Abstract
Eumycetoma is a progressive and destructive chronic granulomatous subcutaneous inflammatory disease caused by certain fungi, the most common being Madurella mycetomatis. The host defence mechanisms against fungi usually range from an early non-specific immune response to activation and induction of specific adaptive immune responses by the production of Th-1 and Th-2 cytokines. The aim of this study is to determine the levels of Th-1 and Th-2 cytokines in patients infected with Madurella mycetomatis, and the association between their levels and disease prognosis. This is a descriptive cross-sectional study conducted at the Mycetoma Research Centre, University of Khartoum, Sudan, where 70 patients with confirmed M. mycetomatis eumycetoma were enrolled; 35 with, and 35 without surgical excision. 70 healthy individuals from mycetoma endemic areas were selected as controls. The levels of serum cytokines were determined by cytometric bead array technique. Significantly higher levels of the Th-1 cytokines (IFN-γ, TNF-α, IL-1β and IL-2) were recorded in patients treated with surgical excision, compared to those treated without surgical excision. In contrast, the Th-2 cytokines (IL-4, IL-5, IL-6 and IL-10) were significantly lower in patients treated with surgical excision compared to those treated without surgical excision. In conclusion, the results of this study suggest that cell-mediated immunity can have a role to play in the pathogenesis of eumycetoma.
Highlights
IntroductionMycetoma is a chronic subcutaneous infection caused by certain bacteria (actinomycetoma) or fungi (eumycetoma) [1]
Mycetoma is a chronic subcutaneous infection caused by certain bacteria or fungi [1]
Higher levels of the Th-1 cytokines (IFN-γ, TNFα, IL-1β and IL-2) were found in patients treated with surgical excision compared to those treated without surgical intervention
Summary
Mycetoma is a chronic subcutaneous infection caused by certain bacteria (actinomycetoma) or fungi (eumycetoma) [1]. It is characterised by a slow progressive infection and a granulomatous inflammatory response that can result in severe soft tissue and muscle damage along with destruction of the underlying bone [1, 2]. Mycetoma is endemic in tropical and subtropical regions; it has been reported globally. The disease is characterised by extensive subcutaneous masses, usually with multiple draining sinuses and fungal grains [1]. Mycetoma disease has significant negative medical health and socio-economic impacts on patients and communities, affects individuals of all ages, but is more frequently seen in adults who work outdoors
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