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Mycetoma is a serious chronic subcutaneous granulomatous inflammatory disease that is endemic in tropical and subtropical regions, where it impacts profoundly on patients, families, and communities. Individual-level risk factors for the disease are poorly understood. To address this, a case-control study was conducted based on data collected from 60 villages in Eastern Sennar Locality, Sennar State, Sudan. Based on the presence of swelling in any part of the body, or sinus formation with or without grain discharge evident from the lesion by ultrasound examination, we diagnosed 359 cases of mycetoma. For each case, we included three healthy sex-matched persons, with no evidence of mycetoma, from the same village as the control group (n = 1077). The odds for mycetoma were almost three times higher in individuals in the age group 16–30 years (Adjusted Odds Ratio (AOR) = 2.804, 95% CI = 1.424–5.523) compared to those in age group ≤ 15 years. Other factors contributing to the odds of mycetoma were history of local trauma (AOR = 1.892, 95% CI = 1.425–2.513), being unmarried (AOR = 3.179, 95% CI = 2.339–4.20) and owning livestock (AOR = 3.941, 95% CI = 2.874–5.405). In conclusion, certain factors found to be associated with mycetoma in this study could inform a high index of suspicion for mycetoma diagnosis, which would improve early case detection. Other factors found to be associated could inform the development of an interventional program for mycetoma control in Sudan, including education on healthy farming practices and the risks of puncture wounds for individuals residing in endemic areas. However, this work was conducted in one endemic state, while mycetoma cases occur in all states of Sudan. Replicating this study over a wider area would give a fuller picture of the situation, providing the control program with more comprehensive information on the risk factors for the disease.

Byline: Swarnava. Tarafdar, Periasamy. Kanimozhi, Sekar. Sabarish, Krishnan. Nagarajan, Devinder. Thappa, Chandrashekar. Laxmisha Sir, Mycetoma are localised chronic granulomatous infection of fungal origin, which can affect skin, subcutaneous tissue and [...]

Microsporum canis is a dermatophyte known to cause superficial skin infections. In immunocompromised patients, it can lead to invasive dermatophytosis. We present a case of biopsy‐proven left knee mycetoma caused by M canis in a renal transplant patient. Identification of M canis was achieved via sequencing of the internal transcribed spacer regions. Treatment involved surgical debridement, oral posaconazole, and reduction in immunosuppression. In addition, we provide a review of current literature on invasive M canis infections. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mycetoma is considered a neglected disease. It mainly affects the poor population working in the agriculture field. The majority of the cases are diagnosed in the medical unities of primary care. Only a few goes to the specialty's hospitals. OBJECTIVE: To investigate the frequency, type of mycetoma and other epidemiological characteristics of this disease in patients attending a high specialty hospital. MATERIALS AND METHODS: A retrospective, observational and analytic study of the mycology reports from Medical Mycology Laboratory of Specialties Hospital, National Medical Center Siglo XXI, Mexico City, was conducted from 1993 to 2016. RESULTS: Thirty-six cases of mycetoma were recorded: 25 actinomycetomas (22 Nocardia spp and 3 Actinomadura madurae) and 11 eumycetomas (9 dematiaceous fungi and 2 hyaline fungi). Thirty-four of the cases were men between 20 and 50 years old (94.4%). The majority of them were working in the agriculture field. Alcoholism of different level was detected in 100% of the patient as well as smoking in 50% of them. Generally, the patients with actinomycetoma had good therapeutical responses compared to the patients with eumycetoma whose response could only permit the slowdown of the disease spread. CONCLUSIONS: In Mexico, even in an advanced specialty hospital, the eumycetoma prognostic is poor due to the lack of antifungic sensitivity studies and of the special studies for rapid diagnostic like PCR and to the weak therapeutic answer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mycetoma is a chronic inflammatory syndrome acquired after exogenous traumatic inoculation of fungi or actinomycetes. Lactosylceramide (CD17) is a cellular receptor found in macrophages, granulocytes, T cells, and dendritic cells, once activated, it induces cell adhesion to bacteria and fungi with a function in phagocytosis, entrapment, motility, and cell proliferation. OBJECTIVE: To demonstrate the in situ presence of the lactosylceramide receptor in the inflammatory cells that surround the grain in human mycetomas, produced by Madurella mycetomatis, Nocardia brasiliensis and Actinomadura madurae. MATERIALS AND METHODS: Prospective study carried out from October 2019 to February 2020. Nine histopathological studies of patients diagnosed with mycetoma by M. mycetomatis, N. brasiliensis and A. madurae at the Dr. Manuel Gea González General Hospital (Mexico City). We performed two sections per sample: one for staining with hematoxylin and eosin, another for labeling lactosylceramide with anti-human CD17 IgM, and as secondary antibody IgG anti-IgM mouse FITC made in rabbit. RESULTS: A high number of CD17+ cells were observed in the mycetoma sections caused by A. madurae, followed with lower number in those caused by N. brasiliensis and M. mycetomatis, which showed the same frequency. CONCLUSIONS: CD17+ cells were found in all mycetomas studied, which can actively participate in the inflammatory response present in this syndrome. [ABSTRACT FROM AUTHOR]

