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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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Ditsios K, Katsimentzas T, Pitsilos C, Koukourikos I, Christidis P, Ditsios T, Konstantinou P, Varitimidis S. Deep Fungal Infections of the Upper Extremity - A Review. Orthop Rev (Pavia) 2024; 16:94570. [PMID: 38469579 PMCID: PMC10927313 DOI: 10.52965/001c.94570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024] Open
Abstract
Deep fungal infections are rare in the upper extremity. Vessel and nerve infection, synovitis, tenosynovitis, myofasciitis, arthritis and osteomyelitis have been discovered in literature. Treatment in most cases includes surgical procedure and antifungal agent use. Amputation is the final, most devastating for patient's functionality, solution. Intravenous antifungal drugs, frequently followed by oral administration, are important ancillary agents both for the initial treatment and the prevention of recurrence. We therefore performed a review of the current literature, in order to assemble the dispersed results of different studies and clarify the various aspects of upper extremity fungal infections.
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Affiliation(s)
- Konstantinos Ditsios
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Triantafyllos Katsimentzas
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Charalampos Pitsilos
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Ilias Koukourikos
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | | | | | - Panagiotis Konstantinou
- 2nd Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Sokrates Varitimidis
- Academic Department of Orthopaedic Surgery School of Medicine, Faculty of Health Sciences, University of Thessaly, Larisa, Greece
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Ali HO, Elkheir LYM, Fahal AH. The use of artificial intelligence to improve mycetoma management. PLoS Negl Trop Dis 2024; 18:e0011914. [PMID: 38329930 PMCID: PMC10852264 DOI: 10.1371/journal.pntd.0011914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Affiliation(s)
- Hyam Omar Ali
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- The Faculty of Mathematical Sciences, University of Khartoum, Khartoum, Sudan
| | - Lamis Yahia Mohamed Elkheir
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- The Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
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Gabani MH, Ahmed AA, Hassan AA, Abdalla MA, Mustafa SA, Alobaid TA, Khatir AA, Mohammed RM, Awad NI, Abdellateef TA, Hassan A, Ahmed ES, Ali MZ, Fahal AH. The nutritional status of mycetoma affected patients seen at the Mycetoma Research Center, Sudan. PLoS Negl Trop Dis 2024; 18:e0011726. [PMID: 38166142 PMCID: PMC10786388 DOI: 10.1371/journal.pntd.0011726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/12/2024] [Accepted: 12/18/2023] [Indexed: 01/04/2024] Open
Abstract
Nutrition plays a critical and crucial role in addressing neglected tropical diseases (NTDs) and their complications, as they often contribute to malnutrition, which can worsen the impact of these conditions. Therefore, it is necessary to investigate the nutritional status of mycetoma patients, which has not been explored previously. This descriptive cross-sectional hospital-based study was conducted at the Mycetoma Research Center (MRC), University of Khartoum, Sudan. The study included 179 confirmed mycetoma patients and an equal number of age- and sex-matched normal controls. The nutritional status of the mycetoma patients was assessed and compared with that of the control group. The majority of the patients were young adults with varying educational levels, predominantly from Central Sudan. The foot was the most commonly affected part; most patients had lesions more than 10 cm in diameter. The Body Mass Index (BMI) was calculated for both study groups, revealing that 43.5% of the patients and 53.6% of controls had a normal BMI. Furthermore, 36% of patients were underweight, contrasting with only 11% in the control group. Correlation analyses indicated no significant associations between BMI and age groups, educational levels, daily meals, food quantity, and appetite in the study population (p > 0.05). Similarly, no significant differences were observed in BMI concerning disease duration and affected sites (p = 0.0577). The Kruskal-Wallis test did not reveal significant differences in BMI means among the groups. The study revealed that most participants consumed three meals daily, and the control group showed a more robust appetite and consumed more food than the patient group (p = 0.005). Nevertheless, there were no significant differences in the consumption of different food types between the patient and control groups and among different BMI categories (p = 0.025 and 0.040, respectively).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Abeer Hassan
- Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
| | | | - Mohammed Zain Ali
- The School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
