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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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van de Sande WWJ, Fahal AH. An updated list of eumycetoma causative agents and their differences in grain formation and treatment response. Clin Microbiol Rev 2024; 37:e0003423. [PMID: 38690871 PMCID: PMC11237709 DOI: 10.1128/cmr.00034-23] [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] [Indexed: 05/03/2024] Open
Abstract
SUMMARYIn 2023, the World Health Organization designated eumycetoma causative agents as high-priority pathogens on its list of fungal priority pathogens. Despite this recognition, a comprehensive understanding of these causative agents is lacking, and potential variations in clinical manifestations or therapeutic responses remain unclear. In this review, 12,379 eumycetoma cases were reviewed. In total, 69 different fungal species were identified as causative agents. However, some were only identified once, and there was no supporting evidence that they were indeed present in the grain. Madurella mycetomatis was by far the most commonly reported fungal causative agent. In most studies, identification of the fungus at the species level was based on culture or histology, which was prone to misidentifications. The newly used molecular identification tools identified new causative agents. Clinically, no differences were reported in the appearance of the lesion, but variations in mycetoma grain formation and antifungal susceptibility were observed. Although attempts were made to explore the differences in clinical outcomes based on antifungal susceptibility, the lack of large clinical trials and the inclusion of surgery as standard treatment posed challenges in drawing definitive conclusions. Limited case series suggested that eumycetoma cases caused by Fusarium species were less responsive to treatment than those caused by Madurella mycetomatis. However, further research is imperative for a comprehensive understanding.
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Affiliation(s)
- Wendy W. J. van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ahmed H. Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
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Konings M, Eadie K, Strepis N, Nyuykonge B, Fahal AH, Verbon A, van de Sande WWJ. The combination of manogepix and itraconazole is synergistic and inhibits the growth of Madurella mycetomatis in vitro but not in vivo. Med Mycol 2023; 61:myad118. [PMID: 37960934 PMCID: PMC10684268 DOI: 10.1093/mmy/myad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/17/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
Mycetoma is a neglected tropical disease commonly caused by the fungus Madurella mycetomatis. Standard treatment consists of extensive treatment with itraconazole in combination with surgical excision of the infected tissue, but has a low success rate. To improve treatment outcomes, novel treatment strategies are needed. Here, we determined the potential of manogepix, a novel antifungal agent that targets the GPI-anchor biosynthesis pathway by inhibition of the GWT1 enzyme. Manogepix was evaluated by determining the minimal inhibitory concentrations (MICs) according to the CLSI-based in vitro susceptibility assay for 22 M. mycetomatis strains and by in silico protein comparison of the target protein. The synergy between manogepix and itraconazole was determined using a checkerboard assay. The efficacy of clinically relevant dosages was assessed in an in vivo grain model in Galleria mellonella larvae. MICs for manogepix ranged from <0.008 to >8 mg/l and 16/22 M. mycetomatis strains had an MIC ≥4 mg/ml. Differences in MICs were not related to differences observed in the GWT1 protein sequence. For 70% of the tested isolates, synergism was found between manogepix and itraconazole in vitro. In vivo, enhanced survival was not observed upon admission of 8.6 mg/kg manogepix, nor in combination treatment with 5.7 mg/kg itraconazole. MICs of manogepix were high, but the in vitro antifungal activity of itraconazole was enhanced in combination therapy. However, no efficacy of manogepix was found in an in vivo grain model using clinically relevant dosages. Therefore, the therapeutic potential of manogepix in mycetoma caused by M. mycetomatis seems limited.