The mycetoma is a granulomatous chronic disease, subcutaneous disease is the common presentation, very few cases are reported affecting central nervous system, but there are not cases in Renal Transplant (RT). [ABSTRACT FROM AUTHOR]

Abstract Background Mycetoma is a neglected infectious disease caused by a fungus (eumycetoma) or bacteria (actinomycetoma); it is characterized by chronic local inflammation with sinus formation and purulent discharge. Its course can be quite devastating because of the difficulty in diagnosing the infection and in eliminating the causative agent. Although endemic in many countries in the tropics and subtropics, the migration of Africans to Europe may increase the presence of this neglected disease in European countries. We present a case of an Eritrean patient living in a non-endemic country who was diagnosed as having an infection of Madurella mycetomatis in an atypical location in his body. Case presentation We report the case of a 35-year-old African male refugee from Eritrea, living in Switzerland since 2015, who presented with a 1-year history of a painful soft tissue swelling associated with dark nodules in his right buttock. He mentioned having several previous surgeries after 2001 while he was in Eritrea due to recurrent abscess formation on this body area. In the previous months, the swelling had become more significant and nodules started draining a purulent fluid. An initial diagnostic hypothesis of buttock abscess was made and he was referred to a dermatologist for diagnostic confirmation and further specialist care due to the size and atypical presentation. After a punch biopsy, the diagnosis of eumycetoma was confirmed and cultures developed Madurella mycetomatis. The initial treatment approach consisted of oral treatment by itraconazole; however, a surgical resection of the lesions was finally needed. Conclusions Although rare, mycetoma should be diagnosed as early as possible to avoid long-lasting complications. Primary care physicians in European countries are frequently in the first line of care of migrant patients and therefore should be aware of the common and uncommon clinical presentations of mycetoma.

INTRODUCTION: A typical presentation of Mycetoma is not uncommon although clinical manifestations might be misleading leading to delay in diagnosis, treatment and consequently leading to poor prognosis. Mycetoma can have a fungal or bacterial etiology and manifestation is usually that of a disfiguring subcutaneous infection that can affect any part of the exposed body. We are reporting a case of Mycetoma in an eleven years old girl that occurred in parts of the lower abdomen, perineum and gluteal region that was initially thought to be a soft tissue sarcoma or disseminated tuberculosis. CASE PRESENTATION: An eleven years old girl presented to Usmanu Danfodiyo University Teaching Hospital, Sokoto with lower abdominal mass and multiple nodular masses with discharging sinuses on the upper part of the right thigh, perineum and gluteal region of six months duration. Swellings started as multiple small boils that subsequently started discharging from various points. Patient usually fetches firewood in the forest for her parents as her routine house chores and she remembered an incident where she had pricks from thorns in the bush around her lower thigh and perineum. On examination she was chronically ill looking, in painful distress, with bilateral inguinal lymphadenopathy. She had nodular lesions of varying sizes ranging from 1x1cm to 4x4cm, tender, involving the upper part of the thigh bilaterally, but more on the right, lower abdomen, labia and gluteal region. Some of the lesions had hyper-pigmented sinuses discharging mucopurulent fluid, with areas of soft tissue swelling around the lower abdomen and upper right thigh extending to the leg. Patient was observed to walk with a limp gait. MANAGEMENT AND OUTCOME: An initial diagnosis of soft tissue infection to rule out soft tissue sarcoma and disseminated tuberculosis (abdomen and lymph nodes) and deep tissue mycosis was made. However, with further investigations and reviews by the medical microbiologist and anatomic pathologist, along with bacteriologic, and mycologic studies of swab samples and aspirate and tissue biopsy for Histology revealed an eumycotic mycetoma. She received Ketoconazole and Trimetoprim-sulphametoxazole. She responded significantly as lesions reduced in sizes, abdominal swelling and leg swelling reduced with closure of discharging sinuses. Patient could walk with some resolution of the limp. Repeat abdominal ultrasound scan showed resolution of initial findings. She spent four weeks in the hospital and was discharged. On subsequent follow-up; she was walking without any limp and lesions were healed with some scar and few areas left to dry up. Further follow-up visits after one month and three month showed progressive healing and complete resolution of lesion respectively. However. Patient was however lost to further follow-up which would have enabled monitoring as to any reoccurrence or not. CONCLUSION: We presented a case of a young girl with an abnormal presentation of eumycotic mycetoma. Patient achieved near cure on medications without the need of surgery due to an excellent multidisciplinary approach between pediatricians, clinicians, clinical microbiologists and anatomic pathologists.