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Abstract
Mycetoma is a chronic, incapacitating, destructive inflammatory disease with many serious damaging impacts. Currently, there is no control or prevention program as many of its epidemiological characteristics, such as the causative organisms' ecological niche, natural habitat, primary reservoir, transmission mode, geographical distribution, incidence, and prevalence, remain unclear. This may be due to a lack of research interest, as mycetoma is still a neglected disease and the scarcity of accurate molecular diagnostic techniques in disease-endemic regions for accurate causative microorganisms identification and mapping. With this background, this study set out to address this knowledge gap by considering the mycetoma environmental occurrence predictors. The medical literature obtained data showed a close association between mycetoma occurrence and its environment. The causative microorganisms are available in the environment in active or dormant forms. Animal dung may be a natural niche and reservoir for these organisms, and thorns may facilitate the subcutaneous inoculation. Some environmental factors, such as the soil type and consistency, temperature, water sources, aridity index, and thorny trees, may be risk factors. The population in endemic areas socioeconomic, hygiene, and health education status are contributory factors for mycetoma. The individual's genetic and immunological backgrounds may determine the disease's susceptibility and resistance. Environmental conditions and personal hygiene improvement are mandatory to reduce disease occurrence. Mycetoma spatial mapping can detect disease cluster areas and then develop public health strategies for early case detection and management to reduce the disease burden. More research interests and facilities are needed to understand disease pathogenesis and appropriate patient management better.
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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: 2] [Impact Index Per Article: 1.0] [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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Hashizume H, Taga S, Sakata MK, Taha MHM, Siddig EE, Minamoto T, Fahal AH, Kaneko S. Detection of multiple mycetoma pathogens using fungal metabarcoding analysis of soil DNA in an endemic area of Sudan. PLoS Negl Trop Dis 2022; 16:e0010274. [PMID: 35275915 PMCID: PMC8942264 DOI: 10.1371/journal.pntd.0010274] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/23/2022] [Accepted: 02/23/2022] [Indexed: 01/14/2023] Open
Abstract
Mycetoma is a tropical disease caused by several fungi and bacteria present in the soil. Fungal mycetoma and eumycetoma are especially challenging to treat; therefore, prevention, early diagnosis, and early treatment are important, but it is also necessary to understand the geographic distribution of these pathogenic fungi. In this study, we used DNA metabarcoding methodology to identify fungal species from soil samples. Soil sampling was implemented at seven villages in an endemic area of Sennar State in Sudan in 2019, and ten sampling sites were selected in each village according to land-use conditions. In total, 70 soil samples were collected from ground surfaces, and DNA in the soil was extracted with a combined method of alkaline DNA extraction and a commercial soil DNA extraction kit. The region for universal primers was selected to be the ribosomal internal transcribed spacer one region for metabarcoding. After the second PCR for DNA library preparation, the amplicon-based DNA analysis was performed using next-generation sequencing with two sets of universal primers. A total of twelve mycetoma-causative fungal species were identified, including the prime agent, Madurella mycetomatis, and additional pathogens, Falciformispora senegalensis and Falciformispora tompkinsii, in 53 soil samples. This study demonstrated that soil DNA metabarcoding can elucidate the presence of multiple mycetoma-causative fungi, which may contribute to accurate diagnosis for patient treatment and geographical mapping. Mycetoma, a chronic subcutaneous and cutaneous disease, designated as a "neglected tropical disease," is prevalent in dry and hot climates. Fungal mycetoma is caused by more than 50 species of soil-dwelling pathogenic fungi, and its diagnosis and treatment can be challenging. The prevention of infection and early diagnosis and treatment are essential, and for this purpose, environmental assessment to understand the fungal habitat is necessary. In this study, we performed DNA metabarcoding analysis using next-generation sequencing (NGS) for mycetoma pathogens from environmental soil samples in Sudan. The results suggest that multiple causative agents of fungal mycetoma are widespread regardless of the environment and can be a source of infection anywhere in an endemic area. Based on the results of this study, we expect that the investigation of fungi in soil using NGS technology may help identify infection routes and create risk maps for the prevention of mycetoma.
