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van de Sande WWJ, Fahal AH. An updated list of eumycetoma causative agents and their differences in grain formation and treatment response. Clin Microbiol Rev 2024; 37:e0003423. [PMID: 38690871 PMCID: PMC11237709 DOI: 10.1128/cmr.00034-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
SUMMARYIn 2023, the World Health Organization designated eumycetoma causative agents as high-priority pathogens on its list of fungal priority pathogens. Despite this recognition, a comprehensive understanding of these causative agents is lacking, and potential variations in clinical manifestations or therapeutic responses remain unclear. In this review, 12,379 eumycetoma cases were reviewed. In total, 69 different fungal species were identified as causative agents. However, some were only identified once, and there was no supporting evidence that they were indeed present in the grain. Madurella mycetomatis was by far the most commonly reported fungal causative agent. In most studies, identification of the fungus at the species level was based on culture or histology, which was prone to misidentifications. The newly used molecular identification tools identified new causative agents. Clinically, no differences were reported in the appearance of the lesion, but variations in mycetoma grain formation and antifungal susceptibility were observed. Although attempts were made to explore the differences in clinical outcomes based on antifungal susceptibility, the lack of large clinical trials and the inclusion of surgery as standard treatment posed challenges in drawing definitive conclusions. Limited case series suggested that eumycetoma cases caused by Fusarium species were less responsive to treatment than those caused by Madurella mycetomatis. However, further research is imperative for a comprehensive understanding.
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Affiliation(s)
- Wendy W. J. van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ahmed H. Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
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2
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Konings M, Gerrits van den Ende B, Raats MWJ, Fahal AH, van de Sande WWJ, Hagen F. Complete Genome Sequence of the Itraconazole Decreased Susceptible Madurella fahalii Type-Strain CBS 129176. Mycopathologia 2024; 189:6. [PMID: 38231295 PMCID: PMC10794591 DOI: 10.1007/s11046-023-00807-0] [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: 03/07/2023] [Accepted: 10/04/2023] [Indexed: 01/18/2024]
Abstract
Madurella fahalii is a causative agent of the implantation mycosis mycetoma with decreased susceptibility to itraconazole, the preferred therapeutic drug to combat mycetoma. Here, we report the M. fahalii type-strain CBS 129176 genome assembly and annotation to identify a glutamic acid insert near the azole-binding pocket in the Cyp51A protein.
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Affiliation(s)
- Mickey Konings
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | - Mirthe W J Raats
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | | | - Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystems Dynamics, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
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3
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Yoshioka I, Mori Y, Fahal AH, Siddig EE, Kaneko S, Yaguchi T. Specific and sensitive loop-mediated isothermal amplification (LAMP) method for Madurella strains, eumycetoma filamentous fungi causative agent. PLoS Negl Trop Dis 2023; 17:e0011644. [PMID: 37721946 PMCID: PMC10538720 DOI: 10.1371/journal.pntd.0011644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/28/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Filamentous fungi of the genus Madurella are the primary causative agents of mycetoma, a disease observed in tropical and subtropical regions. Since early diagnostics based on a morphological approach are difficult and have many shortcomings, a molecular diagnostic method suitable for rural settings is required. In this study, we developed the loop-mediated isothermal amplification (LAMP) method to present a foundational technique of the diagnosis of Madurella spp. (M. mycetomatis, M. pseudomycetomatis, M. tropicana, and M. fahalii), the common causative organisms of eumycetoma. PRINCIPAL FINDINGS We successfully designed a primer pair targeting the rDNAs of three Madurella spp. excluding M. fahalii, and detected up to 100 fg of genomic DNA extracted from isolates of M. mycetomatis and 1 pg of M. pseudomycetomatis and M. tropicana, within one hour. Second, a primer pair specific to M. mycetomatis, the most common causative species, or M. fahalii, a drug-resistant species, was constructed, and the detection limit of both primer pairs was 1 pg. The designed primers accurately distinguished 16 strains of the genus Madurella from various fungal species known to cause mycetomas. CONCLUSION In summary, we established the first model of a LAMP detection method that rapidly and sensitively detects and identifies Madurella isolates for clinical diagnostics. Moreover, the combined designed primer sets could identify mycetoma-causing strains simultaneously.
