dermatology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
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Abushouk A, Nasr A, Masuadi E, Allam G, Siddig EE, Fahal AH. The Role of Interleukin-1 cytokine family (IL-1β, IL-37) and interleukin-12 cytokine family (IL-12, IL-35) in eumycetoma infection pathogenesis. PLoS Negl Trop Dis 2019; 13:e0007098. [PMID: 30946748 PMCID: PMC6483278 DOI: 10.1371/journal.pntd.0007098] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/25/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022] Open
Abstract
Mycetoma is a neglected tropical disease, endemic in many tropical and subtropical regions, characterised by massive deformity and disability and can be fatal if untreated early and appropriately. Interleukins (IL) -35 and IL-37 are newly discovered cytokines that play an important role in suppressing the immune system. However, the expression of these interleukins in patients with Madurella mycetomatis (M. mycetomatis) induced eumycetoma has not yet been explored. The aim of this study is to determine the levels of IL-1 family (IL-1β, IL-37) and IL-12 family (IL-12, IL-35) in a group of these patients and the association between these cytokines levels and the patients’ demographic characteristics. The present, case-control study was conducted at the Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Sudan and it included 140 individuals. They were divided into two groups; group I: healthy controls [n = 70; median age 25 years (range 12 to 70 years)]. Group II: mycetoma patients [n = 70 patients; median age 25 (range 13 to 70 years)]. Cytokines levels were measured in sera using enzyme linked immunosorbent assay (ELISA). There was a significant negative correlation between IL-1β and IL-12 levels and lesion size and disease duration, while IL-37 and IL-35 levels were significantly positively correlated with both lesion size and disease duration. The analysis of the risk factors of higher circulatory levels of IL-37 in patients of mycetoma showed a negative significant association with IL-1β cytokine, where a unit increment in IL-1β will decrease the levels of IL-37 by 35.28 pg/ml. The levels of IL-37 among the patients with a duration of mycetoma infection ≤ 1 year were significantly low by an average of 18.45 pg/ml compared to patients with a mycetoma infection’s duration of ≥ 5years (reference group). Furthermore, the risk factors of higher levels of IL-35 in mycetoma patients revealed a negative significant association with IL-12, as a unit increment in IL-12 decreases the levels of IL-35 by 8.99 pg/ml (p < 0.001). Levels of IL-35 among the patients with duration of mycetoma infection ≤ one year were significantly low on average by 41.82 pg/ml (p value = 0.002) compared to patients with a duration of mycetoma infection ≥ 5 years (reference group). In conclusion, this study indicates that both IL-35 and IL-37 are negatively associated with the levels of IL-1β and IL-12 in eumycetoma mycetoma infection; and high levels of IL-37 and IL-35 may have a negative impact on disease progression. Mycetoma is a progressive chronic granulomatous fungal or bacterial infection that may result in massive destruction of subcutaneous tissues, muscles and bones. Mycetoma is a neglected disease which is endemic in many tropical and subtropical areas. If the disease is not treated properly, eventually it ends up with amputation and adverse medical, health and socioeconomic effects on patients and the community. Previous data suggested a crucial role of adaptive immunity in host resistance to causative agents and in the disease progress. The recently identified IL-35 and IL-37 cytokines revealed an important role in immune suppression. Nevertheless, the expression of these interleukins in patients with mycetoma has not yet been investigated. Therefore, the present case-control study aimed to determine the levels of IL-1 family (IL-1β, IL-37) and IL-12 family (IL-12, IL-35) in these patients and the association between these cytokines levels and the patients’ demographic characteristics. The results of this study showed that, the levels of IL-37 and IL-35 were consistently positively correlated with different diameters of mycetoma lesions as well as its duration. However, the levels of IL-1β and IL-12 were consistently negatively correlated with different diameters of lesions and the duration of mycetoma infection. The analysis of the risk factors of higher circulatory levels of IL-37 in patients of mycetoma showed a negative significant association with IL-1β cytokine Furthermore, the risk factors of higher levels of IL-35 in patients of mycetoma revealed a negative significant association with IL-12. These findings uncover a possible the role of IL-35 and IL-37 in the pathogenesis of mycetoma, and may declare their potential value in treatment of mycetoma.