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Affiliation(s)
- Hiroki Hashizume
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Ecoepidemiology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Suguru Taga
- Department of Ecoepidemiology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Masayuki K. Sakata
- Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | | | | | - Toshifumi Minamoto
- Graduate School of Human Development and Environment, Kobe University, Kobe, Japan
| | | | - Satoshi Kaneko
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Ecoepidemiology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- * E-mail:
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Lee HL, Chen LM, Chang CC, Chen GL. Pulmonary fungal ball due to Trichophyton successfully managed with oral itraconazole: a case report. J Int Med Res 2021; 49:3000605211066250. [PMID: 34936512 PMCID: PMC8721711 DOI: 10.1177/03000605211066250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary fungal balls are caused by long-term fungal infection of the lung. They are sometimes a complication of previous cavitary pulmonary tuberculosis. Pulmonary fungal balls caused by Trichophyton are extremely rare. A 65-year-old man who worked in a leather recycling factory was admitted because of a productive cough and shortness of breath. He had a history of tuberculosis with lung destruction. A chest radiograph showed an opacity surrounding an air lucency over the left lung field, and chest computed tomography showed a mass within a cavity, producing a ball-in-hole appearance, over the left upper lung lobe. Bronchoalveolar lavage was performed, and fungal culture of the lavage fluid yielded Trichophyton. After 6 months of treatment with oral itraconazole, the patient's general condition improved. This case emphasizes the importance of awareness of fungal infection within cavitary lesions of the lung and shows that Trichophyton may be the etiologic organism in such cases. Itraconazole is a recommended treatment of pulmonary fungal balls.
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Affiliation(s)
- Hsu-Lin Lee
- Department of Internal Medicine, 38003Taichung Armed Forces General Hospital, Taichung Armed Forces General Hospital, Taichung.,63452Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Li-Mien Chen
- Department of Internal Medicine, 38003Taichung Armed Forces General Hospital, Taichung Armed Forces General Hospital, Taichung.,63452Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Chen-Chu Chang
- Department of Radiology, 38003Taichung Armed Forces General Hospital, Taichung Armed Forces General Hospital, Taichung.,63452Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Guan-Liang Chen
- Division of Chest Medicine and Respiratory Therapy, Department of Internal Medicine, 38003Taichung Armed Forces General Hospital, Taichung Armed Forces General Hospital, Taichung.,63452Tri-Service General Hospital, National Defense Medical Center, Taipei
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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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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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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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Siddig EE, Mohammed Edris AM, Bakhiet SM, van de Sande WWJ, Fahal AH. Interleukin-17 and matrix metalloprotease-9 expression in the mycetoma granuloma. PLoS Negl Trop Dis 2019; 13:e0007351. [PMID: 31295246 PMCID: PMC6622479 DOI: 10.1371/journal.pntd.0007351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/30/2019] [Indexed: 12/12/2022] Open
Abstract
Mycetoma is a persistent, progressive granulomatous inflammatory disease caused either by fungi or by bacteria. Characteristic of this disease is that the causative agents organise themselves in macroscopic structures called grains. These grains are surrounded by a massive inflammatory reaction. The processes leading to this host tissue reaction and the immunophenotypic characteristics of the mycetoma granuloma are not known. Due to the massive immune reaction and the tissue remodeling involved, we hypothesised that the expression levels of interleukin-17 (IL-17) and matrix metalloprotease-9 (MMP-9) in the mycetoma granuloma formation were correlated to the severity of the disease and that this correlation was independent of the causative agent responsible for the granuloma reaction. To determine the expression of IL-17 and MMP-9 in mycetoma lesions, the present study was conducted at the Mycetoma Research Centre, Sudan. Surgical biopsies from 100 patients with confirmed mycetoma were obtained, and IL-17 and MMP-9 expression in the mycetoma granuloma were evaluated immunohistochemically. IL-17 was mainly expressed in Zones I and II, and far less in Zone III. MMP-9 was detected mainly in Zones II and III, and the least expression was in Zone I. MMP-9 was more highly expressed in Actinomadura pelletierii and Streptomyces somaliensis biopsies compared to Madurella mycetomatis biopsies. MMP-9 levels were directly proportional to the levels of IL-17 (p = 0.001). The only significant association between MMP9 and the patients' characteristics was the disease duration (p<0.001). There was an insignificant correlation between the IL-17 levels and the patients' demographic characteristics.
