Diagnosis Of Mycetoma Research Articles

A Neglected Tropical Disease: Thoracic Actinomycetoma a Succesfull Case Report

Mycetoma is a chronic, granulomatous subcutaneous infection characterized by a triad of inflammation, painless tumour-like lesions and multiple sinuses discharging grains [1]. In Mexico, 97% of mycetomas are caused by bacteria of the order Actinomycetales, where Nocardia brasiliensis is the most important agent, while in eumycetomas the most important genera are Madurella spp. and Trematosphaeria spp [4]. This pathology is more common in men (3:1 to 5:1) between the age of 20 and 40 years, and up to 75% of patients present the injury (being the entry way) in the lower extremity, most commonly in the foot (70%). Other sites include the head, neck, chest, shoulders and arms [6, 7]. The diagnosis of mycetoma is based on clinical presentation, imaging studies and identification of the causative organisms in relevant clinical samples taken from affected tissues using fine-needle aspiration, or surgical biopsy. The diagnosis of mycetoma is based on clinical presentation, imaging studies and identification of the causative organisms in relevant clinical samples taken from affected tissues using fine-needle aspiration, or surgical biopsy. Imaging including X-ray, ultrasound, MRI and CT scan examinations may be required to characterize the spread and extent of disease [3].

Qualitative protocol to support detection of the early presentation and diagnosis of mycetoma in Sudan

The neglected tropical disease (NTD) mycetoma is a chronic and progressively destructive infectious disease endemic in Sudan. There is a growing body of scientific research on mycetoma -causes, transmission, treatment, and impact from a clinical and biomedical perspective. However, there is further need for in-depth medical anthropology research on the disease to successfully translate biomedical advances into elimination and control programmes. Given this background the NIHR Global Health Research Unit on NTDs at Brighton and Sussex Medical School is leading multidisciplinary research on skin NTDs, including mycetoma, with a medical anthropology research component exploring how community engagement can lead to earlier presentation of mycetoma in Sudan. This protocol paper sets out the research aims and methods to generate new knowledge on mycetoma in Sudan once the political situation becomes stable and it is safe to carry out global health research once again. We continue to develop appropriate community engagement intervention strategies, while activities like training and capacity strengthening get underway remotely. In what follows we situate this study in the NIHR Research Unit on NTDs and alongside social science research on mycetoma. This study is part of the programme of research conducted by the NIHR Research Unit on NTDs at Brighton and Sussex Medical School (BSMS). Phase I of the Unit was conducted from 2018–2021. Below we detail key findings from Phase I that have informed our more recent work in Phase II (2021)(2022)(2023)(2024)(2025)(2026). It also sits alongside the Social Sciences for Severe Stigmatising Skin Conditions (5-S) Foundation also at BSMS (‘NIHR 5S Foundation -BSMS’ n.d., 5). The 5-S foundation examines the cultural, social, economic, and policy contexts of podoconiosis, mycetoma, and scabies in relation to the dynamics and dimensions of stigma. This study differs from the aims of the 5S Foundation in that it specifically focuses on the role community engagement can have in the early presentation and diagnosis of mycetoma in Sudan.

Magnetic Resonance Imaging in the Diagnosis of Mycetoma with Equivocal Clinical and Laboratory Features.

Magnetic Resonance Imaging in the Diagnosis of Mycetoma with Equivocal Clinical and Laboratory Features.

Dermoscopy-An Aid in the Diagnosis of Mycetoma.

A 45-year-old farmer consulted for a gradually increasing swelling over right leg. Examination revealed hard swelling with multiple discharging sinuses over right foot. Many pin-point hypopigmented macules arranged in a schematic pattern were seen, corresponding to the site of administration of indigenous medication [Figure 1]. Dermoscopic examination using DermLite™ DL3-3Gen under contact polarized mode from one of the active sinus revealed small black grains, surrounded by bluish white veil suggestive of deeper fungal colonies [Figure 2a]. White structureless area around the openings corresponding to dermal fibrosis was seen[Figure 2b]. Skin punch biopsy from the lesion demonstrated periodic-acid-schiff positive, pigmented fungal colonies over a background of granulation tissue [Figure 3].Figure 1: Diffuse woody hard swelling over dorsum of right foot with multiple discharging sinusesFigure 2: a. Dermoscopy of the sinus opening shows multiple small black grains. b. The sinuses are surrounded by bluish white veil (Red arrow). Crust surrounding the sinus opening can be seen (Yellow arrow) Structureless pink-white areas related to the underlying fibrosis was seen surrounding to the lesion (Star). (DL3 dermoscope, polarized mode 10x)Figure 3: Histopathology shows pigmented fungal colony comprising of radiating hyphae of eumycetoma, showing splendor hoeppli phenomenon and surrounded by dense neutrophilic infiltrate. (PAS stain, 10x)Mycetoma is a granulomatous infection that can be caused by bacteria (actinomycotic mycetoma) or fungi (eumycotic mycetoma). Grains represent the hallmark of mycetoma and color of grains is often suggestive of the probable causative agent. However, diagnostic facilities are often limited and inaccessible to many patients affected by this neglected tropical disease.[1] Dermoscopy is an easy, quick, and noninvasive tool, which can be helpful in visualizing minute grains and ascertain the type of mycetoma.[1] Black colored granules are highly suggestive of eumycotic mycetoma and its visualization by dermoscopy can help in early institution of definitive treatment. The dermoscopic images can also be stored and transferred electronically and an expert opinion sought through teledermoscopy.[2] Dermoscopy has been explored in the diagnosis of many pigmentary disorders, granulomatous infective diseases like leprosy and sporotrichosis.[34] The current report reinstitutes the importance of dermoscopy in diagnosis of dermatological disorders with clinico-dermoscopic-pathological correlation.[2] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Phæohyphomycose à Roussoella percutanea