Objectives To study the safety and efficacy of bronchial artery embolization (BAE) in patients with hemoptysis. Patients and methods This is a prospective study in which 19 patients with hemoptysis were recruited from the chest clinic and emergency room. Patients underwent transcatheter BAE in the Interventional Radiology Unit during the period November 2015 to July 2017. Results The causes of hemoptysis in our study included post-tuberculosis bronchiectasis, mycetoma, congenital bronchiectasis, bronchogenic carcinoma, tuberculosis bronchopneumonia, and vascular malformation. Technical success to catheterize the bronchial arteries was achieved in all cases. In all patients, hemoptysis stopped immediately after embolization, and no patient reported any attack of hemoptysis during the follow-up period, which was 1 year after embolization, except one patient in whom recurrence occurred after 6 months of gel-foam embolization (5.2%) and required a second session of embolization. Conclusion Hemoptysis of whatever cause could be controlled after BAE safely with low risk of recurrence.

Mycetoma, a chronic granulomatous disease more common in tropical countries such as India, has been conventionally diagnosed by invasive and time-consuming modalities like biopsy and microbiological culture. This case series aims to stress on the benefits of leveraging magnetic resonance imaging and ultrasonography in the early diagnosis of mycetoma, avoiding the invasive techniques and preventing debilitating complications that may develop from delay in diagnosis.

Abstract Background In this study, we share our experience of different operative techniques undertaken on 584 eumycetoma patients in the Gezira Mycetoma Center. Methods This is a retrospective, descriptive, hospital-based study, conducted to review the surgical treatment of eumycetoma patients. We included all patients diagnosed with eumycetoma who underwent a surgical operation in the center during January 2013–December 2016. Results A total number of 1654 patients were seen during the study period, and their records were revised, while 584 (35.3%) of them underwent an operation and included in the study. There was a male predominance 446 (76.4%). Surgical excision of mycetoma was the commonest operation performed among 513 (87.8%) patients in comparison with amputation 71 (12.2%). Below-knee amputation and toe amputation are the commonest types of amputation in 36 (6.1%) and 14 (2.3%) patients, respectively. Clinical features determining the type of operation performed included the size of the lesion, whether or not a bone was involved, and the feasibility of primary closure. A wide surgical excision (WSE) is performed mainly when the bone is not involved and when moderate or primary closure is possible or reconstruction is feasible. Amputations will typically follow identifying bone involvement, secondary infection, and an already disabled patient. Conclusion The commonest procedure in our series was WSE and primary skin closure undertaken when the lesion was small ( 10 cm) without bone involvement were treated with excision and flap/graft. Bone involvement and large primary lesions were more likely to be managed by amputation. Recurrent and relapse of mycetoma were observed in patients with bone involvements or presented with recurrent mycetoma for the second time.

Mycetoma, commonly known as Madura foot, is a chronic granulomatous infection caused either by fungi (eumycetoma) known as actinomycete. This disease occurs preferentially in young adults, and it affects the foot in particular. We report a Tunisian case of mycetoma occurring in an old patient, particular by its cystic presentation. [ABSTRACT FROM AUTHOR]

Background Currently there is a wide knowledge gap in our understanding of mycetoma epidemiological characteristics, including the infection route. Methods A cross-sectional descriptive epidemiological study was carried out to determine the role of exposure to animals and insects such as ticks in the transmission of eumycetoma in two adjacent villages at eastern Sudan. Results Significant differences were found between the two villages in the level of contact and exposure to animals and ticks, the percentages of people bitten by ticks, participation in cleaning animal pens and knowledge of the medical importance of ticks. In the village with a high mycetoma prevalence rate, there were high infestation rates of ticks in domestic animals. Hyalomma and Rhipicephalus species were the most prevalent species in houses with mycetoma patients and together they constituted 83% of the total collection. Pool screening of vectors for the detection of Madurella mycetomatis recombinant RNA genes showed one positive pool from Rhipicephalus evertsi following amplification of the universal fungal primer and one positive sample from Hyalomma rufipes following the use of a specific primer. Conclusion The findings indicate a possible role of ticks in the transmission of eumycetoma causative agents. However, further in-depth studies are needed to verify this. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic granulomatous disease that significant affects the subcutaneous tissue and deep structures. Mycetoma is caused by certain fungi (eumycetoma) or higher bacteria (actinomycetoma). The clinical presentation is variable and depends on the causative agent. For proper treatment and patient management, an accurate diagnosis of the species is mandatory. The disease mainly involves the extremities and it is rarely seen in the head and neck or other sites. In this communication, we present an interesting case of both invasive and aggressive mastoid bone eumycetoma caused by Madurella mycetomatis. Such cases are defied by complex challenges in finding effective surgical and medical treatments when the patient does not respond to both prolonged and different antifungal therapies. [ABSTRACT FROM AUTHOR]