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Affiliation(s)
- Mickey Konings
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Kimberly Eadie
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Nikolaos Strepis
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Bertrand Nyuykonge
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Ahmed H Fahal
- Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
| | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of Internal Medicine, UMC Utrecht, Utrecht, The Netherlands
| | - Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
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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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Dolatabadi S, Najafzadeh MJ, Houbraken J, Vicente V, de Hoog S, Meis JF. In vitro activity of eight antifungal drugs against Chaetomiaceae. Med Mycol 2021; 60:6427364. [PMID: 34791380 DOI: 10.1093/mmy/myab074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 11/12/2022] Open
Abstract
The incidence of infections caused by uncommon Chaetomiaceae (Chaetomium and related species) in humans has increased in the recent years. The in vitro activity of eight antifungal drugs (amphotericin B, five azoles, two echinocandins) against 42 morphologically identified Chaetomium strains was determined according to the Clinical and Laboratory Standards Institute (CLSI) guideline. The strains were subsequently identified based on sequences of the internal transcribed spacer 1 and 2 including the intervening 5.8S nrDNA region (ITS) and the partial β tubulin gene (tub2). Chaetomium globosum (n = 24), was the most frequently isolated species, followed by Amesia atrobrunnea (syn. Chaetomium atrobrunnea, n = 6), Dichotomopilus dolichotrichus (syn. Chaetomium dolichotrichum, n = 2) and Acrophialophora jodhpurensis, Chaetomium coarctatum, C. elatum, C. gracile, C. subaffine, C. tarraconense, C. unguicola, Dichotomopilus sp., Dichotomopilus variostiolatus, Ovatospora brasiliensis (all represented by a single strain). The geometric means of the minimum inhibitory concentrations/minimum effective concentrations (MICs/MECs) of the antifungals across all strains were (in increasing order): micafungin 0.12 µg/ml, itraconazole and posaconazole 0.21 µg/ml, amphotericin B 0.25 µg/ml, voriconazole 0.45 µg/ml, isavuconazole 0.54 µg/ml, caspofungin 2.57 µg/ml, and fluconazole 45.25 µg/ml. Micafungin had the lowest geometric mean followed by amphotericin B which had the largest range against tested isolates. All examined C. globosum strains had similar antifungal susceptibility patterns. Fluconazole and caspofungin could not be considered as an option for treatment of infections caused by Chaetomium and chaetomium-like species. LAY SUMMARY Infections caused by uncommon fungi such as Chaetomium have increased in the recent years. Chaetomium globosum has been reported from onychomycosis and phaeohyphomycosis. This species often induces superficial infections in immunocompetent patients. The taxonomy of Chaetomium spp. has changed dramatically in the last years. Antifungal treatment is a crucial step for managing these kinds of infections. Therefore, the in vitro activity of eight antifungal drugs against Chaetomium strains was determined and β-tubulin (tub2) sequencing was applied to identify the strains. Chaetomium globosum was the most frequent species in our dataset. Based on the results of susceptibility testing, micafungin had the lowest geometric mean followed by amphotericin B. Fluconazole and caspofungin cannot be considered a proper treatment option for infections caused by Chaetomium and chaetomium-like species.
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Affiliation(s)
- Somayeh Dolatabadi
- Department of Biology, Hakim Sabzevari University, Sabzevar, 9617976487, Iran
| | - Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91871 45785, Iran
| | - Jos Houbraken
- Westerdijk Fungal Biodiversity Institute, Utrecht, 3584 CT Utrecht, the Netherlands
| | - Vania Vicente
- Bioprocess Engineering and Biotechnology Graduate Program; Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, 82650145, Brazil
| | - Sybren de Hoog
- Bioprocess Engineering and Biotechnology Graduate Program; Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, 82650145, Brazil.,Center of Expertise in Mycology, Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, 6532 SZ Nijmegen, the Netherlands
| | - Jacques F Meis
- Bioprocess Engineering and Biotechnology Graduate Program; Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Basic Pathology, Federal University of Paraná, Curitiba, 82650145, Brazil.,Center of Expertise in Mycology, Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, 6532 SZ Nijmegen, the Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, 6532 SZ Nijmegen, the Netherlands
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Eumycetoma Medical Treatment: Past, Current Practice, Latest Advances and Perspectives. MICROBIOLOGY RESEARCH 2021. [DOI: 10.3390/microbiolres12040066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mycetoma is a neglected tropical disease that is associated with poor communities and socioeconomically impaired individuals in the tropical and sub-tropical areas. Interestingly, the disease is caused by either bacteria (actinomycetoma) or fungus (eumycetoma). The latter form of the disease, eumycetoma, is the most common type in Africa. Eumycetoma is characterized by a prolonged disease duration and low cure rate. The effective case management of eumycetoma largely depends on the accurate diagnosis and identification of the causative agent to the species level and evaluating its susceptibility to the available drugs. This review summarizes the currently available and used antifungal agents for the treatment of eumycetoma and discusses optimizing the newly developed antifungals as a potential second line for eumycetoma treatment.
