Surgical management of eumycetoma: experience from Gezira Mycetoma Center, Sudan

Gismalla, Mohamed Daffalla Awadalla; Ahmed, Gamal; MohamedAli, Mogahid M.; Taha, Sami Mahjoub; Mohamed, Thouria A.; Ahmed, Ahmed E.; Hamed, Lamia S.

doi:10.1186/s41182-018-0129-2

Cited by 16 publications

(19 citation statements)

References 13 publications

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“…For actinomycetoma, this consists of long-term combination antibiotic treatment, given in cycles [ 17 ]. Eumycetoma responds poorly to the few effective medical therapies that exist, so surgical treatment is common [ 18 ]; amputation is a last resort [ 19 ]. Antibiotics and antifungals effective in the treatment of mycetoma are included in the WHO Model List of Essential Medicines [ 20 ], but the long duration of treatment [ 8 ] and monitoring [ 16 ] means they may be prohibitively expensive [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

The global distribution of actinomycetoma and eumycetoma

Emery

Denning

2020

PLoS Negl Trop Dis

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Background Mycetoma, a chronic infection of the skin and underlying structures, affects those with a close relationship to the land, often in resource-poor areas of the world. Whether caused by any one of a variety of fungus or bacteria, mycetoma causes significant disability and mortality. Acknowledged as a neglected tropical disease (NTD) by the World Health Organization (WHO) in 2016, mycetoma is susceptible to being misunderstood, misdiagnosed, and mismanaged. In an effort to shift the balance in favor of recognition and effective treatment, sound epidemiological understanding is required. Methods and findings In this paper, a literature review of case reports and series (332 papers in total) is presented as three maps. We identified 19,494 cases dating from 1876 to 2019, with cases contracted in 102 countries. The first map shows where mycetoma has ever been reported, the second shows how many cases have been reported, and the third shows the ratio of eumycetoma (fungal) to actinomycetoma (bacterial). Most cases are found in Mexico, India, and Sudan, where mycetoma is studied rigorously. We identified emergence of new geographical loci, including the United States, Venezuela, Italy, China, and Australia. Notably, mycetoma is reported far outside the tropics. In the Americas, bacterial forms dominate, whereas, in Africa and Asia, the picture is more varied. Conclusions With better understanding of the epidemiology of mycetoma, more can be done to direct education, preventive measures, and treatment to at-risk areas, enabling a reduction in disease burden.

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Section: Introductionmentioning

confidence: 99%

The global distribution of actinomycetoma and eumycetoma

Emery

Denning

2020

PLoS Negl Trop Dis

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“…Therefore, surgery is recommended as the best treatment option of eumycetoma. The surgical treatments ranges from broad surgical excision to limb amputation [7,8].…”

Section: Introductionmentioning

confidence: 99%

Mycetoma epidemiology, diagnosis management, and outcome in three hospital centres in Senegal from 2008 to 2018

Sow¹,

Ndiaye

Sarr

et al. 2020

PLoS ONE

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Mycetoma is a neglected tropical disease caused by various actinomycetes or fungi. The disease is characterized by the formation of tumor like-swellings and grains. Senegal is an endemic country where mycetoma cases are under-or misdiagnosed due to the lack of capacities and knowledge among health workers and the community; and where the management of eumycetoma, burdened by a high amputation rate, is currently inadequate. This study aimed to update data on the epidemiology of mycetoma cases diagnosed in three hospital centres in Senegal over a 10 years-period. A total of 193 patients, diagnosed from 2008 to 2018, were included in the study. The most frequent presentation was eumycetoma (47.2%); followed by actinomycetoma (36.8%); it remained undetermined in 16.1% of the patients. The mean age was 38.3 years (68.4% of the patients were between 15 and 45 years-old); the male: female ratio was a 2.94; and most were farmers. One hundred fifty-six (80.8%) patients had used phytotherapy before attending the hospital. Mycetoma was mainly located to the lower limbs (91.2%). Grains were observed in 85% of the patients; including white (25.6%) and yellow (4.3%) grains. The etiological diagnosis was complex, resulting in negative direct microscopy, culture and/or histopathology findings, which explains that 16.1% remained uncharacterized. In most of cases, actinomycetoma were treated with a combination of cotrimoxazole, amoxicillin/clavulanic acid, and streptomycin; whereas eumycetoma cases were treated with terbinafine. The surgery was done in 100 (51.8%) of the patients including 9 in actinomycetoma, 78 in eumycetoma and 13 in undetermined form. The high number of uncharacterized mycetoma in this study, the delay in attending a qualified health-care facility, and the lack of available adequate antifungal drug, point out the need to strengthen mycetoma management capacities in Senegal.

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“…During the period January 2013 to December 2016, a total of 1,654 patients were seen at the Gezira Mycetoma Center; of them, 584 underwent surgery, including amputation in 71 patients (12.2%). Diagnoses were made by clinical evaluation, imaging, fine-needle aspiration cytology and histology [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

The genus Madurella: Molecular identification and epidemiology in Sudan

et al. 2020

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Eumycetoma (mycotic mycetoma) is the fungal form of mycetoma, a subcutaneous infection occurring in individuals living in endemic areas of the disease. The Sudan is hyperendemic for mycetoma, with the highest incidence being reported from Gezira State, Central Sudan. The present study was conducted at the Gezira Mycetoma Center and aimed to determine the cause of black-grain eumycetoma in the state and describe its epidemiology. Blackgrain specimens were collected during the surgical operation and direct detection of the causative agent was performed using M. mycetomatis species-specific PCR and ITS PCR followed by sequencing. Black-grain was reported from 93.3% of all confirmed mycetoma cases (n = 111/119), with a prevalence in young males. Of the 91 samples subjected to direct PCR, 90.1% (n = 82) gave positive results. The predominant species (88.2%) was Madurella mycetomatis. One sample was identified as M. fahalii, one as M. tropicana, and one matched the phytopathogenic species Sphaerulina rhododendricola. The highest endemic zones were Southern Gezira (76.6%) and Northern Sinnar (23.4%). The study confirmed that direct molecular detection on grains provides rapid and specific diagnosis of agents of eumycetoma.

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Surgical management of eumycetoma: experience from Gezira Mycetoma Center, Sudan

Cited by 16 publications

References 13 publications

The global distribution of actinomycetoma and eumycetoma

The global distribution of actinomycetoma and eumycetoma

Mycetoma epidemiology, diagnosis management, and outcome in three hospital centres in Senegal from 2008 to 2018

The genus Madurella: Molecular identification and epidemiology in Sudan

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