Background Mycetoma is a unique neglected tropical disease caused by a substantial number of different fungi or bacteria. Many of the disease's epidemiological characteristics are an enigma. Hence, understanding the spatial geographic distribution of mycetoma may clarify the association between the local environmental indicators, the spatial geographical distribution of mycetoma and its epidemiology. Methods This study set out to determine the spatial geographical distribution of mycetoma in the Eastern Sennar locality, Sennar State, one of the highly endemic states in Sudan. It included 594 patients with confirmed mycetoma seen at the Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan, from 1991 to 2020. The spatial geographical distribution of these mycetoma patients was studied. The study area geographic information system data, which included geological, soil, temperature and land cover details, were collected in different geographic information forms. Different geographical analytical techniques were used. Results The patients' demographic characteristics were similar to those of the general characteristics of mycetoma patients in Sudan. Eumycetoma was the predominant type of mycetoma encountered in the studied patients. The data studied showed that most patients were located in the southern part of the locality along the Blue Nile river. The study showed an association between patients' spatial geographical distribution and soil types. Most patients' localities had light clay soil (475 patients [80%]), followed by sandy loam soil (79 [13%]) then loam soil (40 [6.71%]). Also, 85% of patients' localities had the same land cover and vegetation. There was no significant correlation between patients' localities with temperature or any other geological characteristic. Conclusion The present study showed certain associations between mycetoma spatial geographical distribution and certain environmental indicators. However, a further in-depth study to provide greater insight into the disease's epidemiological characteristics is needed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Species of the genus Microascus are uncommon agents of human diseases despite their ubiquitous presence in the environment. In this communication, the first case of white grain eumycetoma caused by the fungus Microascus gracilis is reported. The patient was initially misdiagnosed as having actinomycetoma based on the grains morphological and cytological features and was treated with antimicrobial therapy with no clinical improvement. She underwent wide local surgical excision to improve the response to medical treatment and further grain cultural, molecular and taxonomy techniques were conducted and the diagnosis of mycetoma due to M. gracilis was established. The antifungal susceptibilities of this isolate to nine drugs were tested in vitro and they showed poor activity. Combination therapy with surgery and itraconazole led to complete recovery. A medical literature search revealed no previous report on M. gracilis as a causative agent of eumycetoma and hence we are reporting this new causative agent of human eumycetoma. Also, the difficulty in the management of this patient emphasizes the need for accurate and appropriate diagnostic tests for the identification of mycetoma-causative organisms and thus proper management. [ABSTRACT FROM AUTHOR]

International collaboration on research on neglected tropical diseases (NTDs) is regarded as a norm, but it was not always so. This article is an account of a growing international collaboration on the diagnosis and treatment of mycetoma that started in Sudan in the 1960s and has grown and flourished up to the present day. [ABSTRACT FROM AUTHOR]

Background Mycetoma is a chronic, progressive and destructive inflammatory disease that affects the skin, subcutaneous and other tissues. The objective of this study was to identify all cases of mycetoma diagnosed in three health facilities in Nouakchott, Mauritania during 2016–2018. Methods This retrospective hospital-based study was conducted at the Dermatology, Orthopedics, Mycology and Pathology departments of the National Hospital Center of Nouakchott, the Military Hospital of Nouakchott and the National Institute for Research in Public Health of Nouakchott. Results Eighty-seven patients were included in this study. They comprised 65 male patients (74.71%) and 22 females (25.28%) with a gender ratio of 4:1. The mean age was 41.87 y and ages ranged from 14 to 70 y. The most common age group was 40–45 y (11%). The foot was the most frequently affected site seen in 60 patients (69%), followed by ankle and hand with 6 patients each (7%). In the study, 56 patients (64%) had regional lymphadenopathy. Forty-nine patients (56%) had bone involvement. Thirty-two patients (37%) had medical treatment. Twenty-seven patients (87%) received fluconazole and four patients (13%) had co-trimoxazole treatment. Conclusion The mycetoma patients seen in these three centres were mainly male farmers from rural areas. The lesions were seen mainly in the lower limbs and the majority had bone involvement radiologically. [ABSTRACT FROM AUTHOR]

The Community Dermatology Program established in the state of Guerrero, Mexico for almost 30 y provides an adaptable method of detecting and monitoring skin neglected tropical diseases such as mycetoma, which is endemic in the state. The program utilises general and thematic teaching elements combined with distance learning through teledermatology, direct patient consultations and close collaboration with community teams. Using this approach, a picture of mycetoma in Guerrero has emerged, with a focal hot spot located in the southern part of the state in the Costa Chica region. Although in much of Mexico Nocardia infections dominate, in this area there are also substantial numbers of cases of eumycetoma. This combined approach provides a means of early case detection and long-term surveillance through targeted use of a small specialist team. [ABSTRACT FROM AUTHOR]

In this communication, the Mycetoma Research Center (MRC), University of Khartoum, WHO Collaborating Center on Mycetoma, shares its experience in field surgery for mycetoma. The surgery was conducted in two mycetoma-endemic villages in Sennar and the White Nile States in collaboration with local health authorities, local community leaders, activists and civil society associations. In these villages, the local health centres were renovated and operating theatres were established. The medical and health missions' team was established at the MRC. The team conducted 15 missions over the period 2013–2020 and 1200 mycetoma patients received surgical treatment. These included wide local excisions, minor amputations and debridement that were conducted under spinal or ketamine analgesia. The missions adopted a community holistic management approach, which included medical and surgical treatment, health education sessions, village hygiene improvement and socio-economic support. The latter offered the mycetoma amputees artificial prosthesis and financial support. All these services were provided free of charge. This holistic approach proved to be effective for early case detection and management, optimal treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate decreased and this reduced the medical and socio-economic disease burdens on patients and families. This treatment approach needs the collaboration of all stakeholders for sustainability and quality improvement. [ABSTRACT FROM AUTHOR]