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van de Sande WWJ. In vitro susceptibility testing for black grain eumycetoma causative agents. Trans R Soc Trop Med Hyg 2021; 115:343-354. [PMID: 33537781 PMCID: PMC8046409 DOI: 10.1093/trstmh/traa184] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022] Open
Abstract
Eumycetoma is a neglected tropical implantation mycosis characterized by large subcutaneous swellings. Inside the infected tissue, the causative agents are found in grains. The most common causative agents form black grains and are sterile upon isolation. In vitro susceptibility assays were developed for eumycetoma causative agents. They were based on the Clinical and Laboratory Standards Institute M38A protocol and modified to enable the use of hyphae as a starting inoculum. To ease endpoint reading, viability dyes such as resazurin or XTT have been used. So far the in vitro susceptibility assays developed have mainly been used to establish if causative agents are inhibited in growth by various antifungal agents, but not for clinical decision making. For drug discovery, the assay proved useful in determining which compounds were able to prevent hyphal growth. However, a clear correlation between in vitro inhibition in terms of the half maximal inhibitory concentration or 50% minimum inhibitory concentration (MIC50) and therapeutic efficacy assayed in a novel model system in terms of Galleria mellonella larval survival was not found. For clinical decision making, a range of MICs were found for each antifungal agent. However, no clinical breakpoints have been established for any of the causative agents. For itraconazole, the MIC50 of most causative agents was below the attainable serum levels, which might indicate that they are susceptible. However, before in vitro susceptibility can be used in clinical decision making for mycetoma, a correlation between MIC and clinical outcome needs to be made.
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Affiliation(s)
- Wendy W J van de Sande
- Erasmus Medical Center, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Development and Validation of an In Vitro Resazurin-Based Susceptibility Assay against Madurella mycetomatis. Antimicrob Agents Chemother 2021; 65:AAC.01338-20. [PMID: 33318015 PMCID: PMC8092548 DOI: 10.1128/aac.01338-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/05/2020] [Indexed: 01/08/2023] Open
Abstract
We present an in vitro susceptibility assay for Madurella mycetomatis hyphae using resazurin for endpoint reading. Using this assay, reproducible MICs were obtained for amphotericin B, itraconazole, voriconazole, posaconazole, terbinafine, and micafungin. We present an in vitro susceptibility assay for Madurella mycetomatis hyphae using resazurin for endpoint reading. Using this assay, reproducible MICs were obtained for amphotericin B, itraconazole, voriconazole, posaconazole, terbinafine, and micafungin. Results were comparable with those of a 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide salt (XTT)-based susceptibility assay. The lowest MICs were obtained for itraconazole and posaconazole (MIC50, 0.016 µg/ml) followed by voriconazole (MIC50, 0.063 µg/ml). Amphotericin B, micafungin, and terbinafine appeared much less effective.
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Hata K. Development of E1224 by leveraging a strategic partnership for the medicines creation against neglected tropical diseases. Parasitol Int 2020; 81:102278. [PMID: 33370607 DOI: 10.1016/j.parint.2020.102278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/03/2020] [Accepted: 12/20/2020] [Indexed: 11/16/2022]
Abstract
Neglected tropical diseases (NTDs) are communicable diseases that are uncommon in developed countries but epidemic in developing countries in tropical and subtropical regions of the world. One of the important contributions expected of pharmaceutical companies is the development and provision of drugs effective against NTDs. Eisai's efforts toward improving global health have resulted in a rich portfolio of assets addressing six infectious diseases: malaria, tuberculosis, Chagas disease, lymphatic filariasis, leishmaniasis, and mycetoma. As the most advanced project, Eisai has developed E1224 (fosravuconazole l-lysine ethanolate), which is available in both intravenous and oral formulations, and provides ravuconazole, an active form of fosravuconazole, with a long plasma half-life. The first clinical trials of E1224, for Chagas disease, have already been completed, led by the Drugs for Neglected Diseases initiative (DNDi). As a result, parasite clearance was observed with E1224 during the treatment phase, but parasite regrowth was observed after the end of drug administration, suggesting that the mechanism of action of E1224 on Trypanosoma cruzi is static rather than parasiticidal. On the other hand, a clinical trial for eumycetoma in collaboration with DNDi is ongoing supported by the Global Health Innovative Technology Fund, and is examining the efficacy of weekly treatment with E1224 versus the current standard of care, daily treatment with itraconazole. In this manner, Eisai will continue its drug-discovery research projects in collaboration with various PDPs and academia supported by funding agencies.
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Affiliation(s)
- Katsura Hata
- Global Health Research Section, hhc Data Creation Center, Eisai Co., Ltd., 1-3, Tokodai 5-chome, Tsukuba-shi, Ibaraki 300-2635, Japan.