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Affiliation(s)
- Amir Abushouk
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Amre Nasr
- King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Emad Masuadi
- Research Unit, Department of Medical Education, College of Medicine-Riyadh, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Gamal Allam
- Department of Microbiology and Immunology, College of Medicine, Taif University, Taif, Saudi Arabia
- Immunology Section, Department of Zoology, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | | | - Ahmed H. Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- * E-mail: ,
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The disabling consequences of Mycetoma. PLoS Negl Trop Dis 2018; 12:e0007019. [PMID: 30532253 PMCID: PMC6312340 DOI: 10.1371/journal.pntd.0007019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/31/2018] [Accepted: 11/25/2018] [Indexed: 11/20/2022] Open
Abstract
Mycetoma is a neglected tropical disease endemic in tropical and subtropical countries, particularly Sudan. The disease is characterised by the triad of painless subcutaneous mass, multiple sinuses and discharge that contain grains. It is a chronic, debilitating disease most commonly affecting the feet or hands and leads to substantial morbidity, loss of function and even amputation. It predominantly affects poor, rural populations and patients typically present late with advanced disease and complications. In this descriptive cross-sectional study, we characterise the disabling consequences of mycetoma. The study included 300 patients; 228 (76%) male and 72 (24%) female with confirmed mycetoma seen at the Mycetoma Research Centre, University of Khartoum, Sudan in the period May 2016 and January 2017. The study design was based upon the International Classification of Functioning, Disability and Health, examining the impact of mycetoma on eight life domains. Our major finding is that mycetoma is a significantly disabling disease. Over 60% of the study population (181 patients) had moderate impairment or difficulty in at least one domain variable. The important disability was mobility impairment and walking difficulty that was reported in 119 patients (39.7%). There was significant pain associated with mycetoma lesions in 103 patients (34%), challenging the traditional view of mycetoma as a painless disease. The economic burden was also found to be substantial, with 126 patients (46.7%) reporting barriers to their ability to sustain themselves. This is the first study evaluating the disabling consequences of mycetoma and shows clear areas for intervention and further research. Options for mitigating social and economic impacts include routine integration of analgesia and physiotherapy into treatment protocols, and adapting educational provision and working practices based on disability assessment. Our data show that mycetoma is a public health issue with direct implications on quality of life.
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Mycetoma: The Spectrum of Clinical Presentation. Trop Med Infect Dis 2018; 3:tropicalmed3030097. [PMID: 30274493 PMCID: PMC6161195 DOI: 10.3390/tropicalmed3030097] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/22/2018] [Accepted: 08/30/2018] [Indexed: 11/17/2022] Open
Abstract
Mycetoma is a chronic infection, newly designated by the World Health Organization (WHO) as a neglected tropical disease, which is endemic in tropical and subtropical regions. It follows implantation of infectious organisms, either fungi (eumycetomas) or filamentous bacteria (actinomycetomas) into subcutaneous tissue, from where infection spreads to involve skin, bone and subcutaneous sites, leading to both health related and socioeconomic problems. In common with other NTDs, mycetoma is most often seen in rural areas amongst the poorest of people who have less access to health care. The organisms form small microcolonies that are discharged onto the skin surface via sinus tracts, or that can burrow into other adjacent tissues including bone. This paper describes the clinical features of mycetoma, as early recognition is a key to early diagnosis and the institution of appropriate treatment including surgery. Because these lesions are mostly painless and the majority of infected individuals present late and with advanced disease, simplifying early recognition is an important public health goal.
