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Review
. 2017 Aug 24;11(8):e0005638.
doi: 10.1371/journal.pntd.0005638. eCollection 2017 Aug.

Mycetoma laboratory diagnosis: Review article

Affiliations
Review

Mycetoma laboratory diagnosis: Review article

Amel Altayeb Ahmed et al. PLoS Negl Trop Dis. .

Abstract

Mycetoma is a unique neglected tropical disease caused by a substantial number of microorganisms of fungal or bacterial origins. Identification of the causative organism and the disease extension are the first steps in the management of the affected patients and predicting disease treatment outcome and prognosis. Different laboratory-based diagnostic tools and techniques were developed over the years to determine and identify the causative agents. These include direct microscopy and cytological, histopathological, and immunohistochemical techniques in addition to the classical grain culture. More recently, various molecular-based techniques have joined the mycetoma diagnostic armamentarium. The available mycetoma diagnostic techniques are of various specificity and sensitivity rates. Most are invasive, time consuming, and operator dependent, and a combination of them is required to reach a diagnosis. In addition, they need a well-equipped laboratory and are therefore not field friendly. This review aims to provide an update on the laboratory investigations used in the diagnosis of mycetoma. It further aims to assist practising health professionals dealing with mycetoma by outlining the guidelines developed by the Mycetoma Research Centre, University of Khartoum, WHO collaborating centre on mycetoma following a cumulative experience of managing more than 7,700 mycetoma patients.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Photography showing the mycetoma triad of mass, multiple discharging sinuses, and black grains.
Fig 2
Fig 2. Photography of surgical biopsy showing a well-encapsulated eumycetoma lesion with numerous black grains.
Fig 3
Fig 3. KOH wet mount direct microscopic examination of M. mycetomatis grains showing its hyphal structure.
Fig 4
Fig 4. Photograph showing M. mycetomatis growth in Sabouraud agar media.
Fig 5
Fig 5. Photograph showing the fine-needle aspiration cytology collection technique.
Fig 6
Fig 6. Photomicrograph showing M. mycetomatis and inflammatory infiltrate in a cytological smear.
Haematoxylin and eosin x 40.
Fig 7
Fig 7. Photomicrograph showing a M. mycetomatis grain with a type I tissue reaction.
Haematoxylin and eosin x 10.
Fig 8
Fig 8. Photomicrograph showing M. mycetomatis and a type II tissue reaction.
Haematoxylin and eosin x 10.
Fig 9
Fig 9. Photomicrograph showing a type III tissue reaction.
Haematoxylin and eosin x 10.
Fig 10
Fig 10. Photomicrograph showing M. mycetomatis hyphae and cement substances that are positive for calcium stained with von Kossa stain.
Fig 11
Fig 11. Photograph showing a counterimmunoelectrophoresis test with positive bands.
Fig 12
Fig 12. Showing Lane 1 contain a 100 bp DNA ladder.
Lanes 2 to 4 show the PCR products for three samples which were negative for Madurella mycetomatis. Lane 5 to 8 shows the PCR products for four samples which were positive for Madurella mycetomatis. Lane 10 was a positive control; lane 11 was a negative control.
Fig 13
Fig 13. Flow chart for the diagnosis of mycetoma.

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