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Affiliation(s)
- Isato Yoshioka
- Medical Mycology Research Center, Chiba University, Chiba, Chiba, Japan
- Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
| | - Yugo Mori
- Medical Mycology Research Center, Chiba University, Chiba, Chiba, 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
| | - Takashi Yaguchi
- Medical Mycology Research Center, Chiba University, Chiba, Chiba, Japan
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Litvintseva AP, Bakhiet S, Gade L, Wagner DD, Bagal UR, Batra D, Norris E, Rishishwar L, Beer KD, Siddig EE, Mhmoud NA, Chow NA, Fahal A. Genomics and metagenomics of Madurella mycetomatis, a causative agent of black grain mycetoma in Sudan. PLoS Negl Trop Dis 2022; 16:e0010787. [PMID: 36322569 PMCID: PMC9629555 DOI: 10.1371/journal.pntd.0010787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 09/03/2022] [Indexed: 11/20/2022] Open
Abstract
Madurella mycetomatis is one of the main causative agents of mycetoma, a debilitating neglected tropical disease. Improved understanding of the genomic diversity of the fungal and bacterial causes of mycetoma is essential to advances in diagnosis and treatment. Here, we describe a high-quality genome assembly of M. mycetomatis and results of the whole genome sequence analysis of 26 isolates from Sudan. We demonstrate evidence of at least seven genetically diverse lineages and extreme clonality among isolates within these lineages. We also performed shotgun metagenomic analysis of DNA extracted from mycetoma grains and showed that M. mycetomatis reads were detected in all sequenced samples with the average of 11,317 reads (s.d. +/- 21,269) per sample. In addition, 10 (12%) of the 81 tested grain samples contained bacterial reads including Streptococcus sp., Staphylococcus sp. and others.
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Affiliation(s)
- Anastasia P. Litvintseva
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Sahar Bakhiet
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - Lalitha Gade
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Dhwani Batra
- Office of Advanced Molecular Detection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emily Norris
- Applied Bioinformatics Laboratory, Atlanta, Georgia, United States of America
| | - Lavanya Rishishwar
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Karlyn D. Beer
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Najwa Adam Mhmoud
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - Nancy A. Chow
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ahmed Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
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Mycetoma, chromoblastomycosis and other deep fungal infections: diagnostic and treatment approach. Curr Opin Infect Dis 2022; 35:379-383. [PMID: 35942857 DOI: 10.1097/qco.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW to review recent advances in the epidemiology, diagnosis, and treatment of deep fungal infections. RECENT FINDINGS Mycetoma and chromoblastomycosis are the only deep fungal infections incorporated in the list of neglected tropical diseases. These infections start in the skin but progress to deep tissues if not recognized early. A wide array of fungal pathogens are the causative agents. Molecular methods allow for early and accurate identification of the pathogens, but are unfortunately not available in endemic areas. Treatment options are mostly based upon clinical experience rather than on well-designed clinical trials. SUMMARY Deep fungal infections of the skin and soft tissues are rare conditions of wide world distribution but mostly reported from tropical countries. Urgent need for affordable and easily accessible molecular methods and well-conducted studies to allow for accurate diagnosis and to provide evidence to guide proper therapy are urgently needed.
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The developed molecular biological identification tools for mycetoma causative agents: An update. Acta Trop 2022; 225:106205. [PMID: 34687643 DOI: 10.1016/j.actatropica.2021.106205] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022]
Abstract
Mycetoma is a chronic granulomatous inflammatory disease that is caused either by bacteria or fungi. Bacterial mycetoma (actinomycetoma) can be caused by various causative agents of the genera Nocardia, Streptomyces and Actinomadura. On the other hand, fungal mycetoma (eumycetoma) is most commonly caused by causative agents belonging to the genera Madurella, Scedosporium and Falciformispora. Early and accurate diagnosis of the causative organisms can guide proper patient management and treatment. To allow rapid and accurate species identification, different molecular techniques were developed over the past decades. These techniques can be protein based (MALDI-TOF MS) as well as DNA based (Sequencing, PCR and isothermal amplification methods). In this review, we provide an overview of the different molecular techniques currently in use and identify knowledge gaps, which need to be addressed before we can implement molecular diagnostics for mycetoma in different clinical settings.
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Oladele RO, Ly F, Sow D, Akinkugbe AO, Ocansey BK, Fahal AH, van de Sande WWJ. Mycetoma in West Africa. Trans R Soc Trop Med Hyg 2021; 115:328-336. [PMID: 33728466 DOI: 10.1093/trstmh/trab032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/07/2020] [Accepted: 02/14/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mycetoma is a neglected disease, which is socioeconomically important, and with the possibility of permanent disability in infected persons if not treated early. This is especially true in resource-limited settings such as West Africa, where there is a lack of facilities and skilled personnel to make a definitive laboratory diagnosis. Countries in West Africa have similar climatic conditions to Sudan. The majority of patients seek medical care very late, when there is already bone involvement, resulting in amputations. This results in poor capture of the true burden of the problem in the literature. METHODS A review of the literature revealed about 2685 documented cases in West Africa from 1929 to 2020; from 15 out of 16 countries, Senegal accounted for 74.1% (1943) of cases in the subregion. RESULTS The majority of lesions were found on the foot; however, other body parts were also reported. Rural dwellers accounted for most cases. Only 547 (20.4%) cases had identified isolates reported. Actinomycetoma accounted for 47.9% of cases, eumycetoma 39.7% and unidentified pathogens 12.4%. Actinomadura pelletieri was the predominant pathogen isolated (21.4%; 117 isolates). CONCLUSION There is a dire need for capacity building, provision of facility and health education to raise awareness of this debilitating disease in West Africa.