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Nyuykonge B, Klaassen C, Zandijk W, de Hoog G, Ahmed S, Desnos‐Ollivier M, Verbon A, Bonifaz A, van de Sande W. Diagnostic implications of mycetoma derived from Madurella pseudomycetomatis isolates from Mexico. J Eur Acad Dermatol Venereol 2020; 34:1828-1834. [PMID: 32233084 PMCID: PMC7497165 DOI: 10.1111/jdv.16402] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/10/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND At the dermatology service of the General Hospital of Mexico City, Mexico, two patients, father and son, with black-grain mycetoma were seen. The grains were isolated, and the cultured fungi were identified as Madurella mycetomatis based on morphology. Using the M. mycetomatis specific PCR, amplicons of a different size than that of the M. mycetomatis type strain were obtained. OBJECTIVE To determine the causative agent of the two black-grain mycetoma cases and develop non-culture-based diagnostic tools to identify them to the species level. METHODS The M. mycetomatis specific, the internal transcribed spacer (ITS) region, β-tubulin (BT) and ribosomal binding protein 2 (RBP2) PCRs were used to confirm the identity of the isolates. Genetic variation was established by amplification fragment length polymorphisms. To determine the antifungal susceptibility profile, the Sensititre™ YeastOne™ assay was used. To develop a species-specific PCR primers were designed on the sequenced PCR amplicon from the M. mycetomatis specific PCR. RESULTS By analyzing the ITS, BT and RBP2 regions the isolates were identified as Madurella pseudomycetomatis. The isolates from father and son were similar but not identical to M. pseudomycetomatis from Venezuela and one from an unknown origin. Madurella pseudomycetomatis isolates were inhibited by itraconazole, posaconazole and voriconazole but showed increased MIC values for amphotericin B and fluconazole. They were not inhibited by the echinocandins and five flucytosine. The two patients were treated with itraconazole resulting in cure for the father while the son was lost to follow-up. The species-specific PCR developed for M. pseudomyceotmatis was discriminative and specific. CONCLUSION Madurella pseudomycetomatis is genetically diverse with same susceptibility profile as M. mycetomatis and causes eumycetoma in Latin America. The M. pseudomycetomatis specific PCR can be used to identify this causative agent to the species level; however, this needs to be validated in an endemic setting.
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Affiliation(s)
- B. Nyuykonge
- Department of Medical Microbiology and Infectious DiseasesErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - C.H.W. Klaassen
- Department of Medical Microbiology and Infectious DiseasesErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - W.H.A. Zandijk
- Department of Medical Microbiology and Infectious DiseasesErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - G.S. de Hoog
- Westerdijk Fungal Biodiversity InstituteUtrechtThe Netherlands
| | - S.A. Ahmed
- Westerdijk Fungal Biodiversity InstituteUtrechtThe Netherlands
- Faculty of Medical Laboratory SciencesUniversity of KhartoumKhartoumSudan
| | - M. Desnos‐Ollivier
- Molecular Mycology UnitCNRS UMR 2000National Reference Center for Invasive Mycoses & AntifungalsInstitut PasteurParisFrance
| | - A. Verbon
- Department of Medical Microbiology and Infectious DiseasesErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - A. Bonifaz
- Hospital General de México Dr Eduardo LiceagaMexico CityMexico
| | - W.W.J. van de Sande
- Department of Medical Microbiology and Infectious DiseasesErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
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Pyomelanin Secretion in Madurella mycetomatis Interferes with Spectrophotometric Endpoint Reading Using the Sensititre YeastOne alamarBlue Assay but Not with Visual Endpoint Reading. Antimicrob Agents Chemother 2019; 64:AAC.01532-19. [PMID: 31611353 DOI: 10.1128/aac.01532-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/04/2019] [Indexed: 02/01/2023] Open
Abstract
The use of the Sensititre YeastOne YO10 alamarBlue assay for the in vitro susceptibility testing of Madurella mycetomatis was evaluated in M. mycetomatis isolates with and without pyomelanin secretion. Pyomelanin secretion did not influence visual endpoint reading; however, it caused a shift in peak absorbance from 570 nm to 620 nm when read spectrophotometrically. Therefore, when choosing the method for endpoint reading, the presence of pyomelanin should be considered.