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Affiliation(s)
- Peter Scolding
- Chelsea and Westminster Hospital NHS Foundation Trust; London UK
| | - Ahmed Fahal
- University of Khartoum, Soba University Hospital; Mycetoma Research Centre; PO Box 102 Khartoum Sudan
| | - Rie R Yotsu
- National Center for Global Health and Medicine; Department of Dermatology; 1-21-1 Toyama Shinjuku-ku Tokyo Japan 162-8655
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Bakhiet SM, Fahal AH, Musa AM, Mohamed ESW, Omer RF, Ahmed ES, El Nour M, Mustafa ERM, Sheikh A. Rahman ME, Suliman SH, El Mamoun MAG, El Amin HM. A holistic approach to the mycetoma management. PLoS Negl Trop Dis 2018; 12:e0006391. [PMID: 29746460 PMCID: PMC5944909 DOI: 10.1371/journal.pntd.0006391] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/18/2018] [Indexed: 11/22/2022] Open
Abstract
Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients' socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients' management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families.
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Affiliation(s)
- Sahar Mubarak Bakhiet
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | - Ahmed Mudawi Musa
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | | | | | - Mustafa El Nour
- Department of Medical Imaging, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - El Rayah Mohamed Mustafa
- Department of Medical Imaging, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Manar El Sheikh A. Rahman
- Department of Biostatistics, Faculty of Mathematical Sciences, University of Khartoum, Khartoum, Sudan
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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] [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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Nguyen NM, Sink JR, Carter AJ, Asrani F. Nocardiosis incognito: Primary cutaneous nocardiosis with extension to myositis and pleural infection. JAAD Case Rep 2017; 4:33-35. [PMID: 29296648 PMCID: PMC5739172 DOI: 10.1016/j.jdcr.2017.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nhan M Nguyen
- Department of Dermatology, New York Medical College, New York, New York
| | - Jacquelyn R Sink
- Department of Dermatology, New York Medical College, New York, New York
| | - Adam J Carter
- Department of Dermatology, New York Medical College, New York, New York
| | - Falguni Asrani
- Department of Dermatology, New York Medical College, New York, New York
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Fatahi-Bafghi M. Nocardiosis from 1888 to 2017. Microb Pathog 2017; 114:369-384. [PMID: 29146497 DOI: 10.1016/j.micpath.2017.11.012] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 01/11/2023]
Abstract
The genus Nocardia is an aerobic bacterium, Gram-positive and catalase positive that is in Nocardiaceae family. This bacterium first described by Edmond Nocard in 1888 and is not in human commensal bacteria. To date, nocardiosis incidence is increasing due to increase population growth rate, increase in patients with immune disorder diseases and immunocompromised patients. We surveyed taxonomic position, isolation methods, phenotypic and molecular identification at the genus and species levels, antibiogram, treatment and epidemiology in the world from 1888 to 2017.
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Affiliation(s)
- Mehdi Fatahi-Bafghi
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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30
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Martínez-Cabriales SA, Ocampo-Candiani J, Welsh E, Ayala-Cortés AS, Gómez-Flores M, Welsh O. Actinomycetoma: a therapeutic challenge. Postgrad Med J 2017; 94:126. [PMID: 28972100 DOI: 10.1136/postgradmedj-2016-134765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/27/2017] [Accepted: 09/09/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Sylvia Aide Martínez-Cabriales
- Department of Dermatology, Universidad Autónoma de Nuevo León, Hospital Universitario 'Dr. José Eleuterio González', Monterrey, Nuevo Leon, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, Universidad Autónoma de Nuevo León, Hospital Universitario 'Dr. José Eleuterio González', Monterrey, Nuevo Leon, Mexico
| | - Esperanza Welsh
- Department of Dermatology, Universidad Autónoma de Nuevo León, Hospital Universitario 'Dr. José Eleuterio González', Monterrey, Nuevo Leon, Mexico
| | - Ana Sofía Ayala-Cortés
- Department of Dermatology, Universidad Autónoma de Nuevo León, Hospital Universitario 'Dr. José Eleuterio González', Monterrey, Nuevo Leon, Mexico