Phæohyphomycosis are opportunistic mycosis due to black (dematized) fungi. Although ubiquitous, these infections are more common in tropical countries. We report here the case of a 65-year-old man, of Congolese origin, in France for 40 years, who was consulting for a retro malleolar tumefaction evolving since 4 months. In his background, there was a kidney transplant for cancer a year ago. MRI revealed a mass of 3 cm in diameter without bone involvement. Histological examination revealed septate filaments. The absence of fistulas and grains ruled out the diagnosis of mycetoma. On a cutaneous biopsy fragment, pan-fungal PCR was performed. Sequencing analysis allowed identifying Roussoella percutanea.

Mycetoma laboratory diagnosis: Review article.

Mycetoma is a unique neglected tropical disease caused by a substantial number of microorganisms of fungal or bacterial origins. Identification of the causative organism and the disease extension are the first steps in the management of the affected patients and predicting disease treatment outcome and prognosis.Different laboratory-based diagnostic tools and techniques were developed over the years to determine and identify the causative agents. These include direct microscopy and cytological, histopathological, and immunohistochemical techniques in addition to the classical grain culture. More recently, various molecular-based techniques have joined the mycetoma diagnostic armamentarium. The available mycetoma diagnostic techniques are of various specificity and sensitivity rates. Most are invasive, time consuming, and operator dependent, and a combination of them is required to reach a diagnosis. In addition, they need a well-equipped laboratory and are therefore not field friendly.This review aims to provide an update on the laboratory investigations used in the diagnosis of mycetoma. It further aims to assist practising health professionals dealing with mycetoma by outlining the guidelines developed by the Mycetoma Research Centre, University of Khartoum, WHO collaborating centre on mycetoma following a cumulative experience of managing more than 7,700 mycetoma patients.

Histopathological Approach in Diagnosis of Mycetoma Causative Agents: A Mini Review

Mycetoma is a unique neglected tropical disease which distributed worldwide and endemic in tropical and subtropical regions. This disease is caused by a large number of micro-organisms of fungal (eumycetoma) or bacterial (Actinomycitoma) origins. The disease is characterized by a swelling in the cutaneous and subcutaneous tissues, with the formation of sinuses tract in some patients with numerous deformities and disabilities. Mycetoma infection affects all ages. The diagnosis of the mycetoma is based on identification of the causative organism and the disease extension which in turn considered as the first steps in the management of the affected patients and eventually predicting disease treatment outcome and prognosis. Different diagnostic tools were developed that aimed to identify the causatives agent. These include direct microscopy, Fine needle aspiration, Imprint cytology, histopathological, culturing techniques and molecular identification. Since histopathology is continues to be a rapid diagnostic tool as well as cost effective means of providing a presumptive or/and in some instances a definitive diagnosis of an invasive mycetoma infection, as well as it able to detect the causative agents invasion of tissues and vessels as well as host tissue reaction to the causative agents, however no way to replace the culture and molecular diagnosis that remain the most powerful tools for the definitive diagnosis of the causative agents. In our clinical setting at Mycetoma Research center the histopathology report, considered as a powerful tool as it include a comment stating the morphological appearance of the causative agents and the type of the host tissue reactions as well as it stated clearly the possible differential diagnosis. In this review we will discuss varies histopathological appearance of mycetoma causative agents as well as the common used histochemical stains that can aid in the diagnosis and the host tissue reaction to varies causative agents.

