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Fahal AH, Ahmed IS, Saaed AA, Smith DJ, Alves F, Nyaoke B, Asiedu K, Hay R. Hope amidst neglect: Mycetoma Research Center, University of Khartoum. A holistic management approach to achieve the United Nations' Sustainable Development Goals. PLoS Negl Trop Dis 2024; 18:e0012420. [PMID: 39235990 DOI: 10.1371/journal.pntd.0012420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
Mycetoma is a debilitating neglected tropical disease that affects individuals worldwide, particularly in regions where there is poverty and limited health care access. The Mycetoma Research Center (MRC), based in Khartoum, Sudan, provides a sustainable, holistic approach to patient care as the only World Health Organization collaborating center for mycetoma. We describe MRC activities that align with the United Nations' Sustainable Development Goals to control mycetoma in Sudan and globally.
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Affiliation(s)
| | - Iman Siddig Ahmed
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
| | - Ali Awadallah Saaed
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
- The National University, Khartoum, Sudan
| | - Dallas J Smith
- Mycotic Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Fabiana Alves
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Borna Nyaoke
- Drugs for Neglected Diseases Initiative, Nairobi, Kenya
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Fahal AH, Ahmed ES, Mahmoud AH, Saaed AA. The Mycetoma Research Center, University of Khartoum, Sudan's experience in community engagement initiatives spans 3 decades. PLoS Negl Trop Dis 2024; 18:e0012304. [PMID: 39172748 PMCID: PMC11340884 DOI: 10.1371/journal.pntd.0012304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
Mycetoma profoundly affects marginalised communities, especially in impoverished and remote areas with limited access to healthcare. This chronic and debilitating inflammatory disease highlights the typical issues of neglected tropical diseases (NTDs), such as insufficient attention, funding, and resources, which perpetuate neglect and suffering. Patients often delay seeking medical help, leading to advanced disease stages, severe complications, and lasting disabilities. The lack of medical infrastructure and skilled healthcare professionals worsens the situation, causing delays in diagnosis and inadequate treatment. Engaging affected communities in tailored interventions is essential to tackle these challenges, promote collaboration, raise awareness, and mobilise resources to improve healthcare access and enhance diagnostic and treatment capabilities. Since 1991, the Mycetoma Research Center (MRC) at the University of Khartoum, Sudan, has led community engagement initiatives aimed at improving the quality of life for mycetoma-affected individuals through education, advocacy, and local collaboration. In this communication, the MRC shares its extensive experience in community engagement to benefit mycetoma-affected communities.
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Affiliation(s)
- Ahmed Hassan Fahal
- Mycetoma Research Center, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Eiman Siddig Ahmed
- Mycetoma Research Center, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Ahmed Hussein Mahmoud
- Mycetoma Research Center, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Ali Awadella Saaed
- Mycetoma Research Center, Soba University Hospital, University of Khartoum, Khartoum, Sudan
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Omar Ali H, Abraham R, Desoubeaux G, Fahal AH, Tauber C. Evaluation of a computational model for mycetoma-causative agents identification. Trans R Soc Trop Med Hyg 2024; 118:253-263. [PMID: 38088215 DOI: 10.1093/trstmh/trad057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/21/2023] [Accepted: 11/27/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The therapeutic strategy for mycetoma relies heavily on the identification of the causative agents, which are either fungal or bacterial. While histopathological examination of surgical biopsies is currently the most used diagnostic tool, it requires well-trained pathologists, who are lacking in most rural areas where mycetoma is endemic. In this work we propose and evaluate a machine learning approach that semi-automatically analyses histopathological microscopic images of grains and provides a classification of the disease as eumycetoma or actinomycetoma. METHODS The computational model is based on radiomics and partial least squares. It is assessed on a dataset that includes 890 individual grains collected from 168 patients originating from the Mycetoma Research Centre in Sudan. The dataset contained 94 eumycetoma cases and 74 actinomycetoma cases, with a distribution of the species among the two causative agents that is representative of the Sudanese distribution. RESULTS The proposed model achieved identification of causative agents with an accuracy of 91.89%, which is comparable to the accuracy of experts from the domain. The method was found to be robust to a small error in the segmentation of the grain and to changes in the acquisition protocol. Among the radiomics features, the homogeneity of mycetoma grain textures was found to be the most discriminative feature for causative agent identification. CONCLUSION The results presented in this study support that this computational approach could greatly benefit rural areas with limited access to specialized clinical centres and also provide a second opinion for expert pathologists to implement the appropriate therapeutic strategy.
