Mycetoma in a non-endemic area: a diagnostic challenge

Abstract

BackgroundMycetoma is a chronic granulomatous infectious disease caused by filamentous bacteria or by fungi. The disease is endemic in certain tropical and subtropical areas of the world but can be found elsewhere posing sometimes a diagnostic challenge for clinicians.Case presentationA 65-year- old man presented with a right foot swelling evolving for 25 years. During that time, several diagnosis and treatments have been made without any improvement. The disease spread to bones, and misdiagnosed as Kaposi’s sarcoma. Transtibial amputation has been performed, and the histopathological examination revealed finally the diagnosis of eumycotic mycetoma. The patient recovered well after surgery and orthopedic prosthesis was prescribed for him.ConclusionMycetoma in non endemic areas is usually misdiagnosed and mismanaged leading to unnecessary and inappropriate surgery. Health practitioners should be aware of that fact in order to provide an accurate management.

Epitope - based peptide vaccine againstFructose-bisphosphate aldolase (FBA)ofMadurella mycetomatisusing immunoinformatics approaches

“…The protein length was found to be 363 amino acids and the molec weight was 39675.83 Daltons. The amino acid that formed FBA protein and their number along with t molar percentage (Mol%) were shown in table (4).…”

“…It is widely spread within people who had lived in rural areas and had worked in the farms due to their frequent contact to/with organisms, which have saprobiotic life in soil. In other hand, man to man infection does not occur [4] . There are no ideal diagnostic tools available to identify mycetoma and the identification of the etiological agent is a very challenging issue that reflects directly on the treatment, especially in non-endemic areas [9,12] .…”

Mycetoma: a clinical dilemma in resource limited settings

“…This is probably due to insufficient awareness of its existence as a consequence of low recognition and reporting [ 4 ] as it is not a reportable disease [ 10 ]. This situation may predispose patients to misdiagnosis [ 11 ] and eventual mistreatment [ 12 ] in a scenario where limitation of diagnostic tools prevails, and health personnels are left handicapped with little or no option but to clinically diagnose the patients [ 13 ]. Mycetoma still faces additional challenges such as lack of standardized treatment and strategic public health control guidelines by the World Health Organization (WHO) making its management to be exclusively based on physician’s discretion.…”

Epitope-Based Peptide Vaccine Against Fructose-Bisphosphate Aldolase of Madurella mycetomatis Using Immunoinformatics Approaches

“… 1 , 2 Mycetoma is endemic in many tropical and subtropical countries; these regions are referred to as the “mycetoma belt” that lies between 15° S and 30° N of the equator. 3 – 6 Sudan is considered as one of the most affected regions by this disease; furthermore, 70% of the prevalent causes of mycetoma is related to M. mycetomatis . 2 , 5 , 6 The disease characterized by chronic subcutaneous masses, large tumor-like swellings, multiple draining sinuses, discharge grains, blood, and pus; while the recurrent infection may lead to amputation.…”

“…On other hand, man-to-man infection does not occur. 4 There are no ideal diagnostic tools available to identify mycetoma and the identification of the etiological agent is a very challenging issue that reflects directly on the treatment, especially in non-endemic areas. 8 , 9 The laboratory-based diagnostic tools and techniques of mycetoma detection include direct microscopy and cytological, histopathological, classical grain culture and immunohistochemical, molecular-based methods recently have joined the mycetoma diagnostic armamentarium.…”