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. 2015 Mar 27;9(3):e0003679.
doi: 10.1371/journal.pntd.0003679. eCollection 2015 Mar.

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

Affiliations

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

Ahmed Fahal et al. PLoS Negl Trop Dis. .

Abstract

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%).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Showing massive foot eumycetoma with multiple sinuses and discharge with black grains.
Fig 2
Fig 2. Showing massive hand and forearm eumycetoma with massive deformity.
Fig 3
Fig 3. Showing massive back and gluteal eumycetoma.
Fig 4
Fig 4. Showing massive anterior abdominal wall, perineal, vulval and upper thigh actinomycetoma
Fig 5
Fig 5. Showing knee region X-ray with type finding of eumycetoma; soft tissue mass, periosteal reaction of the lower part of the femur, patella and upper tibia and multiple bone cavities in the upper part of the tibia.
Fig 6
Fig 6. Microphotograph showing many Actinomadura pelletieri grains surrounded by multi-inflammatory cells.
H&E X 200.
Fig 7
Fig 7. Showing the ultrasound appearance of eumycetoma lesion with numerous grains producing numerous and sharp hyper-reflective echoes.
There are multiple thick-walled cavities with no acoustic enhancement.
Fig 8
Fig 8. Showing hand MRI with an extensive eumycetoma lesion infiltrating and obliterating the subcutaneous tissue planes.
There are multiple low signal intensity fungal grains, bone marrow oedema, and a dot-in-circle sign.
Fig 9
Fig 9. Showing a thorn with vesicular structures and a black pigment of M. mycetomatis removed surgically from one patient (H&EX200).

References

    1. Fahal AH. (2004) Mycetoma thorn on the flesh. Trans R Soc Trop Med Hyg. 98(1):3–11. - PubMed
    1. Fahal AH, Hassan MA. (1992) Mycetoma. Br J Surg. 79(11): 1138–1141. - PubMed
    1. Bonifaz A, Tirado-Sánchez A, Calderón L, Saúl A, Araiza J, et al. (2014) Mycetoma: experience of 482 cases in a single center in Mexico. PLoS Negl Trop Dis. 21; 8(8):e3102 doi: 10.1371/journal.pntd.0003102. e Collection 2014 - DOI - PMC - PubMed
    1. Ahmed AO, van Leeuwen W, Fahal A, van de Sande W, Verbrugh H, et al. (2004) Mycetoma caused by Madurella mycetomatis: a neglected infectious burden. Lancet Infect Dis. 4(9):566–74. - PubMed
    1. Ahmed AOA, van de Sande WW, Fahal A, Bakker-Woudenberg I, Verbrugh H, et al. (2007) Management of mycetoma: major challenge in tropical mycoses with limited international recognition. Curr Opin Infect Dis. 20(2):146–51. - PubMed

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