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Ahmed H. Fahal - One of the best experts on this subject based on the ideXlab platform.
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Mycetoma imaging: the best practice.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2021Co-Authors: Mustafa Elnour Bahar, Osama E L Hadi Bakheet, Ahmed H. FahalAbstract:Mycetoma is a recognised neglected tropical disease that for a long time has been accorded inadequate attention across the globe. It is a chronic destructive inflammatory disease caused by fungi (euMycetoma) or actinomycetes (actinoMycetoma). Mycetoma treatment depends on an accurate and precise diagnosis. The cornerstone for proper disease diagnosis is identification of the causative organisms, but also critical for diagnosis and management planning is determination of its extent along and across tissue planes. An initial diagnosis is made after clinical assessment. Clinical examination alone does not identify the causative organism nor does it detect the spread of disease along the different tissue planes and bone. Imaging techniques, such as radiography, ultrasonography, computed tomography scan and magnetic resonance imaging can be used to determine the extent of lesions. In this communication, the Mycetoma Research Centre, World Health Organization Collaborating Centre on Mycetoma, University of Khartoum, presents its experience and recommendations on Mycetoma diagnostic imaging.
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Development of the Global Mycetoma Working Group.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2020Co-Authors: Rita M. Traxler, Wendy Van De Sande, Ahmed H. Fahal, Karlyn D. Beer, David D. Blaney, Kingsley Asiedu, William A. Bower, Tom ChillerAbstract:The Global Mycetoma Working Group (GMWG) was formed in January 2018 in response to the declaration of Mycetoma as a neglected tropical disease (NTD) by the World Health Assembly. The aim of the working group is to connect experts and public health practitioners around the world to accelerate Mycetoma prevention activities and reduce the impact of Mycetoma on patients, healthcare providers and society in the endemic regions. The working group has made tangible contributions to Mycetoma programming, awareness and coordination among scientists, clinicians and public health professionals. The group's connectivity has enabled rapid response and review of NTD documents in development, has created a network of public health professionals to provide regional Mycetoma expertise and has enabled Mycetoma to be represented within broader NTD organizations. The GMWG will continue to serve as a hub for networking and building collaborations for the advancement of Mycetoma clinical management and treatment, research and public health programming.
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The use of traditional medicines among Mycetoma patients.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2020Co-Authors: Ezzan Saeed Mohamed Kunna, Taro Yamamoto, Ahmed H. FahalAbstract:Background Mycetoma patients frequently present with advanced disease, the cause of which is multi-factorial, but the use of traditional medicine modalities has been shown to be an important one. Traditional medicine is an integral part of the Sudanese culture and many Mycetoma patients revert to it because it is accessible, cheap and available. Methods To confirm this anecdotal observation, the pattern and characteristics of traditional medicine use among a group of Mycetoma patients seen at the Mycetoma Research Center in Khartoum, Sudan, were studied. Results In this descriptive, cross-sectional, hospital-based study, 389 Mycetoma-confirmed patients were included. All of them had used traditional medicine at some stage of their Mycetoma treatment. Among them, 66% had first consulted traditional healers for Mycetoma treatment. In this study, 58% had consulted religious healers known as fakis, while the majority (72%) of those who consulted specialist healers had consulted herbalists. The most frequent type of traditional medicine received by patients from religious healers was al-azima (31%) and the most common treatment given by the specialist healers was herbal medicine (46%). Conclusion Traditional medicine can lead to a delay in seeking medical care and serious complications. Collaboration with traditional healers, and training and educating them to refer Mycetoma patients to specialised centres is vital to ensure that they receive proper treatment in a timely and efficient manner.
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Host genetic susceptibility to Mycetoma.
