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Review
. 2014 Jul 3;8(7):e2918.
doi: 10.1371/journal.pntd.0002918. eCollection 2014 Jul.

Merits and pitfalls of currently used diagnostic tools in mycetoma

Affiliations
Review

Merits and pitfalls of currently used diagnostic tools in mycetoma

Wendy W J van de Sande et al. PLoS Negl Trop Dis. .

Abstract

Treatment of mycetoma depends on the causative organism and since many organisms, both actinomycetes (actinomycetoma) and fungi (eumycetoma), are capable of producing mycetoma, an accurate diagnosis is crucial. Currently, multiple diagnostic tools are used to determine the extent of infections and to identify the causative agents of mycetoma. These include various imaging, cytological, histopathological, serological, and culture techniques; phenotypic characterisation; and molecular diagnostics. In this review, we summarize these techniques and identify their merits and pitfalls in the identification of the causative agents of mycetoma and the extent of the disease. We also emphasize the fact that there is no ideal diagnostic tool available to identify the causative agents and that future research should focus on the development of new and reliable diagnostic tools.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Different grains obtained from eumycetoma and actinomycetoma lesions.
In this figure different grain types are shown. A: An eumycetoma surgical excision with numerous black grains, indicative for M. mycetomatis. B: An actinomycetoma surgical biopsy with numerous yellow grains, indicative for S. somaliensis. C: Grains of Madurella mycetomatis fixed in formalin. D: Histological slide of a Madurella mycetomatis grain inside subcutaneous tissue. The grain is clearly seen as a round brown structure (arrow) (×ばつ100). E: Histological slide of a S. somaliensis grain inside subcutaneous tissue (arrow) (×ばつ400).
Figure 2
Figure 2. Imaging techniques used in mycetoma.
A: A radiograph of the foot, showing soft tissue shadow (arrow), and multiple large cavities (c) in line with eumycetoma. B: A typical sonogram of scrotal eumycetoma. In this sonogram multiple cavities with thick walls and multiple hyper-reflective echoes (arrow) are seen, which are in line with grains. C: An MRI of the foot, showing massive soft tissue and bone destruction. In this MRI, grains appear as conglomerates of small (2–5 mm) round hyperintense lesions (arrow).
Figure 3
Figure 3. Obtaining grains via Fine Needle Aspiration.
Figure 4
Figure 4. Flow diagram of histological identification of causative agents of mycetoma, based on references , , .
Figure 5
Figure 5. Identifying mycetoma causative agents by culture.
A: Madurella mycetomatis grown on sabouraud agar. B: Microscopic appearance of Madurella mycetomatis stained with calcofluor white. C: N. brasiliensis colony. D: Microscopic appearance of N. brasiliensis.

References

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    1. Ahmed A, van de Sande WWJ, Fahal A, Bakker-Woudenberg IA, Verbrugh H, et al. (2007) Management of mycetoma: major challenge in tropical mycoses with limited international recognition. Curr Opin Infect Dis 20: 146–151. - PubMed
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