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Elkheir LYM, Delaye PO, Penichon M, Eadie K, Mohamed MA, Besson P, Chesnay A, Desoubeaux G, Roger S, van de Sande WWJ, Fahal AH, Enguehard-Gueiffier C. Emerging therapeutics: The imidazo[1,2-b]pyridazine scaffold as a novel drug candidate for eumycetoma, a neglected tropical disease. Eur J Med Chem 2024; 277:116720. [PMID: 39142148 DOI: 10.1016/j.ejmech.2024.116720] [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: 06/21/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/16/2024]
Abstract
Mycetoma is a neglected invasive infection endemic in tropical and subtropical regions, presenting as a chronic subcutaneous inflammatory mass that can spread to deeper structures, leading to deformities, disabilities, and potentially mortality. The current treatment of eumycetoma, the fungal form of mycetoma, involves antifungal agents, such as itraconazole, combined with surgical intervention. However, this approach has limited success, with low cure rates and a high risk of recurrence. This study addresses to the urgent need for more effective therapeutics by designing and synthesising 47 diversely pharmacomodulated imidazo [1,2-b]pyridazine derivatives using a simple synthetic pathway with good yields and purity. Of these, 17 showed promising in vitro activity against Madurella mycetomatis, the prime causative agent of eumycetoma, with IC50 ≤ 5 μM and demonstrated significantly lower cytotoxicity compared to standard treatments in NIH-3T3 fibroblasts. Notably, compound 14d exhibited an excellent activity with an IC50 of 0.9 μM, in the same order then itraconazole (IC50 = 1.1 μM), and achieved a favourable selectivity index of 16 compared to 0.8 for itraconazole. These promising results warrant further research to evaluate the clinical potential of these novel compounds as safer, more effective treatments for eumycetoma, thus addressing a profound gap in current therapeutic strategies.
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Affiliation(s)
- Lamis Yahia Mohamed Elkheir
- The Mycetoma Research Center, University of Khartoum, Khartoum, Sudan; Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Khartoum, Sudan; EA 7502 Synthèse et Isolement de Molécules Bioactives (SIMBA), University of Tours, France
| | - Pierre-Olivier Delaye
- EA 7502 Synthèse et Isolement de Molécules Bioactives (SIMBA), University of Tours, France
| | - Mélanie Penichon
- EA 7502 Synthèse et Isolement de Molécules Bioactives (SIMBA), University of Tours, France
| | - Kimberly Eadie
- Department of Microbiology and Infectious Diseases, Erasmus Medical Center, University of Rotterdam, the Netherlands
| | - Magdi Awadalla Mohamed
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, KSA, Saudi Arabia
| | - Pierre Besson
- UMR INSERM U1327 ISCHEMIA "Membrane signalling and inflammation in reperfusion injuries", University of Tours, France
| | - Adélaïde Chesnay
- UMR INSERM U 1100 Centre d'Etudes des Pathologies Respiratoires, University of Tours, France
| | - Guillaume Desoubeaux
- UMR INSERM U 1100 Centre d'Etudes des Pathologies Respiratoires, University of Tours, France
| | - Sébastien Roger
- UMR INSERM U1327 ISCHEMIA "Membrane signalling and inflammation in reperfusion injuries", University of Tours, France
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2
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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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3
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Elbahri H, Alnaser AAMA, Babiker SAM, Mohamed AHA. Actinomycetoma distal radius mimic osteosarcoma: A case report of a rare presentation. Clin Case Rep 2023; 11:e7618. [PMID: 37384227 PMCID: PMC10293574 DOI: 10.1002/ccr3.7618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 05/20/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
Key Clinical Message Actinmomycetma is a granulomatous infection with a presentation was very similar to osteosarccoma. Multidisciplinary team and triple assessments are extremely important to prevent misdiagnosis, surgical treatment in combination with medical treatment followed by regular clinical and radiological follow-up can be a limb-saving procedure in such cases. Abstract Various conditions may mimic osteosarcoma. The differential diagnosis of osteosarcoma is broad; Includes tumors, infection, trauma, and inflammatory processes arising from the musculoskeletal system. A proper history, examination, diagnostic imaging studies, and pathological analysis are essential to establish a precise diagnosis. This case report serves to illustrate the significance of recognizing the similarities between these two lesions and other rare features that will help to differentiate between actinomycetoma and osteosarcoma, to prevent late or misdiagnosis.