| | - Minerva Gómez-Flores
- Department of Dermatology, Universidad Autónoma de Nuevo León, Hospital Universitario 'Dr. José Eleuterio González', Monterrey, Nuevo Leon, Mexico
| | - Oliverio Welsh
- Department of Dermatology, Universidad Autónoma de Nuevo León, Hospital Universitario 'Dr. José Eleuterio González', Monterrey, Nuevo Leon, Mexico
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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] [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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32
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Afectación cutánea en las micosis profundas: una revisión de la literatura. Parte 1: micosis subcutáneas. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:806-815. [DOI: 10.1016/j.ad.2016.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/05/2016] [Accepted: 05/29/2016] [Indexed: 01/20/2023] Open
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Cutaneous Involvement in the Deep Mycoses: A Literature Review. Part I—Subcutaneous Mycoses. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Palma-Ramos A, Casillas-Pétriz G, Castrillón-Rivera LE, Castañeda-Sánchez JI, Arenas-Guzmán R, Drago-Serrano ME, Sainz-Espuñes T. Activation and IL-1β secretion of human peripheral phagocytes infected with Actinomadura madurae, Nocardia asteroides and Candida albicans. ASIAN PAC J TROP MED 2016; 9:962-967. [PMID: 27794389 DOI: 10.1016/j.apjtm.2016.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/22/2016] [Accepted: 07/14/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the ability of Actinomadura madurae (A. madurae) and Nocardia asteroides (N. asteroides), using Candida albicans (C. albicans) as prototypic control, to elicit the activation and IL-1β secretion of blood phagocytic cells from healthy donors. METHODS Microscopic evaluation of phagocytosis/activation, cell viability and spectrophotometric quantitation of endocytosis/activation, were assessed by using formazan blue test in human blood phagocytes infected with C. albicans, A. madurae or N. asteroides treated with either normal human serum (NHS) or with decomplemented NHS. Interlukin-1β from culture supernatants of infected polymorphonuclear was tested by ELISA kit assay. RESULTS Microscopic assay showed that phagocytosis and activation of adherent mononuclear phagocytes were greater with C. albicans followed by A. madurae and then by N. asteroides. Spectrophotometric assay in polymorphonuclear phagocytes infected with NHS-treated pathogens indicated that activation was similarly higher by C. albicans and A. madurae and lower by N. asteroides. Kinetic assays in infected polymorphonuclear cells showed that viability was decreased by C. albicans and N. asteroides or unaffected with A. madurae. Levels of IL-1β at 8 h of incubation were higher with C. albicans followed by A. madurae whereas lower levels were found with N. asteroides. CONCLUSIONS The extent of cell-viability and activation as well IL-1β secretion may be related with the virulence of C. albicans and N. asteroides and other parameters remain to be explored for assessing the virulence of A. madurae.
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Affiliation(s)
- Alejandro Palma-Ramos
- Department of Biological Systems, Autonomous Metropolitan University Campus Xochimilco, Calzada del Hueso No. 1100, Ciudad de Mexico, 04960, Mexico
| | - Gilberto Casillas-Pétriz
- Department of Biological Systems, Autonomous Metropolitan University Campus Xochimilco, Calzada del Hueso No. 1100, Ciudad de Mexico, 04960, Mexico
| | - Laura Estela Castrillón-Rivera
- Department of Biological Systems, Autonomous Metropolitan University Campus Xochimilco, Calzada del Hueso No. 1100, Ciudad de Mexico, 04960, Mexico
| | - Jorge Ismael Castañeda-Sánchez
- Department of Biological Systems, Autonomous Metropolitan University Campus Xochimilco, Calzada del Hueso No. 1100, Ciudad de Mexico, 04960, Mexico
| | - Roberto Arenas-Guzmán
- Service of Dermatology and Mycology, General Hospital 'Manuel Gea González', Calzada de Tlalpan 4800, Tlalpan, Sección XVI, 14080, Ciudad de México, Mexico
| | - Maria Elisa Drago-Serrano
- Department of Biological Systems, Autonomous Metropolitan University Campus Xochimilco, Calzada del Hueso No. 1100, Ciudad de Mexico, 04960, Mexico
| | - Teresita Sainz-Espuñes
- Department of Biological Systems, Autonomous Metropolitan University Campus Xochimilco, Calzada del Hueso No. 1100, Ciudad de Mexico, 04960, Mexico.