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Affiliation(s)
- Hyam Omar Ali
- Faculty of Mathematical Sciences, University of Khartoum, 11111, Khartoum, Sudan
- Mycetoma Research Centre, University of Khartoum, 11111, Khartoum, Sudan
- Boulevard Tonnellé, University of Tours, Inserm, 37032, Tours, France
- CNRS U7013, rue de Chartres, University of Orleans, 45067, Orleans, France
| | - Romain Abraham
- CNRS U7013, rue de Chartres, University of Orleans, 45067, Orleans, France
| | - Guillaume Desoubeaux
- Parasitology and Mycology Department, Bretonneau Hospital, 37032, Tours, France
- Boulevard Tonnellé, University of Tours, 37032, Tours, France
| | - Ahmed H Fahal
- Mycetoma Research Centre, University of Khartoum, 11111, Khartoum, Sudan
| | - Clovis Tauber
- Boulevard Tonnellé, University of Tours, Inserm, 37032, Tours, France
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Badri R, Fahal AH. The impact of the Sudan armed conflict on Mycetoma control. PLoS Negl Trop Dis 2023; 17:e0011783. [PMID: 38060462 PMCID: PMC10703249 DOI: 10.1371/journal.pntd.0011783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Rawa Badri
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Santona A, Mhmoud NA, Siddig EE, Deligios M, Fiamma M, Paglietti B, Bakhiet SM, Rubino S, Fahal AH. Metagenomic detection of eumycetoma causative agents from households of patients residing in two Sudanese endemic villages in White Nile State. PLoS Negl Trop Dis 2022; 16:e0010385. [PMID: 36040926 PMCID: PMC9467367 DOI: 10.1371/journal.pntd.0010385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/12/2022] [Accepted: 07/14/2022] [Indexed: 12/04/2022] Open
Abstract
Eumycetoma is a chronic debilitating fungal disease endemic to tropical and subtropical regions, with Sudan featuring the highest eumycetoma incidence. Among the 50 species of fungi most commonly associated with eumycetoma Madurella mycetomatis (M. mycetomatis) is often referenced as the most common pathogen. However, there is an enormous knowledge gap related to this neglected disease and its pathogenesis, epidemiological features, and host-specific factors that could contribute to either the host susceptibility and resistance. In this study, we were able to utilize a metagenomic approach and samples collected from clinical black grains (BG) and familiar household environments aimed to assay both the habitat of eumycetoma-associated fungi and its possible connection with eumycetoma patients living in two different eumycetoma endemic villages within the White Nile State of Sudan. DNA sequencing targeting the fungal ITS2 domain was performed on soil, animal dung, housing walls and roofs, and Acacia-species thorn samples and compared with culture-dependent methods of fungal isolation. Additionally, we compared the soil samples obtained in the endemic zone with that from non-endemic zones, including Wagga village in Kassala State and Port Sudan suburb in Port Sudan State. Overall, a total of 392 Amplicon Sequence Variants (ASVs) were detected by ITS2 metagenomics Eumycetoma causative organisms accounted for 10% of total ASVs which included 11 genera: Exserohilum (2%), Aspergillus (1.7%), Curvularia (1%), Alternaria (0.9%), Madurella (0.5%), Fusarium (0.4%), Cladosporium (0.2%) Exophiala (0.15%), and, in a lesser extent, Microascus (0.05%) Bipolaris and Acremonium (0.01%) for each. Only five genera were identified by culture method, which included Fusarium (29%), Aspergillus (28%), Alternaria (2.5%), Bipolaris (1.6%), and Chaetomium (0.8%). M. mycetomatis was detected within all the studied patients’ houses, accounting for 0.7% of total sequences. It was the first common eumycetoma-associated agent detected in soil samples and the third common in the dung and wall samples. In contrast, it was not detected in the roof or thorn samples nor in the soils from non-endemic regions. Exserohilum rostratum, Aspergillus spp and Cladosporium spp were detected in all samples. M. mycetomatis and other eumycetoma-associated fungal identified in the patients’ black grains (BG) samples by metagenomics were identified in the environmental samples. Only Acremonium alternatum and Falciformispora senegalensis, responsible for eumycetoma in two patients were not detected, suggesting the infections in these patients happened outside these endemic areas. The soil, animal dung, and houses built from the same soil and dung are the main risk factors for M. mycetomatis infection in these endemic villages. Furthermore, the poor hygienic and environmental conditions, walking barefooted, and the presence of animals within the houses increase the risk of M. mycetomatis and other fungi causing eumycetoma. In this pilot study, using a metagenomic approach, we revealed in two Sudanese eumycetoma endemic villages within the While Nile State in Sudan, the habitat of M. mycetomatis and other fungal species responsible for eumycetoma. Although never isolated in culture, M. mycetomatis represented the most abundant eumycetoma-associated species found within soil samples and the third most common species within dung and housing wall samples. All the eumycetoma-associated fungal species detected by metagenomic in black grains samples were identified in patient’s houses, except Falciformispora senegalensis and Acremonium alternatum. The findings obtained in this study provided insight into the habitat of eumycetoma-associated causative species and improved knowledge on eumycetoma origin and risk factors in endemic villages. Furthermore, despite the limited number of samples, these results suggest the main prevention measurements to contain eumycetoma in these endemic areas. These measurements include using gloves and alternative materials to endemic soil and animal dung in building the wall of the houses walls, constructing animal fences and appropriate use of footwear.