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Affiliation(s)
- Hassan Elbahri
- Department of orthopedic, Faculty of MedicineInternational University of AfricaKhartoumSudan
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4
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Chandler DJ, Bonifaz A, van de Sande WWJ. An update on the development of novel antifungal agents for eumycetoma. Front Pharmacol 2023; 14:1165273. [PMID: 37274106 PMCID: PMC10232793 DOI: 10.3389/fphar.2023.1165273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Eumycetoma, a chronic subcutaneous mycosis, responds poorly to the available antifungal treatments and patients often require extensive surgical resection or amputation of the affected limb. More effective treatments are needed for eumycetoma. This article will describe some of the approaches being used to develop and evaluate new treatments for eumycetoma, summarise the latest developments and discuss the challenges that lie ahead.
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Affiliation(s)
- David J. Chandler
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
- Dermatology Department, Brighton General Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Alexandro Bonifaz
- Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Wendy W. J. van de Sande
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, Netherlands
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5
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Hao X, Cognetti M, Burch-Smith R, Mejia EO, Mirkin G. Mycetoma: Development of Diagnosis and Treatment. J Fungi (Basel) 2022; 8:743. [PMID: 35887499 PMCID: PMC9323607 DOI: 10.3390/jof8070743] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 12/03/2022] Open
Abstract
Mycetoma describes a heterogeneous group of cutaneous and subcutaneous infections caused by either fungi (eumycetomas) or bacteria (actinomycetomas). It is characterized by a triad of clinical symptoms: painless subcutaneous tumor-like swelling, multiple sinuses and fistulas, and discharged grains in pus. This predominantly affects the feet in more than 70% of patients. It is endemic in the "mycetoma belt" regions, including Africa, South America, and South Asia. Autochthonous mycetoma is rare in the United States of America (USA). We recently reported a Latin American immigrant with eumycetoma in the State of Maryland, USA. With millions of immigrants from endemic regions, the true number of mycetomas in the USA is most likely higher than currently recognized. With the aim to raise the awareness of clinicians about mycetoma, especially dermatologists and podiatrists, we update the development of the epidemiology, etiology, clinical presentations, pathogenesis, diagnosis, differential diagnosis, and treatment of mycetoma.
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Affiliation(s)
- Xingpei Hao
- Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD 20850, USA
- P4Diagnostix, Beltsville, MD 20705, USA; (M.C.); (R.B.-S.); (E.O.M.)
| | - Marcus Cognetti
- P4Diagnostix, Beltsville, MD 20705, USA; (M.C.); (R.B.-S.); (E.O.M.)
| | | | | | - Gene Mirkin
- Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville, MD 20850, USA
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6
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Nyuykonge B, Lim W, van Amelsvoort L, Bonifaz A, Fahal A, Badali H, Abbastabar M, Verbon A, van de Sande W. Eumycetoma Causative Agents are Inhibited
in vitro
by Luliconazole, Lanoconazole and Ravuconazole. Mycoses 2022; 65:650-655. [PMID: 35398930 PMCID: PMC9321754 DOI: 10.1111/myc.13442] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
Introduction Eumycetoma is a subcutaneous mutilating disease that can be caused by many different fungi. Current treatment consists of prolonged itraconazole administration in combination with surgery. In many centres, due to their slow growth rate, the treatment for eumycetoma is often started before the causative agent is identified. This harbours the risk that the causative fungus is not susceptible to the given empirical therapy. In the open‐source drug program MycetOS, ravuconazole and luliconazole were promising antifungal agents that were able to inhibit the growth of Madurella mycetomatis, the most common causative agent of mycetoma. However, it is currently not known whether these drugs inhibit the growth of other eumycetoma causative agents. Materials and methods Here, we determined the in vitro activity of luliconazole, lanoconazole and ravuconazole against commonly encountered eumycetoma causative agents. MICs were determined for lanoconazole, luliconazole and ravuconazole against 37 fungal isolates which included Madurella species, Falciformispora senegalensis, Medicopsis romeroi and Trematosphaeria grisea and compared to those of itraconazole. Results Ravuconazole, luliconazole and lanoconazole showed high activity against all eumycetoma causative agents tested with median minimal inhibitory concentrations (MICs) ranging from 0.008–2 µg/ml, 0.001–0.064 µg/ml and 0.001–0.064 µg/ml, respectively. Even Ma. fahalii and Me. romeroi, which are not inhibited in growth by itraconazole at a concentration of 4 µg/ml, were inhibited by these azoles. Conclusion The commonly encountered eumycetoma causative agents are inhibited by lanoconazole, luliconazole and ravuconazole. These drugs are promising candidates for further evaluation as potential treatment for eumycetoma.