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Omer RF, Seif EL Din N, Abdel Rahim FA, Fahal AH. Hand Mycetoma: The Mycetoma Research Centre Experience and Literature Review. PLoS Negl Trop Dis 2016; 10:e0004886. [PMID: 27483367 PMCID: PMC4970814 DOI: 10.1371/journal.pntd.0004886] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/08/2016] [Indexed: 01/03/2023] Open
Abstract
Mycetoma is a devastating, neglected tropical disease characterised by extensive tissue involvement resulting in destruction, deformities and disabilities in the affected patients. The hand is commonly affected by mycetoma thus compromises its functionality and hinder the patient's daily activities of living. In this communication, we report on 533 patients with hand mycetoma managed over a period of 24 years at the Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan. Eumycetoma was the commonest type of mycetoma (83.3%) encountered. Males were predominately affected (69.2%) with a sex ratio of 2.2:1. The majority of the patients (84%) were young adult below the age of 40 years old at presentation. The generality of patients (86.4%) were from the Sudan mycetoma belt. Children and adolescents (28.1%), farmers (18.2%) and workers (17.4%) were more frequently affected. The majority of patients (67.4%) had disease duration of less than 5 years at presentation. The study, did not document significant history of local trauma, familial tendency, concomitant medical diseases or other predisposing cause for mycetoma in this population. Pain (23.1%) was not a disease feature in this series and 52% of patients had past surgery for mycetoma and recurrence. The right hand was affected most (60.4%), and 64% of them had small lesion at presentation. Conventional x-ray was only helpful in patients with advanced disease and the MRI accurately determined the disease extension. Cytological smears, surgical biopsies histopathological examination and grains culture were the principal diagnostic tools for causative organisms' identification. In the present series it was difficult to determine the treatment outcome due to high patients follow up dropout.
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Affiliation(s)
| | - Nancy Seif EL Din
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
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Mycetoma: a unique neglected tropical disease. THE LANCET. INFECTIOUS DISEASES 2016; 16:100-112. [PMID: 26738840 DOI: 10.1016/s1473-3099(15)00359-x] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 11/23/2022]
Abstract
Mycetoma can be caused by bacteria (actinomycetoma) or fungi (eumycetoma) and typically affects poor communities in remote areas. It is an infection of subcutaneous tissues resulting in mass and sinus formation and a discharge that contains grains. The lesion is usually on the foot but all parts of the body can be affected. The causative microorganisms probably enter the body by a thorn prick or other lesions of the skin. Mycetoma has a worldwide distribution but is restricted to specific climate zones. Microbiological diagnosis and characterisation of the exact organism causing mycetoma is difficult; no reliable serological test exists but molecular techniques to identify relevant antigens have shown promise. Actinomycetoma is treated with courses of antibiotics, which usually include co-trimoxazole and amikacin. Eumycetoma has no acceptable treatment at present; antifungals such as ketoconazole and itraconazole have been used but are unable to eradicate the fungus, need to be given for long periods, and are expensive. Amputations and recurrences in patients with eumycetoma are common.
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Develoux M. [Mycetoma and their treatment]. J Mycol Med 2016; 26:77-85. [PMID: 27260344 DOI: 10.1016/j.mycmed.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 11/18/2022]
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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García-Romero MT, Lara-Corrales I, Kovarik CL, Pope E, Arenas R. Tropical Skin Diseases in Children: A Review- Part I. Pediatr Dermatol 2016; 33:253-63. [PMID: 27040351 DOI: 10.1111/pde.12831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Because of travel and migration patterns, tropical skin diseases are now seen all around the world, not just in tropical or developing countries. Nutrition, housing, and environmental factors play an important role in these infectious diseases, so when they appear out of their normal environments, their classic presentation may vary. Tropical diseases can also present differently in childhood, making their recognition, diagnosis, and management a clinical challenge. Health care providers in developed countries need to be familiar with tropical skin diseases and be able to diagnose them in returning travelers or immigrants in order to optimize care. This article aims to review the epidemiologic, clinical, diagnostic, and therapeutic aspects of some of the most common tropical dermatologic conditions in children.