PLoS neglected tropical diseases, 2020Co-Authors: Rayan S. Ali, Sahar Mubarak Bakhiet, Melanie J. Newport, Muntaser E. Ibrahim, Ahmed H. FahalAbstract:Mycetoma is one of the badly neglected tropical diseases, characterised by subcutaneous painless swelling, multiple sinuses, and discharge containing aggregates of the infecting organism known as grains. Risk factors conferring susceptibility to Mycetoma include environmental factors and pathogen factors such as virulence and the infecting dose, in addition to host factors such as immunological and genetic predisposition. Epidemiological evidence suggests that host genetic factors may regulate susceptibility to Mycetoma and other fungal infections, but they are likely to be complex genetic traits in which multiple genes interact with each other and environmental factors, as well as the pathogen, to cause disease. This paper reviews what is known about genetic predisposition to fungal infections that might be relevant to Mycetoma, as well as all studies carried out to explore host genetic susceptibility to Mycetoma. Most studies were investigating polymorphisms in candidate genes related to the host immune response. A total of 13 genes had allelic variants found to be associated with Mycetoma, and these genes lie in different pathways and systems such as innate and adaptive immune systems, sex hormone biosynthesis, and some genes coding for host enzymes. None of these studies have been replicated. Advances in genomic science and the supporting technology have paved the way for large-scale genome-wide association and next generation sequencing (NGS) studies, underpinning a new strategy to systematically interrogate the genome for variants associated with Mycetoma. Dissecting the contribution of host genetic variation to susceptibility to Mycetoma will enable the identification of pathways that are potential targets for new treatments for Mycetoma and will also enhance the ability to stratify ‘at-risk’ individuals, allowing the possibility of developing preventive and personalised clinical care strategies in the future.
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Mycetoma in Uganda: A neglected tropical disease
PLoS neglected tropical diseases, 2020Co-Authors: Richard Kwizera, Ahmed H. Fahal, Felix Bongomin, David B. Meya, David W. Denning, Robert LukandeAbstract:Mycetoma is considered a neglected tropical disease globally. However, data on its burden and the associated complications in Uganda are limited. Hence we aimed to estimate its burden in Uganda. Firstly, a systematic PubMed search for all studies of any design on Mycetoma in Uganda without restriction to the year of publication was conducted. A retrospective review of all the biopsy reports at the Pathology Reference Laboratory, Department of Pathology, Makerere University, Kampala, Uganda from January 1950 to September 2019 was conducted to identify any reports on Mycetoma histological diagnosis. During the 70-years study period, 30 cases were identified by the literature review, with 249 additional cases identified by review of biopsy reports (total of 279 cases). The average incidence was estimated at 0.32/100,000 persons and prevalence of 8.32/100,000 persons per decade. However, there was a general decline in the number of cases detected recently. Males and the age group of 21–30 years were the most affected by Mycetoma in Uganda, and only 7% of the cases were children. The highest number of cases was recorded from Kampala (n = 30) and Jinja (n = 19) districts. The majority of the cases (68%) were referred from surgical units. The foot was the most affected part of the body (72%). Ten per cent of the cases had bone involvement of which 58% required amputation. Fungi were the most common causative agents (89%) followed by Nocardia species (5%) and Actinomycetes (4%). The index of clinical suspicion of Mycetoma was low (45%) with a very large differential diagnosis. Mycetoma is a relatively rare disease in Uganda, mostly caused by fungi, and there is a big gap in data and epidemiological studies. More systematic studies are warranted to define the true burden of Mycetoma in Uganda.
Wendy Van De Sande - One of the best experts on this subject based on the ideXlab platform.
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Development of the Global Mycetoma Working Group.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2020Co-Authors: Rita M. Traxler, Wendy Van De Sande, Ahmed H. Fahal, Karlyn D. Beer, David D. Blaney, Kingsley Asiedu, William A. Bower, Tom ChillerAbstract:The Global Mycetoma Working Group (GMWG) was formed in January 2018 in response to the declaration of Mycetoma as a neglected tropical disease (NTD) by the World Health Assembly. The aim of the working group is to connect experts and public health practitioners around the world to accelerate Mycetoma prevention activities and reduce the impact of Mycetoma on patients, healthcare providers and society in the endemic regions. The working group has made tangible contributions to Mycetoma programming, awareness and coordination among scientists, clinicians and public health professionals. The group's connectivity has enabled rapid response and review of NTD documents in development, has created a network of public health professionals to provide regional Mycetoma expertise and has enabled Mycetoma to be represented within broader NTD organizations. The GMWG will continue to serve as a hub for networking and building collaborations for the advancement of Mycetoma clinical management and treatment, research and public health programming.