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Affiliation(s)
- Bertrand Nyuykonge
- Erasmus MC University Medical Center Rotterdam Department of Medical Microbiology and Infectious Diseases Dr Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Wilson Lim
- Erasmus MC University Medical Center Rotterdam Department of Medical Microbiology and Infectious Diseases Dr Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Lukas van Amelsvoort
- Erasmus MC University Medical Center Rotterdam Department of Medical Microbiology and Infectious Diseases Dr Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | | | | | - Hamid Badali
- Invasive Fungi Research Center (IFRC) Communicable Diseases Institute Mazandaran University of Medical Sciences Sari Iran
| | - Mahdi Abbastabar
- Invasive Fungi Research Center (IFRC) Communicable Diseases Institute Mazandaran University of Medical Sciences Sari Iran
| | - Annelies Verbon
- Erasmus MC University Medical Center Rotterdam Department of Medical Microbiology and Infectious Diseases Dr Molewaterplein 40 3015 GD Rotterdam The Netherlands
| | - Wendy van de Sande
- Erasmus MC University Medical Center Rotterdam Department of Medical Microbiology and Infectious Diseases Dr Molewaterplein 40 3015 GD Rotterdam The Netherlands
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Abstract
As the at-risk population expands and new antifungal resistance patterns develop, it is critical to understand and recognize cutaneous manifestations of old and emerging fungal diseases. PURPOSE OF REVIEW The aim of this review is to provide an overview of the most frequent and emerging deep cutaneous fungal infections following either primary inoculation or secondary spread after haematogenous seeding in disseminated infections in different geographical areas. RECENT FINDINGS Fungal skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions based on the site of the infection, route of acquisition of the pathogen, epidemiological setting and the virulence of the fungus in relation to the host. The approach to a patient suspected of having a fungal SSTI is complex and usually poses a major diagnostic challenge. The treatment approach should include attempts at immune reconstitution, targeted antifungal therapy and/or aggressive surgical debridement. SUMMARY Fungal SSTIs can be an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients and are being reported with increasing frequency worldwide.
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Hassan R, Deribe K, Fahal AH, Newport M, Bakhiet S. Clinical epidemiological characteristics of mycetoma in Eastern Sennar locality, Sennar State, Sudan. PLoS Negl Trop Dis 2021; 15:e0009847. [PMID: 34898611 PMCID: PMC8699598 DOI: 10.1371/journal.pntd.0009847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/23/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Mycetoma epidemiological features remain uncharacterised. Few studies have been conducted in a community-based setting to explore the epidemiological features and risk factors for mycetoma in Sudan. To bridge this gap, this study was conducted in Eastern Sennar Locality, Sennar State, Sudan, to report the clinical, epidemiological characteristics of mycetoma patients and the disease burden in the state. We used cluster sampling; sixty villages were randomly selected across the locality's five administrative units, and a household-to-household survey was conducted. We collected data using pre-designed questionnaires at the community, household, and individual levels. We performed descriptive analyses of the data and produced prevalence maps using ArcGIS 10.5 ([ESRI] Inc., Redlands CA, USA). A total of 41,176 individuals were surveyed, and 359 mycetoma patients were identified. The overall prevalence of mycetoma was 0.87% (95%CI = 0.78-0.97%), the prevalence among males was 0.83% (95%CI = 0.71-0.96%), and females 0.92% (95% CI = 0.79-1.06%). Individuals in the age group 31-45 years had the highest prevalence among the different age groups (1.52%, 95% CI = 1.23-1.86%). The prevalence map showed patients clustered within the central and north-eastern part of the locality, while villages in the south-western part had few or no cases. In conclusion, this clinical epidemiological study is pioneering and shows that mycetoma is prevalent in certain parts of Sudan. This data obtained will support the design of measures to reduce the disease burden in the state. The survey procedures and protocols can be adopted for further studies in Sudan and beyond.
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Affiliation(s)
- Rowa Hassan
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
- Children’s Investment Fund Foundation, Addis Ababa, Ethiopia
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Melanie Newport
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Sahar Bakhiet
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
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9
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Hassan R, Simpson H, Cano J, Bakhiet S, Ganawa E, Argaw D, Newport MJ, Deribe K, Fahal AH. Modelling the spatial distribution of mycetoma in Sudan. Trans R Soc Trop Med Hyg 2021; 115:1144-1152. [PMID: 34037803 PMCID: PMC8486737 DOI: 10.1093/trstmh/trab076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mycetoma is a neglected tropical disease that is reported worldwide and Sudan has the highest reported number of mycetoma infections across the globe. The incidence, prevalence and burden of mycetoma globally are not precisely known and its risk factors remain largely unelucidated. METHODS This study aimed to identify the environmental predictors of fungal and bacterial mycetoma in Sudan and to identify areas of the country where these niche predictors are met. Demographic and clinical data from confirmed mycetoma patients seen at the Mycetoma Research Centre from 1991 to 2018 were included in this study. Regression and machine learning techniques were used to model the relationships between mycetoma occurrence in Sudan and environmental predictors. RESULTS The strongest predictors of mycetoma occurrence were aridity, proximity to water, low soil calcium and sodium concentrations and the distribution of various species of thorny trees. The models predicted the occurrence of eumycetoma and actinomycetoma in the central and southeastern states of Sudan and along the Nile river valley and its tributaries. CONCLUSION Our results showed that the risk of mycetoma in Sudan varies geographically and is linked to identifiable environmental risk factors. Suitability maps are intended to guide health authorities, academic institutes and organisations involved in planning national scale surveys for early case detection and management, leading to better patient treatment, prevention and control of mycetoma.