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Affiliation(s)
- Antonella Santona
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Najwa A. Mhmoud
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Emmanuel Edwar Siddig
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Massimo Deligios
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Maura Fiamma
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Bianca Paglietti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Sahar Mubarak Bakhiet
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ahmed Hassan Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- * E-mail: ,
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Siddig EE, El Had Bakhait O, El Nour Bahar M, Siddig Ahmed E, Bakhiet SM, Motasim Ali M, Babekir Abdallah O, Ahmed Hassan R, Verbon A, van de Sande WWJ, Fahal AH. Ultrasound-guided Fine Needle Aspiration Cytology significantly improved mycetoma diagnosis. J Eur Acad Dermatol Venereol 2022; 36:1845-1850. [PMID: 35748131 PMCID: PMC9543342 DOI: 10.1111/jdv.18363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
Background Ultrasound (US)‐guided fine‐needle aspiration cytology (US‐FNAC) has improved the diagnosis of many malignancies, infections and other diseases as it is safe, simple, quick and accurate. In mycetoma, it is assumed that this technique may have a better diagnostic yield than the conventional FNAC as it can accurately identify the optimal site for the aspiration. Objective To compare the diagnostic yield of conventional FNAC with US‐FNAC. Methods This descriptive cross‐sectional hospital‐based study included 80 patients with clinically suspected mycetoma. Results Of the 80 patients included, 35 proved to have actinomycetoma, and 37 had eumycetoma based on surgical biopsies, histopathological examination and the culture of grains. Eight patients appeared to have no mycetoma. For actinomycetoma diagnosis, the US‐guided FNAC improved sensitivity to 97% and negative predictive value (NPV) to 83% compared to the conventional FNAC, which had 63% sensitivity; and NPV of 28%. No improvement was found for specificity. For eumycetoma, the conventional FNAC had 86.5% sensitivity, 100% specificity, 100% PPV and 37.5% NPV. The US‐FNAC for the diagnosis of eumycetoma had 100% sensitivity and specificity. Conclusions and relevance The obtained results showed that US‐FNAC is better than the conventional FNAC with lower false‐negative results. It can accurately distinguish between the two types of mycetoma, allowing rapid initiation of proper treatment. The technique can be used in rural areas with low resources and for epidemiological surveys as a quick screening tool for patients suspected of mycetoma.
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Affiliation(s)
- Emmanuel Edwar Siddig
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan.,ErasmusMC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.,Department of Histopathology and Cytology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | | | | | | | - Sahar Mubarak Bakhiet
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan.,Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | | | | | - Annelies Verbon
- ErasmusMC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Wendy W J van de Sande
- ErasmusMC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
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Abstract
As the at-risk population expands and new antifungal resistance patterns develop, it is critical to understand and recognize cutaneous manifestations of old and emerging fungal diseases. PURPOSE OF REVIEW The aim of this review is to provide an overview of the most frequent and emerging deep cutaneous fungal infections following either primary inoculation or secondary spread after haematogenous seeding in disseminated infections in different geographical areas. RECENT FINDINGS Fungal skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions based on the site of the infection, route of acquisition of the pathogen, epidemiological setting and the virulence of the fungus in relation to the host. The approach to a patient suspected of having a fungal SSTI is complex and usually poses a major diagnostic challenge. The treatment approach should include attempts at immune reconstitution, targeted antifungal therapy and/or aggressive surgical debridement. SUMMARY Fungal SSTIs can be an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients and are being reported with increasing frequency worldwide.
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Fahal AH, Otieno LA, Ahmed ES, Kashif T, Khalid M, Mahmoud AH, Ododo L, Kyalo T, Bakhiet SM. OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022. [PMCID: PMC9667873 DOI: 10.1093/trstmh/trac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Eiman Siddig Ahmed
- Mycetoma Research Center, Soba University Hospital, University of Khartoum, Sudan
| | - Taysir Kashif
- Mycetoma Research Center, Soba University Hospital, University of Khartoum, Sudan
| | - Mahmoud Khalid
- Mycetoma Research Center, Soba University Hospital, University of Khartoum, Sudan
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Fahal LA, Ahmed ES, Bakhiet SM, Siddig EE, Fahal AH. The Mycetoma Research Centre experience during the COVID-19 pandemic: obstacles and beyond. Trans R Soc Trop Med Hyg 2021; 116:1-3. [PMID: 34313305 PMCID: PMC8344511 DOI: 10.1093/trstmh/trab111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/23/2021] [Accepted: 07/14/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lamis Ahmed Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
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