Background Eumycetoma is a chronic subcutaneous granulomatous disease that is endemic in Sudan and other countries. It can be caused by eight different fungal orders. The gold standard diagnostic test is culture, however, culture-independent methods such as imaging, histopathological and molecular techniques can support diagnosis, especially in cases of negative cultures. Methods The amplicon-based internal transcribed spacer 2 metagenomic technique was used to study black grains isolated from 14 tissue biopsies from patients with mycetoma. Furthermore, mycological culture and surgical biopsy histopathological examinations of grains were performed. Results Madurella mycetomatis (n=5) and Falciformispora spp. (n=4) organisms were identified by culture and confirmed by metagenomics. Metagenomics recognised, at the species level, Falciformispora as Falciformispora tompkinsii (n=3) and Falciformispora senegalensis (n=1), while in culture-negative cases (n=5), Madurella mycetomatis (n=3), Falciformispora senegalensis (n=1) and Fusarium spp. (n=1) were identified. Interestingly, the metagenomics results showed a 'consortium' of different fungi in each sample, mainly Ascomycota phylum, including various species associated with eumycetoma. The microbial co-occurrence in eumycetoma showed the co-presence of Madurella with Trichoderma, Chaetomium , Malasseziales and Sordariales spp. while Falciformispora co-presented with Inocybe and Alternaria and was in mutual exclusion with Subramaniula, Aspergillus and Trichothecium. Conclusion Metagenomics provides new insights into the aetiology of eumycetoma in samples with negative culture and into the diversity and complexity of grains mycobiota, calling into question the accuracy of traditional culture for the identification of causative agents. [ABSTRACT FROM AUTHOR]

Mycetoma is a chronic subcutaneous granulomatous disease of the soft tissue and extremities. Herein we report four cases of mycetoma caused by different agents, two caused by Madurella mycetomatis , with Actinomadura madurae and Streptomyces somaliensis affecting the others. These lesions originated at different sites but eventually spread to the inguinal region. The exact mechanism for such spread is still unknown and the clinical presentation of our case series was distinctive and required intensive follow-up for appropriate management. [ABSTRACT FROM AUTHOR]

Mycetoma is a recognised neglected tropical disease that for a long time has been accorded inadequate attention across the globe. It is a chronic destructive inflammatory disease caused by fungi (eumycetoma) or actinomycetes (actinomycetoma). Mycetoma treatment depends on an accurate and precise diagnosis. The cornerstone for proper disease diagnosis is identification of the causative organisms, but also critical for diagnosis and management planning is determination of its extent along and across tissue planes. An initial diagnosis is made after clinical assessment. Clinical examination alone does not identify the causative organism nor does it detect the spread of disease along the different tissue planes and bone. Imaging techniques, such as radiography, ultrasonography, computed tomography scan and magnetic resonance imaging can be used to determine the extent of lesions. In this communication, the Mycetoma Research Centre, World Health Organization Collaborating Centre on Mycetoma, University of Khartoum, presents its experience and recommendations on mycetoma diagnostic imaging. [ABSTRACT FROM AUTHOR]

Background Eumycetoma is a fungal infection characterised by the formation of black grains by causative agents. The melanin biosynthetic pathways used by the most common causative agents of black-grain mycetoma are unknown and unravelling them could identify potential new therapeutic targets. Method Melanin biosynthetic pathways in the causative fungi were identified by the use of specific melanin inhibitors. Results In Trematosphaeria grisea and Falciformispora tompkinsii , 1,8-dihydroxynaphthalene (DHN)-melanin synthesis was inhibited, while DHN-, 3,4-dihydroxyphenylalanine (DOPA)- and pyo-melanin were inhibited in Medicopsis romeroi and Falciformispora senegalensis. Conclusion Our data suggest that Me. romeroi and F. senegalensis synthesise DHN-, DOPA- and pyo-melanin, while T. grisea and F. tompkinsii only synthesise DHN-melanin. [ABSTRACT FROM AUTHOR]

Mycetoma is a neglected tropical disease that causes tremendous suffering and misery to affected patients. In Sudanese rural communities, many patients hide their lesions, especially those located in the perineal, scrotal, inguinal and genital regions, and they regard them as sources of social stigma. We report the case of a 45-year-old male from northern Kordofan State, Sudan, who presented with multiple discharging sinuses in the perineal region. Clinical diagnosis was actinomycetoma and fine-needle aspiration cytology was consistent with Actinomadura pelletieri , confirmed by culture and biochemical analysis. To our knowledge, this is the first case of A. pelletieri with urethral complications and subsequent implications for management. [ABSTRACT FROM AUTHOR]