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Affiliation(s)
- Rowa Hassan
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum, 11111, Sudan
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9PX, UK
| | - Hope Simpson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Jorge Cano
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Sahar Bakhiet
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum, 11111, Sudan
| | - Eltayeb Ganawa
- Department of GIS and Cartography, Faculty of Geography and Environmental Sciences, University of Khartoum, Khartoum, 11111, Sudan
| | - Daniel Argaw
- World Health Organization, Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management, Geneva, Switzerland
| | - Melanie J Newport
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9PX, UK
| | - Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9PX, UK
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Hassan Fahal
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum, 11111, Sudan
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10
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Awad A, Alnaser A, Abd-Elmaged H, Abdallah R, Khougali HS. Eumycetoma Osteomyelitis Calcaneus in Adolescent; report of case and literature review. BMC Infect Dis 2021; 21:995. [PMID: 34556037 PMCID: PMC8461936 DOI: 10.1186/s12879-021-06695-3] [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] [Received: 02/26/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mycetoma is the most common neglected disease in humans. It is a chronic, progressive, and destructive disease primarily caused by fungi or bacteria characterized by formation of dark pale grains commonly involve skin, soft tissue and rarely bone. CASE PRESENTATION A 19 year old male patient with chronic right ankle pain, swelling and abscess formation for more than 1 year, patient was treated repeatedly with incision and drainage without any success. No X-ray, biopsy or swab for culture and sensitivity had been considered through the course of presentation. Patient was referred to Omdurman hospital where osteomyelitis secondary euomycetoma infection has been confirmed based on radiological and pathological assessment. Patient was treated surgically with aggressive debridement and bone curettage plus postoperative Itraconazole for 1 year. CONCLUSION Clinicians must consider osteomyelitis as important differential diagnosis during initial assessment Eumycetoma infection in adults. Aggressive bone curettage followed by regular X-ray follow up can be limb saving procedure in such cases.
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Affiliation(s)
- Ammar Awad
- University of Kordofan, Al-Ubayyid, Sudan
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11
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Agarwal P, Jagati A, Rathod SP, Kalra K, Patel S, Chaudhari M. Clinical Features of Mycetoma and the Appropriate Treatment Options. Res Rep Trop Med 2021; 12:173-179. [PMID: 34267575 PMCID: PMC8275212 DOI: 10.2147/rrtm.s282266] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/05/2021] [Indexed: 11/23/2022] Open
Abstract
Mycetoma is a chronic, suppurative and debilitating granulomatous infection seen mainly in tropical and subtropical areas and is now declared as a neglected tropical disease by the World Health Organization. The clinical diagnosis is usually characterized by a classical triad of localized swelling, underlying sinus tracts, and production of grains or granules, but unusual presentations are also seen. It is classified into eumycetoma caused by the fungus, and actinomycetoma caused by the bacteria. The clinical presentation of both is almost similar and a definite diagnosis is essential before starting the treatment as it differs for both. Surgical debulking followed by a prolonged course of medical therapy now forms the mainstay of treatment due to the long course of the disease and suboptimal response. This review focuses on the various usual as well as unusual clinical presentations of mycetoma, established treatment regimens as well as recent changes in the mode of administration of drugs and newer drugs for mycetoma.