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Kloezen W, Parel F, Brüggemann R, Asouit K, Helvert-van Poppel M, Fahal A, Mouton J, van de Sande W. Amphotericin B and terbinafine but not the azoles prolong survival in Galleria mellonella larvae infected with Madurella mycetomatis. Med Mycol 2019; 56:469-478. [PMID: 28992315 DOI: 10.1093/mmy/myx064] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/08/2017] [Indexed: 11/12/2022] Open
Abstract
Mycetoma is a tropical neglected disease characterized by large subcutaneous lesions in which the causative organisms reside in the form of grains. The most common causative agent is Madurella mycetomatis. Antifungal therapy often fails due to these grains, but to identify novel treatment options has been difficult since grains do not form in vitro. We recently used Galleria mellonella larvae to develop an in vivo grain model. In the current study, we set out to determine the therapeutic efficacy of commonly used antifungal agents in this larval model. Pharmacokinetics of ketoconazole, itraconazole, voriconazole, posaconazole, amphotericin B, and terbinafine were determined in the hemolymph of G. mellonella larvae. Antifungal therapy was given either therapeutically or prophylactic on three consecutive days in therapeutically equivalent dosages. Survival was monitored for 10 days and colony-forming units (cfu) and melanization were determined on day 3. Measurable concentrations of antifungal agents were found in the hemolymph of the larvae. None of the azole antifungal agents prolonged survival when given therapeutically or prophylactically. Amphotericin B and terbinafine did prolong survival, even at concentrations below the minimal inhibitory concentration of M. mycetomatis. The cfu and melanization did not differ between any of the treated groups and phosphate-buffered saline (PBS) treated groups. Grains were still present in surviving larvae but appeared to be encapsulated. This study demonstrated for the first time a comparison between the efficacy of different antifungal agents toward grains of M. mycetomatis. It appeared that amphotericin B and terbinafine were able to prolong larval survival.
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Affiliation(s)
- Wendy Kloezen
- ErasmusMC Department of Medical Microbiology and Infectious Diseases Wytemaweg 80 3015 CE Rotterdam, The Netherlands
| | - Florianne Parel
- ErasmusMC Department of Medical Microbiology and Infectious Diseases Wytemaweg 80 3015 CE Rotterdam, The Netherlands
| | - Roger Brüggemann
- Radboud University Medical Centre Pharmacy PO BOX 9101 6500 HB Nijmegen, The Netherlands
| | - Khalid Asouit
- Radboud University Medical Centre Pharmacy PO BOX 9101 6500 HB Nijmegen, The Netherlands
| | - Marilyn Helvert-van Poppel
- St Elisabeth Ziekenhuis Department of clinical pathology Hilvarenbeekseweg 60 5022 GC Tilburg, The Netherlands
| | | | - Johan Mouton
- ErasmusMC Department of Medical Microbiology and Infectious Diseases Wytemaweg 80 3015 CE Rotterdam, The Netherlands
| | - Wendy van de Sande
- ErasmusMC Department of Medical Microbiology and Infectious Diseases Wytemaweg 80 3015 CE Rotterdam, The Netherlands
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van de Sande W, Fahal A, Ahmed SA, Serrano JA, Bonifaz A, Zijlstra E. Closing the mycetoma knowledge gap. Med Mycol 2018; 56:153-164. [PMID: 28992217 DOI: 10.1093/mmy/myx061] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/14/2017] [Indexed: 12/13/2022] Open
Abstract
On 28th May 2016, mycetoma was recognized as a neglected tropical disease by the World Health Organization. This was the result of a 4-year journey starting in February 2013 with a meeting of global mycetoma experts. Knowledge gaps were identified and included the incidence, prevalence, and mapping of mycetoma; the mode of transmission; the development of methods for early diagnosis; and better treatment. In this review, we review the road to recognition, the ISHAM working group meeting in Argentina, and we address the progress made in closing the knowledge gaps since 2013. Progress included adding another 9000 patients to the literature, which allowed us to update the prevalence map on mycetoma. Furthermore, based on molecular phylogeny, species names were corrected and four novel mycetoma causative agents were identified. By mapping mycetoma causative agents an association with Acacia trees was found. For early diagnosis, three different isothermal amplification techniques were developed, and novel antigens were discovered. To develop better treatment strategies for mycetoma patients, in vitro susceptibility tests for the coelomycete agents of black grain mycetoma were developed, and the first randomized clinical trial for eumycetoma started early 2017.