In this communication, we report on the first-ever patient presenting with 17 lesions of Madurella mycetomatis eumycetoma in different parts of the body. The reported patient is a 15-y-old female who presented to the Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan, in 2017 with recurrent back and anterior abdominal wall eumycetoma lesions. They were surgically excised, and during the course of follow-up, she developed 15 other eumycetoma lesions, scattered mostly on her upper and lower limbs and gluteal region. The diagnosis of Madurella mycetomatis was confirmed by molecular identification of grains and culture, histopathological examination and ultrasound examination. The cause and the explanation of such a presentation in puzzling; it is not due to multiple subcutaneous implantations because of the lack of history of relevant local trauma. Lymphatic spread is unlikely as the distribution of the lesions is not in line with this. Haematogenous spread is a possible explanation. This rare presentation of eumycetoma poses a great challenge for diagnosis and management. [ABSTRACT FROM AUTHOR]

The Global Mycetoma Working Group (GMWG) was formed in January 2018 in response to the declaration of mycetoma as a neglected tropical disease (NTD) by the World Health Assembly. The aim of the working group is to connect experts and public health practitioners around the world to accelerate mycetoma prevention activities and reduce the impact of mycetoma on patients, healthcare providers and society in the endemic regions. The working group has made tangible contributions to mycetoma programming, awareness and coordination among scientists, clinicians and public health professionals. The group's connectivity has enabled rapid response and review of NTD documents in development, has created a network of public health professionals to provide regional mycetoma expertise and has enabled mycetoma to be represented within broader NTD organizations. The GMWG will continue to serve as a hub for networking and building collaborations for the advancement of mycetoma clinical management and treatment, research and public health programming. [ABSTRACT FROM AUTHOR]

Background Mycetoma patients frequently present with advanced disease, the cause of which is multi-factorial, but the use of traditional medicine modalities has been shown to be an important one. Traditional medicine is an integral part of the Sudanese culture and many mycetoma patients revert to it because it is accessible, cheap and available. Methods To confirm this anecdotal observation, the pattern and characteristics of traditional medicine use among a group of mycetoma patients seen at the Mycetoma Research Center in Khartoum, Sudan, were studied. Results In this descriptive, cross-sectional, hospital-based study, 389 mycetoma-confirmed patients were included. All of them had used traditional medicine at some stage of their mycetoma treatment. Among them, 66% had first consulted traditional healers for mycetoma treatment. In this study, 58% had consulted religious healers known as fakis, while the majority (72%) of those who consulted specialist healers had consulted herbalists. The most frequent type of traditional medicine received by patients from religious healers was al-azima (31%) and the most common treatment given by the specialist healers was herbal medicine (46%). Conclusion Traditional medicine can lead to a delay in seeking medical care and serious complications. Collaboration with traditional healers, and training and educating them to refer mycetoma patients to specialised centres is vital to ensure that they receive proper treatment in a timely and efficient manner. [ABSTRACT FROM AUTHOR]

Nocardia africana is a recently identified organism and has rarely been reported to cause mycetoma. Here we report the case of a 40-year-old woman who presented with discharging sinuses and nodules for the past 7 years along with few discrete axillary lymph nodes. Cultures and Maldi-TOF MS (Matrix-assisted laser desorption/ionization–time of flight mass spectrometry) method identified the causative organism as Nocardia africana/nova. The organism was acid-fast positive on modified Ziehl-Neelsen stain and Gram's stain revealed branched filamentous beaded gram-positive bacilli, while histopathology showed granulation tissue along with few ill-defined epithelioid cell granulomas, with giant cells. Based on the sensitivity report, the patient was started on tablet moxifloxacin and cotrimoxazole, and has shown considerable improvement at 2.5 months of follow-up. [ABSTRACT FROM AUTHOR]

Context: Mycetoma is a chronic, granulomatous disease caused by fungi (eumycetoma) or aerobic filamentous actinomycetes (actinomycetoma). Actinomadura madurae is one of the most frequent actinomycetes. Aim: The study aims to provide an update on clinical, diagnostic, therapeutic, and outcome data for patients with actinomycetoma in a single center in Mexico. Settings and Design: This was a retrospective study of 47 cases diagnosed with actinomycetoma. Subjects and Methods: The cases were selected from a total of 536 mycetoma obtained during 35 years (from 1985 to 2019). Clinical data were retrieved from the clinical records of our department. Microbiological data were obtained from our Mycology laboratory. Statistical Analysis: Frequencies and percentages were used for categorical variables. Normality was determined with the Kolmogorov–Smirnov test. We used means and medians to describe the variables. Results: Forty-seven patients with actinomycetoma were included; female:male ratio 1.9:1; median age 38 years. The foot was the most affected region in 76.5% of cases. The bone invasion was observed in 89%. The time between symptoms onset and diagnosis was 5.5 years. Grain detection by direct examination was positive in 95% of cases. The most commonly used, as well as the most effective treatment scheme was streptomycin + sulfamethoxazole-trimethoprim with dapsone. Sixty-three percent (30 patients) achieved clinical and mycological cure, and 10.6% (5 patients) had treatment failure. Conclusions: We highlight the importance of designing therapeutic strategies to standardize treatments and gain more experience to improve the care of these patients. [ABSTRACT FROM AUTHOR]