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Affiliation(s)
- Pooja Agarwal
- Department of Dermatology, Smt. SCL Hospital, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
| | - Ashish Jagati
- Department of Dermatology, Smt. SCL Hospital, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
| | - Santoshdev P Rathod
- Department of Dermatology, Smt. SCL Hospital, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
| | - Kirti Kalra
- Department of Dermatology, Smt. SCL Hospital, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
| | - Shefali Patel
- Department of Dermatology, Smt. SCL Hospital, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
| | - Malay Chaudhari
- Department of Dermatology, Smt. SCL Hospital, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
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12
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Siddig EE, van de Sande WWJ, Fahal AH. Actinomycetoma laboratory-based diagnosis: a mini-review. Trans R Soc Trop Med Hyg 2021; 115:355-363. [PMID: 33449118 DOI: 10.1093/trstmh/traa176] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/22/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
Mycetoma is a chronic granulomatous inflammatory disease that is caused either by fungi (eumycetoma) or bacteria (actinomycetoma). The latter is caused by various actinomycetes of the genera Nocardia, Streptomyces and Actinomadura. They have different geographical distributions within mycetoma-endemic regions. In parts of Latin America, Nocardia species are more often encountered while in Africa, Streptomyces species dominate. For instituting a proper patient treatment plan, accurate identification of the causative organism is vital. For actinomycetoma, different laboratory-based techniques have been developed during recent decades. These include direct microscopy, cytology, histopathology and serology. More recently, different molecular techniques and matrix-assisted laser desorption ionisation-time of flight mass spectrometry have been included as diagnostic methods for actinomycetoma. In this review, an update on the laboratory techniques currently in use for the identification of actinomycetoma-causative agents to the species level is presented.
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Affiliation(s)
- Emmanuel Edwar Siddig
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
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13
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Omer RF, Ahmed ES, Ali BM, Alhaj HE, Bakhiet SM, Mohamed ESW, Strub-Wourgaft N, Fahal AH. The challenges of recruitment in clinical trials in developing countries: the Mycetoma Research Centre experience. Trans R Soc Trop Med Hyg 2021; 115:397-405. [PMID: 33484566 DOI: 10.1093/trstmh/traa165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/05/2020] [Accepted: 11/26/2020] [Indexed: 11/14/2022] Open
Abstract
Mycetoma is a chronic disease caused either by fungi (eumycetoma) or bacteria (actinomycetoma). Treatment remains suboptimal and based on personal clinical experience. Recently, the Mycetoma Research Centre (MRC), a WHO Collaborating Centre on mycetoma, began the first-ever double-blind clinical trial. Here, we report the challenges and barriers faced in the recruitment and retention of patients in the MRC experience. Patient recruitment and retention are critical determinants of clinical trial success and yet a substantial number of trials fail to reach their recruitment goals. Recruitment challenges are identified throughout the different stages of the clinical trial, starting from planning, participant screening and intervention, through to retaining participants for the entire study duration. The MRC made efforts to address these challenges to ensure the constant flow of patients. The recruitment committee at the MRC conducted training workshops for the medical staff in the endemic areas, along with regular meetings with health authorities and local leaders. Moreover, telemedicine technology was used to examine patients in endemic areas. Challenges and barriers facing clinical trial conduct need to be examined thoroughly to ensure actionable, evidence-based recommendations for improving patient recruitment and retention. In conclusion, effective patient recruitment and retention are based on three pillars, which are proper clinical trial design and protocol development, realistic and feasible trial site selection, and objective communication with the trial stakeholders.
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Affiliation(s)
| | | | | | - Hana E Alhaj
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - Sahar Mubarak Bakhiet
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan.,Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan
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14
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Konings M, Eadie K, Lim W, Fahal AH, Mouton J, Tesse N, van de Sande WWJ. The synthetic synergistic cinnamon oil CIN-102 is active against Madurella mycetomatis, the most common causative agent of mycetoma. PLoS Negl Trop Dis 2021; 15:e0009488. [PMID: 34106933 PMCID: PMC8216527 DOI: 10.1371/journal.pntd.0009488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 06/21/2021] [Accepted: 05/20/2021] [Indexed: 12/01/2022] Open
Abstract
Mycetoma is a devastating neglected tropical infection of the subcutaneous tissue and most commonly caused by the fungus Madurella mycetomatis. Treatment of mycetoma consists of a combination of a long term antifungal treatment with itraconazole and surgery. However, treatment is associated with low success rates. Therefore, there is a need to identify novel treatments for mycetoma. CIN-102 is a synthetic partial copy of cinnamon oils with activity against many pathogenic bacteria and fungi. In this study we determined the in vitro activity of CIN-102 against 21 M. mycetomatis isolates and its in vivo efficacy in a M. mycetomatis infected Galleria mellonella larval model. In vitro, CIN-102 was active against M. mycetomatis with MICs ranging from 32 μg/mL to 512 μg/mL. 128 μg/mL was needed to inhibit the growth in 50% of tested isolates. In vivo, concentrations below the MIC of 40 mg/kg and 80 mg/kg CIN-102 prolonged larval survival, but higher concentrations of CIN-102 did not. Mycetoma is a tropical infection causing large tumorous lesions on mainly the foot. This infection is most commonly caused by the fungus Madurella mycetomatis. Mycetoma is treated with antifungal agents and surgery but with low success rates. In our search for novel treatments for mycetoma we determined if CIN-102, a synthetic oil that resembles cinnamon oil, would be therapeutic in mycetoma. We therefore determined the activity of this oil against the fungus in vitro. We found that CIN-102 could inhibit M. mycetomatis growth in vitro. To determine if CIN-102 was also active against the mycetoma grain in vivo, we determined the efficacy in our Galleria mellonella grain model. Interestingly, CIN-102 was found to be effective in the larvae at a low concentrations.