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Affiliation(s)
- Emmanuel Edwar Siddig
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
- ErasmusMC, University Medical Centre Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
- * E-mail:
| | | | | | - Wendy W. J. van de Sande
- ErasmusMC, University Medical Centre Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
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Sawatkar GU, Wankhade VH, Supekar BB, Singh RP, Bhat DM, Tankhiwale SS. Mycetoma: A Common Yet Unrecognized Health Burden in Central India. Indian Dermatol Online J 2019; 10:256-261. [PMID: 31149567 PMCID: PMC6536075 DOI: 10.4103/idoj.idoj_358_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Context: Mycetoma is a chronic suppurative infective disorder of skin, subcutaneous tissue, fascia, and bones caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. Triad of tumefaction, discharging sinuses, and grains characterizes the disease. Aims: This study was undertaken to study the clinical spectrum and treatment response of mycetoma in central India. Settings and Design: It was a retrospective study of clinical and/or biopsy-proven and treated cases of mycetoma from November 2015 to October 2016. Subjects and Methods: Medical records of diagnosed and treated mycetoma patients were enrolled retrospectively during November 2015 and October 2016. Case records of patients were evaluated with respect to demographic, clinical, microbiological details, bone involvement, and treatment. Type of therapies and outcome, wherever available, were also assessed. Statistical Analysis: Statistical analysis was done using proportion, mean, and percentages. Results: Eleven cases (male = 8) were seen during the study period (seven actinomycetoma and four eumycetoma). Foot and lower extremity was the most common site (9/11), whereas upper extremity and forehead were involved in one case each. On culture, the organisms isolated were Phialophora and Fusarium. Modified Welsch regimen was started in six of seven patients with actinomycetoma, whereas one was started on sulfamethoxazole–trimethoprim and a combination of amoxicillin and clavulanic acid therapy. All four cases of eumycetoma were treated with itraconazole. On follow-up, six cases of actinomycetoma cases showed significant improvement. Two cases of eumycetoma showed mild to moderate improvement and one case required surgical intervention. One case each of actinomycetoma and eumycetoma were lost to follow-up. Conclusion: Mycetoma has been recognized as a neglected tropical disease by the World Health Organization, recently. There are very few case reports from the central part of India. Prominent case detection in our study emphasizes the need of larger studies to know the extent of disease in this part of India.