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Affiliation(s)
- Rita Okeoghene Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Fatimata Ly
- Dermatology unit of Institut d'Hygiene Sociale de Dakar Hospital, Faculty of Medicine Pharmacy Odontology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | - Douduo Sow
- Service de Parasitologie-Mycologie, UFR Sciences de la Santé, Université Gaston Berger, Saint-Louis, Sénégal
| | - Ayesha O Akinkugbe
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Bright K Ocansey
- Dermatology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ahmed H Fahal
- The Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
| | - Wendy W J van de Sande
- Erasmus MC, University Medical Centre Rotterdam, Department of Medical Microbiology and Infectious Diseases, Wytemaweg 80, 3015 CE, Rotterdam, the Netherlands
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Musa HH, Musa TH, Musa IH, Musa IH. Global scientific research progress in mycetoma: a bibliometric analysis. Trans R Soc Trop Med Hyg 2021; 115:1414-1426. [PMID: 33982760 DOI: 10.1093/trstmh/trab072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mycetoma is a neglected tropical disease that attracts little attention in regard to research and publications and hence this study was undertaken to determine the trends and global scientific research output in mycetoma-related fields. METHODS Mycetoma data were retrieved from the Web of Science (WoS) and Scopus databases. The MeSH Browser was used to extract relevant keywords. Biblioshiny software (R-studio cloud), VOSviewer v. 1.6.6 and SPSS software were used for data management. RESULTS Research trends on mycetoma increased globally from 1999 to 2020. The results were 404 documents (4444 citations) in WoS and 513 documents (5709 citations) in Scopus, and the average number of citations per article was 11 in WoS and 11.13 in Scopus. There was a significant association between the total number of citations and the total citations per year in both WoS (r=0.833, p<0.0001) and Scopus (r=0.926, p<0.0001). Sudan, India, the Netherlands and Mexico were the top-ranking productive countries for mycetoma publications in WoS, while India, the USA and Mexico were the top-ranking countries in Scopus. Articles on mycetoma were mainly published in PLoS Neglected Tropical Diseases, the International Journal of Dermatology and the Journal of Clinical Microbiology. A. H. Fahal from the Mycetoma Research Centre, University of Khartoum, Sudan, had the highest number of citations in mycetoma research during 1999-2020, followed by W. W. J. van de Sande from the Erasmus Medical Centre, University of Rotterdam, the Netherlands, during 2003-2020. CONCLUSION The analysis provides insight into a global overview of Mycetoma research. In addition, the analysis holds a better understanding of the development trends that have emerged in Mycetoma over the past 21 years, which can also offer a scientific reference for future research.
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Affiliation(s)
- Hassan H Musa
- Biomedical Research Institute, Darfur College, Nyala, Sudan.,Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, University of Khartoum, Sudan
| | - Taha H Musa
- Biomedical Research Institute, Darfur College, Nyala, Sudan.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Ibrahim H Musa
- Biomedical Research Institute, Darfur College, Nyala, Sudan.,Department of Software Engineering, School of Computer Science and Engineering, Southeast University, Nanjing, China
| | - Idriss H Musa
- Biomedical Research Institute, Darfur College, Nyala, Sudan.,Department of Surgery, School of Medicine, Darfur College, Nyala, Sudan
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Tirado-Sánchez A, Franco-Paredes C, Bonifaz A. Subcutaneous Mycoses in Travelers. CURRENT TROPICAL MEDICINE REPORTS 2020; 7:141-152. [PMID: 35665217 PMCID: PMC9162435 DOI: 10.1007/s40475-020-00216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
Purpose of Review The increase in international travel in recent decades has contributed to the risk of acquiring diseases considered endemic to a region or country and the change in the epidemiology of these diseases. Endemic mycoses that may be acquired by travelers in the short or long term are endemic subcutaneous mycoses such as sporotrichosis and lobomycosis, while endemic systemic mycoses are a group of serious diseases including histoplasmosis and coccidioidomycosis. Herein, we review the current knowledge and highlight the most important aspects of these fungal infections in travelers. Recent Findings The most relevant advances in the study of these mycoses involve the epidemiological distribution; human mycoses can be fatal and there are few antifungal drugs available, increasing drug resistance, and a risk of emerging fungal diseases associated with climate change, as well as the increasing virulence, and the diagnostic strategies that may be limited in many countries. Summary Although endemic mycoses are relatively rare, they should be considered as potentially travel-related illnesses. A recent or late trip to an endemic country may guide the clinical suspicion, an early diagnosis, and the institution of effective therapy.
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Affiliation(s)
- Andrés Tirado-Sánchez
- Dermatology Service & Micology Department, Hospital General de México “Dr Eduardo Liceaga”, Dr. Balmis 148, colonia Doctores, PZ: 06720 Mexico City, Mexico
| | - Carlos Franco-Paredes
- Department of Medicine, Division of Infectious Diseases, Anschutz Medical Center, University of Colorado, Aurora, CO, USA
- Instituto Nacional de Salud, Hospital Infantil de México, Federico Gómez, Mexico City, Mexico
| | - Alexandro Bonifaz
- Dermatology Service & Micology Department, Hospital General de México “Dr Eduardo Liceaga”, Dr. Balmis 148, colonia Doctores, PZ: 06720 Mexico City, Mexico
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