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Affiliation(s)
- Mickey Konings
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Kimberly Eadie
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Wilson Lim
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Ahmed H. Fahal
- Mycetoma Research Center, University of Khartoum, Khartoum, Sudan
| | - Johan Mouton
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Nicolas Tesse
- Septeos, Research and experimental development on biotechnology, Paris, France
| | - Wendy W. J. van de Sande
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
- * E-mail:
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Bamorovat M, Sharifi I, Rashedi E, Shafiian A, Sharifi F, Khosravi A, Tahmouresi A. A novel diagnostic and prognostic approach for unresponsive patients with anthroponotic cutaneous leishmaniasis using artificial neural networks. PLoS One 2021; 16:e0250904. [PMID: 33951081 PMCID: PMC8099060 DOI: 10.1371/journal.pone.0250904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
Abstract
Cutaneous leishmaniasis (CL) imposes a major health burden throughout the tropical and subtropical regions of the globe. Unresponsive cases are common phenomena occurred upon exposure to the standard drugs. Therefore, rapid detection, prognosis and classification of the disease are crucial for selecting the proper treatment modality. Using machine learning (ML) techniques, this study aimed to detect unresponsive cases of ACL, caused by Leishmania tropica, which will consequently be used for a more effective treatment modality. This study was conducted as a case-control setting. Patients were selected in a major ACL focus from both unresponsive and responsive cases. Nine unique and relevant features of patients with ACL were selected. To categorize the patients, different classifier models such as k-nearest neighbors (KNN), support vector machines (SVM), multilayer perceptron (MLP), learning vector quantization (LVQ) and multipass LVQ were applied and compared for this supervised learning task. Comparison of the receiver operating characteristic graphs (ROC) and confusion plots for the above models represented that MLP was a fairly accurate prediction model to solve this problem. The overall accuracy in terms of sensitivity, specificity and area under ROC curve (AUC) of MLP classifier were 87.8%, 90.3%, 86% and 0.88%, respectively. Moreover, the duration of the skin lesion was the most influential feature in MLP classifier, while gender was the least. The present investigation demonstrated that MLP model could be utilized for rapid detection, accurate prognosis and effective treatment of unresponsive patients with ACL. The results showed that the major feature affecting the responsiveness to treatments is the duration of the lesion. This novel approach is unique and can be beneficial in developing diagnostic, prophylactic and therapeutic measures against the disease. This attempt could be a preliminary step towards the expansion of ML application in future directions.
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Affiliation(s)
- Mehdi Bamorovat
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Iraj Sharifi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmat Rashedi
- Department of Electrical and Computer Engineering, Graduate University of Advanced Technology, Kerman, Iran
| | - Alireza Shafiian
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Fatemeh Sharifi
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Khosravi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
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16
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AlKaabi LA, Ahmed LS, Al Attiyah MF, Abdel-Rahman ME. Predicting hypertension using machine learning: Findings from Qatar Biobank Study. PLoS One 2020; 15:e0240370. [PMID: 33064740 PMCID: PMC7567367 DOI: 10.1371/journal.pone.0240370] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
Background and objective Hypertension, a global burden, is associated with several risk factors and can be treated by lifestyle modifications and medications. Prediction and early diagnosis is important to prevent related health complications. The objective is to construct and compare predictive models to identify individuals at high risk of developing hypertension without the need of invasive clinical procedures. Methods This is a cross-sectional study using 987 records of Qataris and long-term residents aged 18+ years from Qatar Biobank. Percentages were used to summarize data and chi-square tests to assess associations. Predictive models of hypertension were constructed and compared using three supervised machine learning algorithms: decision tree, random forest, and logistics regression using 5-fold cross-validation. The performance of algorithms was assessed using accuracy, positive predictive value (PPV), sensitivity, F-measure, and area under the receiver operating characteristic curve (AUC). Stata and Weka were used for analysis. Results Age, gender, education level, employment, tobacco use, physical activity, adequate consumption of fruits and vegetables, abdominal obesity, history of diabetes, history of high cholesterol, and mother’s history high blood pressure were important predictors of hypertension. All algorithms showed more or less similar performances: Random forest (accuracy = 82.1%, PPV = 81.4%, sensitivity = 82.1%), logistic regression (accuracy = 81.1%, PPV = 80.1%, sensitivity = 81.1%) and decision tree (accuracy = 82.1%, PPV = 81.2%, sensitivity = 82.1%. In terms of AUC, compared to logistic regression, while random forest performed similarly, decision tree had a significantly lower discrimination ability (p-value<0.05) with AUC’s equal to 85.0, 86.9, and 79.9, respectively. Conclusions Machine learning provides the chance of having a rapid predictive model using non-invasive predictors to screen for hypertension. Future research should consider improving the predictive accuracy of models in larger general populations, including more important predictors and using a variety of algorithms.