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interleukin 17 and matrix metalloprotease 9 expression in the Mycetoma granuloma
PLOS Neglected Tropical Diseases, 2019Co-Authors: Emmanuel Edwar Siddig, Wendy Van De Sande, Sahar Mubarak Bakhiet, Ali Mahmoud Mohammed Edris, Ahmed H. FahalAbstract:Mycetoma is a persistent, progressive granulomatous inflammatory disease caused either by fungi or by bacteria. Characteristic of this disease is that the causative agents organise themselves in macroscopic structures called grains. These grains are surrounded by a massive inflammatory reaction. The processes leading to this host tissue reaction and the immunophenotypic characteristics of the Mycetoma granuloma are not known. Due to the massive immune reaction and the tissue remodeling involved, we hypothesised that the expression levels of interleukin-17 (IL-17) and matrix metalloprotease-9 (MMP-9) in the Mycetoma granuloma formation were correlated to the severity of the disease and that this correlation was independent of the causative agent responsible for the granuloma reaction. To determine the expression of IL-17 and MMP-9 in Mycetoma lesions, the present study was conducted at the Mycetoma Research Centre, Sudan. Surgical biopsies from 100 patients with confirmed Mycetoma were obtained, and IL-17 and MMP-9 expression in the Mycetoma granuloma were evaluated immunohistochemically. IL-17 was mainly expressed in Zones I and II, and far less in Zone III. MMP-9 was detected mainly in Zones II and III, and the least expression was in Zone I. MMP-9 was more highly expressed in Actinomadura pelletierii and Streptomyces somaliensis biopsies compared to Madurella Mycetomatis biopsies. MMP-9 levels were directly proportional to the levels of IL-17 (p = 0.001). The only significant association between MMP9 and the patients' characteristics was the disease duration (p<0.001). There was an insignificant correlation between the IL-17 levels and the patients' demographic characteristics.
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Closing the Mycetoma knowledge gap.
Medical mycology, 2018Co-Authors: Wendy Van De Sande, Ahmed H. Fahal, Alexandro Bonifaz, Sarah A. Ahmed, Julian Alberto Serrano, Ed E. ZijlstraAbstract:On 28th May 2016, Mycetoma was recognized as a neglected tropical disease by the World Health Organization. This was the result of a 4-year journey starting in February 2013 with a meeting of global Mycetoma experts. Knowledge gaps were identified and included the incidence, prevalence, and mapping of Mycetoma; the mode of transmission; the development of methods for early diagnosis; and better treatment. In this review, we review the road to recognition, the ISHAM working group meeting in Argentina, and we address the progress made in closing the knowledge gaps since 2013. Progress included adding another 9000 patients to the literature, which allowed us to update the prevalence map on Mycetoma. Furthermore, based on molecular phylogeny, species names were corrected and four novel Mycetoma causative agents were identified. By mapping Mycetoma causative agents an association with Acacia trees was found. For early diagnosis, three different isothermal amplification techniques were developed, and novel antigens were discovered. To develop better treatment strategies for Mycetoma patients, in vitro susceptibility tests for the coelomycete agents of black grain Mycetoma were developed, and the first randomized clinical trial for euMycetoma started early 2017.
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Mycetoma laboratory diagnosis: Review article
PLoS Neglected Tropical Diseases, 2017Co-Authors: Amel Altayeb Ahmed, Wendy Van De Sande, Ahmed Hassan FahalAbstract: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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mapping the potential risk of Mycetoma infection in sudan and south sudan using ecological niche modeling
PLOS Neglected Tropical Diseases, 2014Co-Authors: Wendy Van De Sande, Ahmed H. Fahal, Abdallah M Samy, Townsend A PetersonAbstract:In 2013, the World Health Organization (WHO) recognized Mycetoma as one of the neglected tropical conditions due to the efforts of the Mycetoma consortium. This same consortium formulated knowledge gaps that require further research. One of these gaps was that very few data are available on the epidemiology and transmission cycle of the causative agents. Previous work suggested a soil-borne or Acacia thorn-prick-mediated origin of Mycetoma infections, but no studies have investigated effects of soil type and Acacia geographic distribution on Mycetoma case distributions. Here, we map risk of Mycetoma infection across Sudan and South Sudan using ecological niche modeling (ENM). For this study, records of Mycetoma cases were obtained from the scientific literature and GIDEON; Acacia records were obtained from the Global Biodiversity Information Facility. We developed ENMs based on digital GIS data layers summarizing soil characteristics, land-surface temperature, and greenness indices to provide a rich picture of environmental variation across Sudan and South Sudan. ENMs were calibrated in known endemic districts and transferred countrywide; model results suggested that risk is greatest in an east-west belt across central Sudan. Visualizing ENMs in environmental dimensions, Mycetoma occurs under diverse environmental conditions. We compared niches of Mycetoma and Acacia trees, and could not reject the null hypothesis of niche similarity. This study revealed contributions of different environmental factors to Mycetoma infection risk, identified suitable environments and regions for transmission, signaled a potential Mycetoma-Acacia association, and provided steps towards a robust risk map for the disease.