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Affiliation(s)
- Wendy van de Sande
- ErasmusMC, Department of Medical Microbiology and Infectious Diseases, Wytemaweg 80, 3015 CE, Rotterdam, The Netherlands
| | - Ahmed Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | | | | | - Alexandro Bonifaz
- General Hospital of Mexico, Department of Mycology, Dermatology Service, Mexico City, Mexico
| | - Ed Zijlstra
- Rotterdam Centre for Tropical Medicine, Rotterdam, The Netherlands
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Motokawa N, Miyazaki T, Hara A, Fukuda Y, Morino S, Nakamura H, Iwasaki K, Soda H, Izumikawa K, Yanagihara K, Ohno H, Miyazaki Y, Kohno S, Mukae H. Pulmonary Scedosporium apiospermum Infection with Pulmonary Tumorlet in an Immunocompetent Patient. Intern Med 2018; 57:3485-3490. [PMID: 30101932 PMCID: PMC6306550 DOI: 10.2169/internalmedicine.1239-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Scedosporium apiospermum is an opportunistic fungus that can cause various types of infections, including localized infections and life-threatening disseminated infections, particularly in immunocompromised patients. Treatment is especially challenging due to its multidrug resistance. We herein report the case of a 73-year-old woman who was non-immunocompromised but developed S. apiospermum lung infection and a pulmonary tumorlet. To our knowledge, this is the first report of the coexistence of pulmonary S. apiospermum infection and tumorlet. The lung lesion was successfully treated by surgical excision without any antifungal agents, and no recurrence of the tumorlet or S. apiospermum infection has occurred.
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Affiliation(s)
- Nana Motokawa
- Division of Respiratory Medicine, Sasebo City General Hospital, Japan
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Taiga Miyazaki
- Division of Respiratory Medicine, Sasebo City General Hospital, Japan
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsuko Hara
- Division of Respiratory Medicine, Sasebo City General Hospital, Japan
| | - Yuichi Fukuda
- Division of Respiratory Medicine, Sasebo City General Hospital, Japan
| | - Shigeyuki Morino
- Division of Thoracic Surgery, Sasebo City General Hospital, Japan
| | - Hiroaki Nakamura
- Division of Thoracic Surgery, Sasebo City General Hospital, Japan
| | | | - Hiroshi Soda
- Division of Respiratory Medicine, Sasebo City General Hospital, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hideaki Ohno
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Japan
| | - Shigeru Kohno
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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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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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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Rapid and Robust Identification of the Agents of Black-Grain Mycetoma by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry. J Clin Microbiol 2017; 55:2521-2528. [PMID: 28592546 DOI: 10.1128/jcm.00417-17] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/27/2017] [Indexed: 01/19/2023] Open
Abstract
Eumycetoma, a chronic fungal infection endemic in India, Indonesia, and parts of Africa and South and Central America, follows traumatic implantation of saprophytic fungi and frequently requires radical surgery or amputation in the absence of appropriate treatment. Fungal species that can cause black-grain mycetomas include Madurella spp., Falciformispora spp., Trematosphaeria grisea, Nigrograna mackinnonii, Pseudochaetosphaeronema larense, Medicopsis romeroi, and Emarellia spp. Rhytidhysteron rufulum and Parathyridaria percutanea cause similar subcutaneous infections, but these infections lack the draining sinuses and fungal grains characteristic of eumycetoma. Accurate identification of the agents of subcutaneous fungal infection is essential to guide appropriate antifungal therapy. Since phenotypic identification of the causative fungi is often difficult, time-consuming molecular approaches are currently required. In the study described here we evaluated whether matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry might allow the accurate identification of eumycetoma agents and related fungi. A panel of 57 organisms corresponding to 10 different species from confirmed cases of eumycetoma and subcutaneous pedal masses, previously formally identified by PCR amplification and sequencing of internal transcribed spacer 1 (ITS1), was employed. Representative isolates of each species were used to create reference MALDI-TOF spectra, which were then used for the identification of the remaining isolates in a user-blinded manner. Here, we demonstrate that MALDI-TOF mass spectrometry accurately identified all of the test isolates, with 100%, 90.4%, and 67.3% of isolates achieving log scores greater than 1.8, 1.9, and 2.0, respectively.