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Affiliation(s)
- Latifa A. AlKaabi
- Department of Public Health, College of Health Science, QU Health, Qatar University, Doha, Qatar
| | - Lina S. Ahmed
- Department of Public Health, College of Health Science, QU Health, Qatar University, Doha, Qatar
| | - Maryam F. Al Attiyah
- Department of Public Health, College of Health Science, QU Health, Qatar University, Doha, Qatar
| | - Manar E. Abdel-Rahman
- Department of Public Health, College of Health Science, QU Health, Qatar University, Doha, Qatar
- * E-mail:
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Elkheir LYM, Haroun R, Mohamed MA, Fahal AH. Madurella mycetomatis causing eumycetoma medical treatment: The challenges and prospects. PLoS Negl Trop Dis 2020; 14:e0008307. [PMID: 32853199 PMCID: PMC7452721 DOI: 10.1371/journal.pntd.0008307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lamis Y. M. Elkheir
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Rayan Haroun
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Magdi Awadalla Mohamed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Jouf, KSA
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18
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Yeroushalmi S, Shirazi JY, Friedman A. New Developments in Bacterial, Viral, and Fungal Cutaneous Infections. CURRENT DERMATOLOGY REPORTS 2020; 9:152-165. [PMID: 32435525 PMCID: PMC7224073 DOI: 10.1007/s13671-020-00295-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW This review highlights clinically relevant updates to common and significant bacterial, viral, and fungal cutaneous infection within the past 5 years. Recent developments are presented so that the clinician may provide evidence-based, high-quality patient care. RECENT FINDINGS New resistance patterns in cutaneous pathogens have recently emerged as a result of inappropriate antimicrobial use. Several new FDA-approved antimicrobials have been approved to treat such infections, including multi-drug resistant pathogens. Several organizational guidelines for cutaneous infection management have been updated with new recommendations for screening, diagnostic, and treatment strategies. SUMMARY Clinicians should be aware of the most recent evidence and guidelines for the management of cutaneous infections in order to reduce the emergence of antimicrobial resistance and most effectively treat their patients.
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Affiliation(s)
- Samuel Yeroushalmi
- The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW, Washington, DC 20037 USA
| | | | - Adam Friedman
- The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave NW, Washington, DC 20037 USA
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19
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Abdelrahman M, Jumabhoy I, Saad EA, Abdulla GM. Reconstructive surgery for mycetoma: a case series. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-1502-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Abushouk A, Nasr A, Masuadi E, Allam G, Siddig EE, Fahal AH. The Role of Interleukin-1 cytokine family (IL-1β, IL-37) and interleukin-12 cytokine family (IL-12, IL-35) in eumycetoma infection pathogenesis. PLoS Negl Trop Dis 2019; 13:e0007098. [PMID: 30946748 PMCID: PMC6483278 DOI: 10.1371/journal.pntd.0007098] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/25/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022] Open
Abstract
Mycetoma is a neglected tropical disease, endemic in many tropical and subtropical regions, characterised by massive deformity and disability and can be fatal if untreated early and appropriately. Interleukins (IL) -35 and IL-37 are newly discovered cytokines that play an important role in suppressing the immune system. However, the expression of these interleukins in patients with Madurella mycetomatis (M. mycetomatis) induced eumycetoma has not yet been explored. The aim of this study is to determine the levels of IL-1 family (IL-1β, IL-37) and IL-12 family (IL-12, IL-35) in a group of these patients and the association between these cytokines levels and the patients’ demographic characteristics. The present, case-control study was conducted at the Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Sudan and it included 140 individuals. They were divided into two groups; group I: healthy controls [n = 70; median age 25 years (range 12 to 70 years)]. Group II: mycetoma patients [n = 70 patients; median age 25 (range 13 to 70 years)]. Cytokines levels were measured in sera using enzyme linked immunosorbent assay (ELISA). There was a significant negative correlation between IL-1β and IL-12 levels and lesion size and disease duration, while IL-37 and IL-35 levels were significantly positively correlated with both lesion size and disease duration. The analysis of the risk factors of higher circulatory levels of IL-37 in patients of mycetoma showed a negative significant association with IL-1β cytokine, where a unit increment in IL-1β will decrease the levels of IL-37 by 35.28 pg/ml. The levels of IL-37 among the patients with a duration of mycetoma infection ≤ 1 year were significantly low by an average of 18.45 pg/ml compared to patients with a mycetoma infection’s duration of ≥ 5years (reference group). Furthermore, the risk factors of higher levels of IL-35 in mycetoma patients revealed