Mycétome actinomycosique extrapodal plurifocal : bonne réponse au traitement par l’association cotrimoxazole et AINS

Mycetoma is a bacteriological or fungal infectious disease affecting the skin and/or soft tissues, which can be complicated by bone involvement. The most common feature is a tumor of the foot, but extrapodal localizations have been described. We report one case of a 47-year-old man who presented with tumefaction of a leg with multiple skin fistulae. Histopathological examination permitted to confirm the diagnosis of actinomycetoma and TDM showed the degree of bone and soft tissues involvement. Our case was characterized by the very inflammatory aspect of the tumor, its localization to the leg without foot involvement, the modest functional signs compared to the importance of radiological bone involvements, the deep destruction of the fibula while the tibia was apparently intact and the good response to treatment. In spite of its characteristic features, diagnosis of mycetoma is still late in our country, often with bone and/or articular spread. Priority may be given to measures for reduction of mycetoma diagnosis lateness.

Mycetoma in the Sudan: an update from the Mycetoma Research Centre, University of Khartoum, Sudan.

This communication reports on the Mycetoma Research Centre of the University of Khartoum, Sudan experience on 6,792 patients seen during the period 1991–2014.The patients were predominately young (64% under 30 years old) males (76%). The majority (68%) were from the Sudan mycetoma belt and 28% were students. Madurella mycetomatis eumycetoma was the most common type (70%). In 66% of the patients the duration of the disease was less than five years, and 81% gave a history of sinuses discharging mostly black grains (78%). History of trauma at the mycetoma site was reported in 20%. Local pain was reported in 27% of the patients, and only 12% had a family history of mycetoma. The study showed that 57% of the patients had previous surgical excisions and recurrence, and only 4% received previous medical treatment for mycetoma. Other concomitant medical diseases were reported in 4% of the patients. The foot (76%) and hand (8%) were the most commonly affected sites. Less frequently affected sites were the leg and knee (7%), thigh (2%), buttock (2%) and arm and forearm (1%). Rare sites included the chest wall, head and neck, back, abdominal wall, perineum, oral cavity, tongue and eye. Multiple sites mycetoma was recorded in 135 (2%) of cases. At presentation, 37% of patients had massive lesions, 79% had sinuses, 8% had local hyper-hydrosis at the mycetoma lesion, 11% had regional lymphadenopathy, while 6% had dilated tortuous veins proximal to the mycetoma lesions. The diagnosis of mycetoma was established by combined imaging techniques and cytological, histopathological, serological tests and grain culture. Patients with actinomycetoma received a combination of antimicrobial agents, while eumycetoma patients received antifungal agents combined with various surgical excisions. Surgical excisions in the form of wide local excision, debridement or amputation were done in 807 patients, and of them 248 patients (30.7%) had postoperative recurrence. Different types of amputations were done in 120 patients (1.7%).

IgG anti nocardia brasiliensis antibodies block IgM mediated protective effect in BALB/c mice. (MPF2P.814)

Abstract Intracellular bacteria such as, Nocardia brasiliensis, produce a chronic human disease named actinomycetoma. Diagnosis of mycetoma is made on clinical findings as swelling and deformation of infected tissue and confirmed by culturing the offending microbe or by an ELISA test. Pathogenesis of mycetoma is little known and role of antibodies is controversial but it has been published that that cell mediated immunity is responsible of host protection in other intracellular bacterial infections. We used Nocardia brasiliensis to infect BALB/c mice and studied the role of both monoclonal and polyclonal antigen-specific IgM and IgG antibodies. We investigated antibodies role in host protection using passive immunization. Mice recipients of anti N. brasiliensis antibodies were then infected to assess actinomycetoma development. We found that IgM but not IgG anti N. brasiliensis antibodies from sera of infected animals and IgM, but not IgG anti N. brasiliensis monoclonal antibodies were able to confer protection and prevented actinomycetoma infection in experimental animals. IgG antibodies blocked the IgM protective effect in vivo. Implications of these finding in vaccine development are presented.

Oral eumycetoma of infancy: A rare presentation and a brief review

Mycetoma is a chronic granulomatous infection of skin and subcutaneous tissue, which may involve bone. The disease is caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). Both types of organism are important soil saprophytes, and therefore infection is normally acquired by traumatic inoculation of the skin by contaminated material. Clinically, mycetomas are characterized by tumefaction, draining sinuses and discharging grains. The grains are aggregates of fungal hyphae or bacterial filaments, and grain size, colour and consistency provide the initial clue to the causative organism. To our knowledge, this probably is the first case report of oral eumycetoma of infancy. Review of literature shows only ten cases of eumycetoma involving the head and neck, including the present case. Histological examinations of the biopsies were the cornerstone in the diagnosis of mycetoma. The distinction between eumycetoma and actinomycetoma is essential for treatment. Direct microscopic examination of the grain and histopathological examination, using histochemical staining will distinguish between the two. Treatment consists of long courses of antifungals and antibacterials agents, often combined with surgery.