El Sheikh Mahgoub - One of the best experts on this subject based on the ideXlab platform.
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Mycetoma in the Sudan: An Update from the Mycetoma Research Centre, University of Khartoum, Sudan
PLoS neglected tropical diseases, 2015Co-Authors: Ahmed H. Fahal, El Sheikh Mahgoub, Ahmed M. El Hassan, Manar E. Abdel-rahmanAbstract: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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Head and Neck Mycetoma: The Mycetoma Research Centre Experience
PLoS neglected tropical diseases, 2015Co-Authors: Ahmed H. Fahal, El Sheikh Mahgoub, Ahmed M. El Hassan, Angom Osman Jacoub, Doaa HassanAbstract:Mycetoma is a unique neglected tropical disease which is endemic in what is known as the “Mycetoma belt”. The disease has many devastating impacts on patients and communities in endemic area and is characterised by massive deformity, destruction and disability. Mycetoma is commonly seen in the foot and hand and less frequent in other parts of the body. Mycetoma of the head and neck is a rarity and is associated with high morbidity and even mortality if not treated early. In this communication we report on 49 patients with head and neck Mycetoma followed up at the Mycetoma Research Centre in Khartoum. Most of the reported patients had actinoMycetoma and the majority were young adult males from Mycetoma endemic areas in the Sudan. Most of them were students, farmers and workers. Prior to presentation the majority had long disease duration and the cause was multifactorial. Advanced disease with massive lesion, deformity and disability was the common presentation. There was no obvious history of local trauma, familial tendency or other predisposing factor identified in this group of patients. MRI and CT scan were the most accurate diagnostic tools to determine the disease extent. The treatment outcome was rather poor and characterised by low cure rate, poor outcome and high follows-up dropout. Such a gloomy outcome calls for structured and objective health education programs.
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A New Model for Management of Mycetoma in the Sudan
PLoS neglected tropical diseases, 2014Co-Authors: Ahmed H. Fahal, El Sheikh Mahgoub, Ahmed M. El Hassan, Manar E. Abdel-rahman, Yassir Alshambaty, Ahmed Hashim, Ali Hago, E.e. ZijlstraAbstract:Patients with Mycetoma usually present late with advanced disease, which is attributed to lack of medical and health facilities in endemic areas, poor health education and low socio-economic status. With this background, an integrated patient management model at the village level was designed to address the various problems associated with Mycetoma. The model was launched in an endemic village in the Sudan, between 2010 and 2013. This model is described in a prospective, descriptive, community-based study, aimed to collect epidemiological, ecological, and clinical data and to assess knowledge, attitude and practice (KAP) in order to design effective and efficient management measures. In this study, the prevalence of Mycetoma was 14.5 per 1,000 inhabitants. The patients were farmers, housewives and children of low socio-economic status, and no obvious risk group was detected. All had surgery performed in a mobile surgical unit in the village which encouraged patients to present early with small early lesion leading to a good clinical outcome. The close contact with the Acacia tree thorns, animals and animal dung, walking bare footed and practising poor hygiene may all have contributed to the development of Mycetoma in the village. Knowledge of Mycetoma was poor in 96.3% of the study population, 70% had appropriate attitudes and beliefs towards interaction with Mycetoma patients and treatment methods, and 49% used satisfactory or good practices in the management of Mycetoma. Knowledge and practices on Mycetoma were found to be significantly associated with age. Based on the KAP and epidemiological data, several health education sessions were conducted in the village for different target groups. The integrated management approach adopted in this study is unique and appeared successful and seems suitable as an immediate intervention. While for the longer term, establishment of local health facilities with trained health staff remains a priority.