a negative significant association with IL-12, as a unit increment in IL-12 decreases the levels of IL-35 by 8.99 pg/ml (p < 0.001). Levels of IL-35 among the patients with duration of mycetoma infection ≤ one year were significantly low on average by 41.82 pg/ml (p value = 0.002) compared to patients with a duration of mycetoma infection ≥ 5 years (reference group). In conclusion, this study indicates that both IL-35 and IL-37 are negatively associated with the levels of IL-1β and IL-12 in eumycetoma mycetoma infection; and high levels of IL-37 and IL-35 may have a negative impact on disease progression. Mycetoma is a progressive chronic granulomatous fungal or bacterial infection that may result in massive destruction of subcutaneous tissues, muscles and bones. Mycetoma is a neglected disease which is endemic in many tropical and subtropical areas. If the disease is not treated properly, eventually it ends up with amputation and adverse medical, health and socioeconomic effects on patients and the community. Previous data suggested a crucial role of adaptive immunity in host resistance to causative agents and in the disease progress. The recently identified IL-35 and IL-37 cytokines revealed an important role in immune suppression. Nevertheless, the expression of these interleukins in patients with mycetoma has not yet been investigated. Therefore, the present case-control study aimed to determine the levels of IL-1 family (IL-1β, IL-37) and IL-12 family (IL-12, IL-35) in these patients and the association between these cytokines levels and the patients’ demographic characteristics. The results of this study showed that, the levels of IL-37 and IL-35 were consistently positively correlated with different diameters of mycetoma lesions as well as its duration. However, the levels of IL-1β and IL-12 were consistently negatively correlated with different diameters of lesions and the duration of mycetoma infection. The analysis of the risk factors of higher circulatory levels of IL-37 in patients of mycetoma showed a negative significant association with IL-1β cytokine Furthermore, the risk factors of higher levels of IL-35 in patients of mycetoma revealed a negative significant association with IL-12. These findings uncover a possible the role of IL-35 and IL-37 in the pathogenesis of mycetoma, and may declare their potential value in treatment of mycetoma.
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Affiliation(s)
- Amir Abushouk
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Amre Nasr
- King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Emad Masuadi
- Research Unit, Department of Medical Education, College of Medicine-Riyadh, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Gamal Allam
- Department of Microbiology and Immunology, College of Medicine, Taif University, Taif, Saudi Arabia
- Immunology Section, Department of Zoology, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | | | - Ahmed H. Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- * E-mail: ,
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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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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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Abstract
A 58-year-old agricultural worker from a remote Western province farming community in Saudi Arabia presented with a 2-year history of right plantar foot soft tissue mass. According to the patient, the swelling had gradually increased in size over a few years, but it was painless and thus had not restricted him from continuing to farm until the lesion started to affect mobility. An MRI, microbiology and histopathology reported a rare infectious agent—Actinomyces spp, otherwise referred to as Madura foot. Three-dimensional CT aided in a preoperative surgical plan which included mass excision/debulking for this challenging lesion. Full eradication was not possible, and the patient required prolonged anti-infective therapy (>6 months) along with close surveillance to map resolution of infective symptoms.
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Bakhiet SM, Fahal AH, Musa AM, Mohamed ESW, Omer RF, Ahmed ES, El Nour M, Mustafa ERM, Sheikh A. Rahman ME, Suliman SH, El Mamoun MAG, El Amin HM. A holistic approach to the mycetoma management. PLoS Negl Trop Dis 2018; 12:e0006391. [PMID: 29746460 PMCID: PMC5944909 DOI: 10.1371/journal.pntd.0006391] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/18/2018] [Indexed: 11/22/2022] Open
Abstract
Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients' socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients' management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families.
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Affiliation(s)
- Sahar Mubarak Bakhiet
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | - Ahmed Mudawi Musa
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | | | | | | | - Mustafa El Nour
- Department of Medical Imaging, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - El Rayah Mohamed Mustafa
- Department of Medical Imaging, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Manar El Sheikh A. Rahman
- Department of Biostatistics, Faculty of Mathematical Sciences, University of Khartoum, Khartoum, Sudan
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