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Abstract
Mycetoma is a localized chronic, suppurative, and deforming granulomatous infection seen in tropical and subtropical areas. It is a disorder of subcutaneous tissue, skin and bones, mainly of feet, characterized by a triad of localized swelling, underlying sinus tracts, and production of grains or granules. Etiological classification divides it into eumycetoma caused by fungus, and actinomycetoma caused by bacteria. Since the treatment of these two etiologies is entirely different, a definite diagnosis after histopathological and microbiological examination is mandatory, though difficult. Serological test exists but is not so reliable; however, molecular techniques to identify relevant antigens have shown promise. The disease is notoriously difficult to treat. Eumycetoma may be unresponsive to standard antifungal therapy. Actinomycetoma responds to antibiotic therapy, but prolonged treatment is necessary. This review focuses on the etiopathogenesis, clinical features, laboratory diagnosis, and treatment of mycetoma.
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Affiliation(s)
- Vineet Relhan
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
| | - Khushbu Mahajan
- Department of Dermatology, NDMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - Pooja Agarwal
- Department of Dermatology, AMC Medical College, Ahmedabad, Gujarat, India
| | - Vijay Kumar Garg
- Department of Dermatology, Maulana Azad Medical College, New Delhi, India
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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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Novel Taxa Associated with Human Fungal Black-Grain Mycetomas: Emarellia grisea gen. nov., sp. nov., and Emarellia paragrisea sp. nov. J Clin Microbiol 2016; 54:1738-1745. [PMID: 27076666 DOI: 10.1128/jcm.00477-16] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/07/2016] [Indexed: 01/19/2023] Open
Abstract
Eumycetoma is a debilitating, chronic, fungal infection that is endemic in India, Indonesia, and parts of Africa and South and Central America. It remains a neglected tropical disease in need of international recognition. Infections follow traumatic implantation of saprophytic fungi and frequently require radical surgery or amputation in the absence of appropriate treatment. Several fungal species can cause black-grain mycetomas, including Madurella spp. (Sordariales), Falciformispora spp., Trematosphaeria grisea, Biatriospora mackinnonii, Pseudochaetosphaeronema larense, and Medicopsis romeroi (all Pleosporales). We performed phylogenetic analyses based on five loci on 31 isolates from two international culture collections to establish the taxonomic affiliations of fungi that had been isolated from cases of black-grain mycetoma and historically classified as Madurella grisea Although most strains were well resolved to species level and corresponded to known agents of eumycetoma, six independent isolates, which failed to produce conidia under any conditions tested, were only distantly related to existing members of the Pleosporales Five of the six isolates shared >99% identity with each other and are described as Emarellia grisea gen. nov. and sp. nov; the sixth isolate represents a sister species in this novel genus and is described as Emarellia paragrisea. Several E. grisea isolates were present in both United Kingdom and French culture collections and had been isolated independently over 6 decades from cases of imported eumycetoma. Four of the six isolates involved patients that had originated on the Indian subcontinent. All isolates were all susceptible in vitro to the azole antifungals, but had elevated MICs with caspofungin.
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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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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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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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Echinocandins: production and applications. Appl Microbiol Biotechnol 2013; 97:3267-84. [PMID: 23463246 DOI: 10.1007/s00253-013-4761-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/06/2013] [Accepted: 02/07/2013] [Indexed: 10/27/2022]
Abstract
The first echinocandin-type antimycotic (echinocandin B) was discovered in the 1970s. It was followed by the isolation of more than 20 natural echinocandins. These cyclic lipo-hexapeptides are biosynthesized on non-ribosomal peptide synthase complexes by different ascomycota fungi. They have a unique mechanism of action; as non-competitive inhibitors of β-1,3-glucan synthase complex they target the fungal cell wall. Results of the structure-activity relationship experiments let us develop semisynthetic derivatives with improved properties. Three cyclic lipohiexapeptides (caspofungin, micafungin and anidulafungin) are currently approved for use in clinics. As they show good fungicidal (Candida spp.) or fungistatic (Aspergillus spp.) activity against the most important human pathogenic fungi including azole-resistant strains, they are an important addition to the antifungal armamentarium. Some evidence of acquired resistance against echinocandins has been detected among Candida glabrata strains in recent years, which enhanced the importance of data collected on the mechanism of acquired resistance developing against the echinocandins. In this review, we show the structural diversity of natural echinocandins, and we summarize the emerging data on their mode of action, biosynthesis and industrial production. Their clinical significance as well as the mechanism of natural and acquired resistance is also discussed.