Functional endoscopic sinus surgery (FESS) is a treatment of choice for fungal sinus ball (mycetoma), which is considered safe with a very low major complication rate. We present an unusual case of a 12-year-old female, who underwent FESS for a sphenoid sinus mycetoma and which was complicated by an acute, compressive epidural fluid collection. This presumably resulted from sinus irrigation in the setting of an under-appreciated skull base and mucosal defects causing a ball-valve effect. Our patient had a temporary neurologic deficit with complete recovery, however, similar complications can have fatal consequences. [ABSTRACT FROM AUTHOR]

Invasive fungal sinusitis often occurs in patients with immune deficiency. We can group fungal sinusitis under 4 groups. Invasive forms: 1-Acute (Fulminant) 2-Chronic (Indolent). Non-invasive forms are 3-Mycetoma and 4- Allergic fungal sinusitis..Invasive fungal sinusitis is generally seen in immunocompromised patients. Diabetes mellitus and leukemia are the most common underlying pathologies, respectively. Delayed diagnosis and inadequate treatment can be mortal, especially for invasive forms. In this case report, the management of a patient with invasive fungal sinusitis, who was referred to us due to unilateral preseptal edema developing during hospitalization for diabetic ketoacidosis treatment, is presented in the light of the current literature. [ABSTRACT FROM AUTHOR]

Nocardiosis is an uncommon infection caused by Nocardia species, a group of aerobic actinomycetes. Nocardiosis may affect immunocompromised or immunocompetent patients and as this case was affected by a rare disorder, we describe it in this study. This paper describes a case of nocardial mycetoma from a hospital affiliated to Shiraz University of Medical Sciences. The case was a 52-year-old man with diabetes mellitus, who was admitted to our institution with a 5-year history of right lower extremity swelling with multiple discharging sinuses localized in distal part of the leg and dorsum of the foot following a penetrating injury to the affected foot. The wound culture yielded the growth of Nocardia species after incubation. Nocardiosis should be considered in the differential diagnosis of skin lesions, especially if patients have a history of trauma or contact with soil-contaminated materials. Our reported case increases knowledge about this rare, sporadic infection in our country. [ABSTRACT FROM AUTHOR]

Background: The therapeutic strategy for mycetoma relies heavily on the identification of the causative agents, which are either fungal or bacterial. While histopathological examination of surgical biopsies is currently the most used diagnostic tool, it requires well-trained pathologists, who are lacking in most rural areas where mycetoma is endemic. In this work we propose and evaluate a machine learning approach that semi-automatically analyses histopathological microscopic images of grains and provides a classification of the disease as eumycetoma or actinomycetoma., Methods: The computational model is based on radiomics and partial least squares. It is assessed on a dataset that includes 890 individual grains collected from 168 patients originating from the Mycetoma Research Centre in Sudan. The dataset contained 94 eumycetoma cases and 74 actinomycetoma cases, with a distribution of the species among the two causative agents that is representative of the Sudanese distribution., Results: The proposed model achieved identification of causative agents with an accuracy of 91.89%, which is comparable to the accuracy of experts from the domain. The method was found to be robust to a small error in the segmentation of the grain and to changes in the acquisition protocol. Among the radiomics features, the homogeneity of mycetoma grain textures was found to be the most discriminative feature for causative agent identification., Conclusion: The results presented in this study support that this computational approach could greatly benefit rural areas with limited access to specialized clinical centres and also provide a second opinion for expert pathologists to implement the appropriate therapeutic strategy., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Surgical treatments of mycetoma are a cornerstone in management. However, while doing a wide surgical excision of mycetoma lesion, surgeons think about how to close the skin defect, which can be closed primarily, left to heal by secondary intension, by skin grafts or local flaps. In this review, we demonstrate the various applications and changes of mycetoma reconstruction after surgical excision., Methods: This is a systematic literature search and review conducted to determine articles presenting mycetoma reconstruction options. Articles were identified, and the time of publication, type of study, time of study, and country of study were checked. Additionally, all patients in those articles were included. Patients' names, sex, clinical presentation, and management were identified., Results: A total number of 9 articles fulfilled our inclusion criteria; 8 of them are case reports, and 1 is a case series. The first mycetoma reconstruction case was published in 1959. The country of publication varies from tropical and non-tropical countries. The total number of patients found in those articles is 34 patients, most of whom are male. The causative organism is mainly eumycetoma. The site of mycetoma lesions is varied with variable sizes. The reconstruction options used were skin graft and local or regional flaps, where only 1 case underwent a free flap for reconstruction., Conclusion: Reconstruction of mycetoma should be considered following mycetoma surgery in small or large size defects if skin closure is not feasible and there is no indication for amputation., Competing Interests: The authors declare no competing interests., (© 2024 The Author(s).)

Madura foot, relatively easy to diagnose in tropical countries, is very rare and unrecognized in Morocco, causing diagnostic delays. We present the case of a 54-year-old patient with mycetoma for 3 years who initially consulted two general practitioners, then an endocrinologist and finally a dermatologist in order to be diagnosed correctly. The diagnosis of mycetoma based on biological criteria was established at a late stage of irreversible bone lesions; requiring amputation by the orthopedic team. Mycetomas are fungal or bacterial. Delays in diagnosis and care are frequent in Morocco. The diagnosis is based on biology; however, radiological examinations are necessary to assess the extension. The initial treatment is medicinal. Surgery takes place in late stages.