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Affiliation(s)
| | - Irene Lara-Corrales
- Dermatology Section, Department of Pediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Carrie L Kovarik
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elena Pope
- Dermatology Section, Department of Pediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Roberto Arenas
- Mycology Section, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
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Ezaldeen EA, Mohamed Ahmed R, Wadella ES, El Dawi N, Hassan Fahal A. Cervical spinal cord compression: a rare and serious complication of Actinomadura pelletieri actinomycetoma. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | | | - Nadia El Dawi
- Department of Histopathology, Soba University Hospital, Khartoum, Sudan
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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] [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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Nenoff P, van de Sande WWJ, Fahal AH, Reinel D, Schöfer H. Eumycetoma and actinomycetoma--an update on causative agents, epidemiology, pathogenesis, diagnostics and therapy. J Eur Acad Dermatol Venereol 2015; 29:1873-83. [PMID: 25726758 DOI: 10.1111/jdv.13008] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/08/2015] [Indexed: 11/30/2022]
Abstract
Mycetoma is a chronic putrid infection of the cutaneous and subcutaneous tissue concerning predominantly the feet, and more rarely other body parts. Mycetoma can be caused by both fungi (eumycetoma) and bacteria (actinomycetoma). Mode of infection is an inoculation of the causative microorganism via small injuries of the skin. The clinical correlate of both forms of mycetoma is tumescence with abscesses, painless nodules, sinuses and discharge. The latter is commonly serous-purulent and contains grains (filamentous granules) which can be expressed for diagnostic purposes. Distinctive for both eumycetoma and actinomycetoma, are the formation of grains. Grains represent microcolonies of the microorganism in vivo in the vital tissue. The most successful treatment option for eumycetomas offers itraconazole in a dosage of 200 mg twice daily. This triazole antifungal is considered as 'gold standard' for eumycetomas. Alternatively, the cheaper ketoconazole was widely used, however, it was currently stopped by the FDA. Actinomycetomas should be treated by the combination of trimethoprim-sulphamethoxazole (co-trimoxazole 80/400 to 160/800 mg per day) and amikacin 15 mg/kg body weight per day. Mycetomas are neglected infections of the poor. They are more than a medical challenge. In rural areas of Africa, Asia and South America mycetomas lead to socio-economic consequences involving the affected patients, their families and the society in general.
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Affiliation(s)
- P Nenoff
- Labor für medizinische Mikrobiologie, Partnerschaft Prof. Pietro Nenoff & Dr. Constanze Krüger, Mölbis, Germany
| | - W W J van de Sande
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - A H Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - D Reinel
- Hautarztpraxis, Hamburg, Germany
| | - H Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
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Rouzaud C, Mainardi JL, Lortholary O, Lebeaux D. Traitement des nocardioses : plus de questions que de réponses ? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.antinf.2014.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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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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A 48-year-old male immigrant with a painful foot mass. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 25:191-3. [PMID: 25285121 PMCID: PMC4173937 DOI: 10.1155/2014/107549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Mycetoma is a tropical disease which is caused by a taxonomically diverse range of actinomycetes (actinomycetoma) and fungi (eumycetoma). The disease was only recently listed by the World Health Organization (WHO) as a neglected tropical disease (NTD). This recognition is the direct result of a meeting held in Geneva on February 1, 2013, in which experts on the disease from around the world met to identify the key research priorities needed to combat mycetoma. The areas that need to be addressed are highlighted here. The initial priority is to establish the incidence and prevalence of the disease in regions where mycetoma is endemic, prior to determining the primary reservoirs of the predominant causal agents and their mode of transmission to susceptible individuals in order to establish novel interventions that will reduce the impact of the disease on individuals, families, and communities. Critically, economical, reliable, and effective methods are required to achieve early diagnosis of infections and consequential improved therapeutic outcomes. Molecular techniques and serological assays were considered the most promising in the development of novel diagnostic tools to be used in endemic settings. Improved strategies for treating eumycetoma and actinomycetoma are also considered.