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van Belkum A, Fahal A, van de Sande WWJ. Mycetoma caused by Madurella mycetomatis: a completely neglected medico-social dilemma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 764:179-89. [PMID: 23654067 DOI: 10.1007/978-1-4614-4726-9_15] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Mycetoma is a debilitating disease with a highly particular geographical distribution. The mycetoma belt circles the entire world just above the equator and defines the region with the highest prevalence and incidence. Although the disease is seen in Central America, India and all across Africa, Sudan seems to be the homeland of mycetoma. Mycetoma is an infectious disease caused either by bacteria (actinomycetoma) or true fungi (eumycetoma). In Sudan most cases are caused by the fungal species Madurella mycetomatis. The precise natural habitat of this fungus is still an enigma, but its DNA can easily be found in soil and plant samples in endemic areas. Although the entire human population in these areas are in regular contact with the fungus, most individuals are unaffected. Thus mycetoma is an ideal clinical and experimental model system for the study of host-pathogen interactions. Also, given its relative importance locally, improvements in clinical and laboratory diagnostics and knowledge of the epidemiology of the disease are badly needed. This chapter describes the current state of affairs in the field of eumycetoma caused by M. mycetomatis. The value of laboratory research on this disease and future perspective for control and prevention of the infection are discussed.
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Affiliation(s)
- Alex van Belkum
- BioMérieux, Microbiology Unit, La Balme-Les-Grottes, France.
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Abstract
Subcutaneous mycoses are common in tropical and subtropical regions of the world. These infections have multiple features in common, including similar epidemiology, mode of transmission, indolent chronic presentation with low potential for dissemination in immunocompetent hosts, and pyogranulomatous lesions on histopathology. Herein, we provide up-to-date epidemiologic, clinical, diagnostic, and therapeutic data for three important subcutaneous mycoses: chromoblastomycosis, mycetoma, and sporotrichosis.
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Affiliation(s)
- Ricardo M La Hoz
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, Tinsley Harrison Tower 229, Birmingham, AL, 35294-0006, USA
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27
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Abstract
“Mycetoma” means a fungal tumor. Mycetoma is a chronic, granulomatous, subcutaneous tissue infection caused by both bacteria (actinomycetoma) and fungi (eumycetoma). This chronic infection was termed Madura foot and eventually mycetoma, owing to its etiology. Inoculation commonly follows minor trauma, predominantly to the foot and hence is seen more among the barefoot-walking populations, common among adult males aged 20 to 50 years. The hallmark triad of the disease includes tumefaction, fistulization of the abscess, and extrusion of colored grains. The color of these extruded grains in the active phase of the disease offers a clue to diagnosis. Radiology, ultrasonology, cytology, histology, immunodiagnosis, and culture are tools used in diagnosis. Recently, DNA sequencing has also been used successfully. Though both infections manifest with similar clinical findings, Actinomycetoma has a rapid course and can lead to amputation or death secondary to systemic spread. However, actinomycetomas are more responsive to antibiotics, whereas eumycetomas require surgical excision in addition to antifungals. Complications include secondary bacterial infections that can progress to full-blown bacteremia or septicemia, resulting in death. With extremely disfiguring sequelae, following the breakdown of the nodules and formation of discharging sinuses, it poses a therapeutic challenge.
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Reshuffling of Aspergillus fumigatus cell wall components chitin and β-glucan under the influence of caspofungin or nikkomycin Z alone or in combination. Antimicrob Agents Chemother 2011; 56:1595-8. [PMID: 22203603 DOI: 10.1128/aac.05323-11] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chitin and β-glucan are major cell wall components of Aspergillus spp. We investigated the antifungal activity of chitin synthesis inhibitors nikkomycin Z, polyoxin D, flufenoxuron, lufenuron, and teflubenzuron, alone and combined with the β-glucan synthesis inhibitor caspofungin. Only nikkomycin Z and caspofungin were found to act synergistically. The nikkomycin Z-induced chitin decrease corresponded with a β-glucan increase, while with the caspofungin-induced β-glucan decrease, an increase in chitin was found. This could explain the synergistic activity of this combination of drugs.
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In vitro susceptibility of Madurella mycetomatis to posaconazole and terbinafine. Antimicrob Agents Chemother 2011; 55:1771-3. [PMID: 21263050 DOI: 10.1128/aac.01045-10] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Presently, therapy of eumycetoma in Sudan is still based on surgery combined with prolonged ketoconazole therapy. This usually results in a poor clinical outcome. To determine if posaconazole and terbinafine could offer better therapeutic alternatives, the in vitro susceptibilities of 34 Madurella mycetomatis strains were determined. It appeared that posaconazole was highly active against M. mycetomatis but terbinafine was only moderately active. Since posaconazole has an excellent safety profile, it might provide an important alternative in mycetoma therapy.
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