A60-year-old man came to the orthopedics department with swelling of the entire right foot with multiple painful nodules, which oozed pus and blood intermittently for 25 years [Figure 1]. This caused disability and daily limitations to his lifestyle. He had presented with this complaint several times and was referred to a tertiary care center. Examination of the foot showed a swollen foot and ankle with multiple subcutaneous nodules and draining sinuses.

Skin disease is a common illness in most tropical regions where the pattern of clinical, presentations is dominated by infections. Along with common diseases such as pyodermas and fungal infections, a group of conditions known collectively as the neglected tropical diseases of the skin or Skin NTDs, which are the targets for worldwide control or elimination are also seen in health care facilities. These diseases range from the common, such a scabies, to those that are less frequent including leprosy and mycetoma. The initiative to use skin presentations of tropical diseases as a route to diagnosis by front line health workers is both logical and welcome. However, this requires training and monitoring and as the work gets under way, it is critically important that time invested in this programme is backed by firm and lasting commitment at regional and national levels.

Mycetoma, formerly known as Madura foot, is a chronic, localized, gradually increasing in size, granulomatous exogenous infection of the skin and subcutaneous tissue with risks of bone and visceral involvement. It is unevenly found worldwide but it is endemic in tropical and subtropical countries. Two groups of mycetoma exist with similar clinical presentation; eumycetoma due to true fungi, and actinomycetoma due to aerobic bacteria from actinomycomycetes species. Mycetoma is difficult to treat and can lead to serious sequelae including disability, deformity and even death, so early diagnosis and treatment can elicit good results. The diagnosis is made based on a clinical picture of a triad of painless tumefaction, draining sinuses and granules of the causative micro-organism along with direct microscopic examination and histological study. It is very important to distinguish between actinomycetoma and eumycetoma for selecting the therapy. Actinomycetomas generally respond well to antimicrobials compared with eumycetomas, which respond poorly and need a combination of medical and surgical therapy. Bone involvement makes treatment more difficult, keeping surgical amputation as the only choice of treatment. Despite the possibility of a cure with medical treatment alone, treatment failure may occur even with long-term therapy, which necessitates adding surgical intervention to achieve cure. We report a case of gluteal actinomycetoma in an Omani man, treated successfully by combined medical treatment and surgical excision with graft reconstruction after failure of different regimens of antimicrobials.

Mycetoma is a progressive destructive disease causing severe disability, if untreated, in otherwise healthy people. Susceptible populations are usually adult males and disease is characterized by the triad of tumor formation, presence of grains and draining sinuses. Here, we report a case of mycetoma of a young female, manifested only as a painful swelling over left ankle which was initially suspected as a malignancy. The preliminary diagnosis of mycetoma came with the presence of characteristic “dot in circle” sign in radiological evaluation which was confirmed by the positive fungal culture of 2nd biopsy for M. mycetomatis.

Abstract Background Mycetoma is a chronic mutilating disease of the skin and the underlying tissues caused by fungi or bacteria. Although recently included in the list of neglected tropical diseases by the World Health Organization, strategic control and preventive measures are yet to be outlined. Thus, it continues to pose huge public health threat in many tropical and sub-tropical countries. If not detected and managed early, it results into gruesome deformity of the limbs. Its low report and lack of familiarity may predispose patients to misdiagnosis and delayed treatment initiation. More so in situation where diagnostic tools are limited or unavailable, little or no option is left but to clinically diagnose these patients. Therefore, an overview of clinical course of mycetoma, a suggested diagnostic algorithm and proposed use of materials that cover the exposed susceptible parts of the body during labour may assist in the prevention and improvement of its management. Furthermore, early reporting which should be encouraged through formal and informal education and sensitization is strongly suggested. Main text An overview of the clinical presentation of mycetoma in the early and late phases, clues to distinguish eumycetoma from actinomycetoma in the field and the laboratory, differential diagnosis and a suggested diagnostic algorithm that may be useful in making diagnosis amidst the differential diagnosis of mycetoma is given. Additionally, a proposed preventive measures which may be helpful in the community is also provided. Since treatment is currently based on expert opinion, we encourage active research to establish treatment guideline for it. Conclusion Since delay in visiting health facility results into gruesome complication, early presentation, recognition and initiation of appropriate choice of regimen is helpful in reducing complications. The clinical overview of mycetoma and the suggested algorithm may enhance suspicion and possibly increase recognition of mycetoma in the community and further guide in differentiation of eumycetoma from actinomycetoma. There is an urgent need for research funding for mycetoma, a disease plagued by severe physical disabilities and social stigma leading to isolation.

This case report is of a 40 years old male who came with symptoms and radiological signs of lung cancer (i.e. hyper dense soft tissue mass of lung without Monad's sign an increase in size of the mass from 4 cm st nd to 5.8cm compared on the 1 and 2 CT scan and associated multiple enlarged mediastinal lymph nodes but was diagnosed preoperatively with Mycetoma.