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Ndiaye M, Diatta B, Sow D, Diallo M, Diop A, Diadie S, Diallo S, Ndiaye M, Niang S, Ly F, Dieng M, Kane A. Une présentation atypique tumorale d’un mycétome actinomycosique dorsolombaire. J Mycol Med 2014; 24:44-7. [DOI: 10.1016/j.mycmed.2013.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 10/25/2022]
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Nocardiosis in transplant recipients. Eur J Clin Microbiol Infect Dis 2013; 33:689-702. [PMID: 24272063 DOI: 10.1007/s10096-013-2015-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/31/2013] [Indexed: 01/11/2023]
Abstract
Nocardiosis is a rare opportunistic infection caused by Nocardia spp., an aerobic actinomycete, that mainly affects patients with cell-mediated immunity defects, such as transplant recipients. Despite recent progress regarding Nocardia identification and changes in taxonomic assignment, many challenges remain for the diagnosis or management of nocardiosis. This opportunistic infection affects 0.04 to 3.5 % of patients with solid organ or hematopoietic stem cell transplantation, depending on the organ transplanted, cytomegalovirus (CMV) infection, corticosteroids dose and calcineurin inhibitors level. Nocardiosis diagnosis relies on appropriate clinical, radiological and microbiological workup that includes the sampling of an accessible involved site and molecular microbiology tools. In parallel, extensive clinical and radiological evaluations are mandatory, including brain imaging, even in the absence of neurological signs. In transplanted patients, differential diagnosis is challenging, with co-infections reported in 20 to 64 % of cases. As the antibiotic susceptibility pattern varies among species, the antimicrobial regimen before species identification should rely on the association of antibiotics active on all species of Nocardia. Bactericidal antibiotics are required in cases of severe or disseminated disease. Furthermore, in transplant recipients, combination therapy is difficult to manage because of cumulative toxicity and interactions with immunosuppressive agents. Because of a high recurrence rate, antibiotic therapy should be prescribed for 6 to 12 months.
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Welsh O, Vera-Cabrera L, Salinas-Carmona MC. Current treatment for nocardia infections. Expert Opin Pharmacother 2013; 14:2387-98. [DOI: 10.1517/14656566.2013.842553] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mattioni S, Develoux M, Brun S, Martin A, Jaureguy F, Naggara N, Bouchaud O. Management of mycetomas in France. Med Mal Infect 2013; 43:286-94. [PMID: 23916308 DOI: 10.1016/j.medmal.2013.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/02/2013] [Accepted: 06/17/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE OF THE STUDY Mycetomas are chronic sub-cutaneous tropical infections in which exogenous causative agents, fungal (eumycetes) or bacterial (actinomycetes), generate grains. The typical presentation is multi-fistulized pseudotumors. This disease, particularly eumycetoma, is difficult to treat. It is a major health problem in tropical and subtropical countries. In France, the disease is rare, but patients have access to a broader range of treatments. The authors had for objective to present the cases of mycetomas diagnosed in developed country and their management. PATIENTS AND METHODS A retrospective study was made on the clinical presentation and management of mycetomas from 1995 to 2011, in the Bobigny Avicenne teaching hospital. RESULTS Six patient files were studied. The patients were men with a median age of 31 years (16-70). Five patients were from Sub Saharan Africa, one from Sri Lanka. The etiologies were one actinomycetoma and five eumycetomas. There was bone involvement in five cases. There was one atypical presentation: a primary intra-osseous mycetoma. Three patients were cured including two by surgical management and one by medical treatment (actinomycetoma). Antifungal therapy failed (four patients) in every case (voriconazole, itraconazole, ketoconazole, terbinafine, caspofungin). CONCLUSION The results of this study made in a non-epidemic zone revealed that despite a typical clinical presentation, the diagnosis and management were delayed because this imported disease is rare in France. The patients received new broad-spectrum triazole and caspofungin, but none were cured with antifungal therapy alone.
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Affiliation(s)
- S Mattioni
- Service de maladies infectieuses et tropicales, hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93000 Bobigny, France.
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