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merits and pitfalls of currently used diagnostic tools in Mycetoma
PLOS Neglected Tropical Diseases, 2014Co-Authors: Wendy Van De Sande, Ahmed H. Fahal, El Sheikh Mahgoub, Michael Goodfellow, Oliverio Welsh, Ed E. ZijlstraAbstract: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.
S Alsip - One of the best experts on this subject based on the ideXlab platform.
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Criteria for the diagnosis of sinus Mycetoma
The Journal of allergy and clinical immunology, 1997Co-Authors: Richard D. Deshazo, M. O'brien, K. Chapin, M. Soto-aguilar, R. Swain, M. Lyons, W C Bryars, S AlsipAbstract:Recent improvements in the treatment options for fungal disease of the sinuses make rapid distinction between the syndromes of invasive and noninvasive sinusitis necessary. On the basis of the extensive review of the literature detailed here, we developed case-finding criteria for the noninvasive syndrome of sinus Mycetoma. Using these criteria, we identified 20 cases of sinus Mycetoma in the medical literature and compared findings in these patients to those of five patients with Mycetoma evaluated in our clinics. Like those in the literature, our patients appeared immunocompetent and were often first seen for evaluation of symptoms other than those usually associated with sinusitis. Two were first seen with a new-onset seizure disorder and one with nasal obstruction alone. Patients from both groups more commonly had Mycetoma in their maxillary sinuses, and fungus failed to grow from the cheesy, grey-green, hyphae-rich material removed at the time of surgery. Clinical features in our five patients, which are not noted in published reports of sinus Mycetoma, included frequent atopy, nasal polyps, calcification within the sinus on computed tomography, and an excellent response to surgical treatment. Serendipitously, one patient had both allergic fungal sinusitis and a Mycetoma in the same sinus. On the basis of this experience, we have modified our case-finding criteria into proposed diagnostic criteria for sinus Mycetoma. The elements of these criteria are designed to: (1) exclude patients with invasive fungal sinusitis and (2) differentiate sinus Mycetoma from other forms of noninvasive fungal sinusitis on the basis of specific histopathologic findings. This study and the criteria presented reflect our view that sinus Mycetoma represents a distinct but not necessarily isolated element in the spectrum of noninvasive fungal disease of the sinuses.
Doreen Addrizzoharris - One of the best experts on this subject based on the ideXlab platform.
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clinical presentation of pulmonary Mycetoma in hiv infected patients
Chest, 2002Co-Authors: Alissa K Greenberg, Jocelyn Knapp, William N Rom, Doreen AddrizzoharrisAbstract:Study objectives Although pulmonary Mycetoma has been well-described in immunocompetent hosts, the only description in HIV-infected patients has been of 10 patients from our institution, from 1992 to 1995. To further investigate the impact of HIV status on the presentation and course of pulmonary Mycetoma, we conducted a follow-up study. Design Retrospective review of all cases of pulmonary Mycetoma at Bellevue Hospital from 1992 to 1999. Setting Patients were evaluated on the inpatient chest service and in the outpatient chest and HIV clinics of Bellevue Hospital in New York City. Patients We identified 74 patients with pulmonary Mycetoma; 20 of them were HIV-infected (27%). Interventions The 20 HIV-infected patients were treated with antiretroviral and/or antifungal therapy. Measurements and results Predisposing diseases were pulmonary tuberculosis (TB), Pneumocystis carinii pneumonia (PCP), or both TB and PCP. Seventeen patients had a CD4+ cell count of Conclusions PCP is a risk factor for pulmonary Mycetoma in the HIV-infected individual. HIV-infected patients with Mycetomas have a significant rate of disease progression, although they rarely have life-threatening hemoptysis. A combination of antifungal and antiretroviral therapy may improve the clinical outcome in HIV-infected patients with pulmonary Mycetoma.