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Affiliation(s)
- Gitesh U Sawatkar
- Department of Dermatology, Venereology and Leprology, Government Medical College, Nagpur, Maharashtra, India
| | - Vaishali H Wankhade
- Department of Dermatology, Venereology and Leprology, Government Medical College, Nagpur, Maharashtra, India
| | - Bhagyashree B Supekar
- Department of Dermatology, Venereology and Leprology, Government Medical College, Nagpur, Maharashtra, India
| | - Rajesh Pratap Singh
- Department of Dermatology, Venereology and Leprology, Government Medical College, Nagpur, Maharashtra, India
| | - Dharitri M Bhat
- Department of Pathology, Government Medical College, Nagpur, Maharashtra, India
| | - Supriya S Tankhiwale
- Department of Microbiology, Vasantrao Naik Government Medical College Yavatmal, Maharashtra, India
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14
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Lin S, Capstick R, Ng S. Actinomycetoma of the hand: a case report. ANZ J Surg 2019; 90:E44-E45. [PMID: 31069882 DOI: 10.1111/ans.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sandra Lin
- Plastic Surgery Department, Austin Hospital, Melbourne, Victoria, Australia
| | - Robert Capstick
- Plastic Surgery Department, Austin Hospital, Melbourne, Victoria, Australia
| | - Sally Ng
- Plastic Surgery Department, Austin Hospital, Melbourne, Victoria, Australia
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15
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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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Reis CMS, Reis-Filho EGDM. Mycetomas: an epidemiological, etiological, clinical, laboratory and therapeutic review. An Bras Dermatol 2018; 93:8-18. [PMID: 29641691 PMCID: PMC5871356 DOI: 10.1590/abd1806-4841.20187075] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/19/2017] [Indexed: 11/22/2022] Open
Abstract
Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue, characterized by a symptomatic triad: tumor, fistulas and grains. It can be caused by fungi (eumycetoma) and bacteria (actinomycetoma), with similar clinical features. Diagnosis is based on the clinical presentation and identification of the etiological agents in the tissue, by mycological/bacteriological, histopathological and immunohistochemical tests. It is important to specify the fungal or bacterial etiology, because the treatments are different. An approach that involves early diagnosis, the use of systemic antibiotics or antifungal agents, including surgical removal of lesions, is the basis for the treatment of these diseases. In this review, the most commonly used diagnostic methods and treatments will be discussed. Also, we will review the history of the disease through epidemiological and etiological aspects.
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Affiliation(s)
- Carmelia Matos Santiago Reis
- Dermatology Service. Laboratory of Medical Mycology of the
University Hospital of Brasilia - University of Brasilia (HUB-UnB) - Brasilia (FD),
Brazil
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Camozzota C, Goldman A, Tchernev G, Lotti T, Wollina U. A Primary Cutaneous Nocardiosis of the Hand. Open Access Maced J Med Sci 2017; 5:470-472. [PMID: 28785335 PMCID: PMC5535660 DOI: 10.3889/oamjms.2017.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nocardiosis is caused by an aerobic actinomycete, most commonly introduced through the respiratory tract. The Nocardiae are gram-positive, partially acid-fast bacteria. Primary cutaneous nocardiosis infections are rare and caused by the traumatic introduction of organisms percutaneously. The manifestation is usually an opportunistic infection. Cutaneous involvement may develop as one of four types: mycetoma, lymphocutaneous infection, superficial skin infection, or systemic disease with cutaneous involvement. Diagnosis and evaluation of appropriate specimens are principally by culture. CASE PRESENTATION A 55-year-old female patient with diabetes type II presented with chronic skin lesions on the hand. Otherwise, her medical history was unremarkable. There were no signs of systemic disease. Direct examination of swabs demonstrated gramme bacteria and culture on Sabouraud agar was positive for Nocardia spp. The specimen of nocardiae was not identified. The patient was treated during nine months with sulfamethoxazole plus trimethoprim. There was an important clinical improvement of the cutaneous aspect of the lesions in hand. Some scars and fibrosis remained after nocardiosis. CONCLUSIONS Primary cutaneous nocardiosis of the hand is a rare condition. The clinical diagnosis is difficult, and culture is mandatory.
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Affiliation(s)
- Camilla Camozzota
- Santa Casa de Misericórdia Hospital, Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Torello Lotti
- Department of Dermatology, University of Rome "G. Marconi", Rome, Italy; Department of Biotechnology, Delft University of Technology, 2628 BC, Delft, The Netherlands
| | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany
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