Mycetoma in children in Sudan

We report on 722 children with confirmed mycetoma seen at the Mycetoma Research Centre, Khartoum, Sudan during May 1991 to March 2009. There were 531 males (73.5%) and 191 females (26.5%) with an age range of 4-17 years (mean 13.7+/-2.9 years); most were students. The majority of patients were from Central and Western Sudan. The disease duration ranged between 6 months and 14 years (mean 2.27+/-2.12 years). Most of the patients had eumycetoma (79.1%). The clinical course was typical in the majority of the patients. Family history of mycetoma was reported in 15% of patients. The foot was affected most, followed by knee, hand, head and neck, chest wall and buttocks. In the foot, the metatarsal bones and calcaneum were affected most. Cytological and ultrasonic examinations of the lesions and histological examination of the surgical biopsies were the cornerstone in the diagnosis of mycetoma. Combined medical treatment and surgical excision was the standard treatment. Disease recurrence after surgical excision was reported in 17.9% of patients. The morbidity rate in this study was high, and it had led to high school dropout and many socioeconomic impacts on patients, families and community. Children with mycetoma need psychological support to identify and to treat their psychosocial problems.

The cell block technique: a new diagnostic tool for mycetoma

Aim The aim is to describe the use of cell block technique as a new tool for the cytodiagnosis of mycetoma. Methods This study included 230 patients. In each patient, the suspected lesion was aspirated with a 21-gauge needle attached to a 10 mL syringe. The aspirated material was processed as that described for the histopathological examination. Results The different mycetoma grains had distinct morphological features on cell block and they were identical to those seen in histopathological sections. They were surrounded by polymorphous inflammatory cells. The distinction between eumycetoma and actinomycetoma and their classification according to the causative agents were feasible. Discussion This study showed that mycetoma can be accurately diagnosed by cell block. The appearance of the grains and the tissue reactions in the cell block were morphologically identical to histopathological sections. The technique is simple, rapid, specific and inexpensive. It can be used in routine diagnosis of mycetoma, to obtain grains for culture identification and in epidemiological studies. The cell blocks can be preserved for a long duration for future identification of the causative organisms by special stains, immunocytochemical and other molecular biological studies. As far as we know, this is the first such report.

Intracavitary Hematoma Simulating Mycetoma Formation

This case report details the initial radiographic findings of a patient with mixed connective-tissue disease who presented with significant hemoptysis. Several radiographic findings suggested mycetoma formation, prompting appropriate antibiotic therapy; however, the rapid resolution and subsequent reappearance of the lesion on serial images pointed toward a diagnosis of hemorrhage into a preexisting cavity. Chest radiographic and computed tomographic findings commonly described as pathognomonic for the diagnosis of mycetoma are, in fact, nonspecific and can be simulated by several other entities that result in intracavitary masses. Familiarity with these radiographic "mimickers" of mycetoma will aid in avoiding misdiagnosis and unnecessary or improper invasive interventions when the appropriate clinical history and course of disease are appreciated.

Mycetoma in a Grand Eclectus (Eclectus roratus roratus) Parrot

A Grand Eclectus parrot with central nervous system disturbances and wing paralysis was necropsied. There were two grayish-black nodules in the upper left thoracic cavity and one nodule in the lower left lung. In addition, several nodules were present in the cerebral hemispheres and optic lobes. The cerebellum had extensive areas of granulomatous lesions. Microscopically, brown-staining hyphae were observed in the nodules. Curvularia geniculata was isolated from the lesions. A diagnosis of mycetoma was based on histologic lesions and isolation of fungus from the lesions.

Further studies on the diagnosis of mycetoma by double diffusion in agar

Antigens were prepared from four of the commonest organisms capable of causing mycetoma. By double diffusion in agar precipitating antibodies were demonstrated in all sera of humans (69) and animals (12) infected with these organisms. The antigens were entirely specific as between fungus and aerobic actinomycete, though there was cross reactivity between different species of the latter.

The value of gel diffusions in the diagnosis of mycetoma

Precipitating antibodies were demonstrated in 23 sera from natural human mycetoma and in 12 sera from mice experimentally infected with M. mycetomi. There were no cross reactions between actinomycetoma and maduromycetoma, and control sera were uniformly negative.

MYCETOMA IN AMERICA

Although mycetoma, or Madura foot, was described by Kaempfer 1 in 1712, its occurrence, or rather its recognition, in America is of quite recent date. Of the cases originating in this country, that described by Adami and Fitzpatrick 2 is probably the first. Their patient was a French Canadian, 21 years old, a native of Montreal who had never been outside of Canada. Parkes' patient 3 had previously resided in India, and in the case described by Kemper and Jameson 4 the course of the disease was so rapid and the pain so great that, in the absence of corroborative microscopic evidence, a diagnosis of mycetoma may safely be excluded. In the example reported by Hyde and Senn 5 the patient was a dental student, 20 years of age, a native and resident of Iowa. Artwine and Lamb's 6 case occurred in a Mexican laborer, 45 years old, and Pope