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    A holistic approach to the mycetoma management
    (University of Khartoum, 2018) Sahar Mubarak Bakhiet ; Ahmed Hassan Fahal ; Ahmed Mudawi Musa ; El Samani Wadaa Mohamed ; Rowa Fathelrahman Omer1 ; Eiman Siddig Ahmed ; Mustafa El Nour ; El Rayah Mohamed Mustafa ; Manar El Sheikh A. Rahman ; Suliman Hussein Suliman ; Mohamed A. Gadir El Mamoun ; Hajo Mohamed El Amin
    ycetoma, one of the badly neglected tropical diseases, it is a localised chronic granuloma tous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropri ately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite prog ress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. How ever, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treat ment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health per sonals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This compre hensive approach had also addressed the patients’ socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients’ management proved to be effective for early case detection and management, optimal treatment and treatment out come and favourable disease prognosis. During the study period, the number of patients
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    The Mycetoma Research Centre experience during the COVID-19 pandemic: obstacles and beyond
    (University of Khartoum, 2021) Lamis Ahmed Fahal ; Eiman Siddig Ahmed ; Sahar Mubarak Bakhiet ; Emmanuel Edwar Siddig ; Ahmed Hassan FahaL
    Mr E. L. Safi is a middle-aged singer and musician from West Sudan. He is representative of the large number of patients who experienced long-standing mycetoma during the COVID-19 pan demic, along with their families, the medical, health and socioe conomic community and the health system at large. The patient had mycetoma that eventually ended in leg amputation due to neglect of the small, painless subcutaneous swelling of his foot, resulting from his low socioeconomic and health education lev els, geographical isolation, as well as the disruption to medical care caused by the impact of the COVID-19 pandemic. The COVID-19 pandemic Coronavirus disease 2019 (COVID-19) is a major health prob lem worldwide and almost every country affected by the disease has experienced a high mortality rate. It has caused 2 460 000 deaths worldwide over a period of 14 mo. In Sudan, the virus affected 34 889 individuals, of whom 27 949 recovered, while 2568 deaths occurred.1 The COVID-19 pandemic led to reorgan isation of healthcare facilities, many of which were closed, along with a lack of operational medical staff, fully equipped facilities and personal protective equipment.1,2 In this communication, we reflect on our experience at the Mycetoma Research Centre (MRC), University of Khartoum—a WHO Collaborating Centre— where abrupt interruption to services at national level due to the pandemic had a severe impact on clinical services and staff.
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    The developed molecular biological identification tools for mycetoma causative agents: An update
    (University of Khartoum, 2022) Emmanuel Edwar Siddig ; Annelies Verbon ; Sahar Bakhiet ; Ahmed Hassan Fahal ; W.J. van de Sande,Wendy
    Mycetoma is a chronic granulomatous inflammatory disease that is caused either by bacteria or fungi. Bacterial mycetoma (actinomycetoma) can be caused by various causative agents of the genera Nocardia, Streptomyces and Actinomadura. On the other hand, fungal mycetoma (eumycetoma) is most commonly caused by causative agents belonging to the genera Madurella, Scedosporium and Falciformispora. Early and accurate diagnosis of the caus ative organisms can guide proper patient management and treatment. To allow rapid and accurate species identification, different molecular techniques were developed over the past decades. These techniques can be protein based (MALDI-TOF MS) as well as DNA based (Sequencing, PCR and isothermal amplification methods). In this review, we provide an overview of the different molecular techniques currently in use and identify knowledge gaps, which need to be addressed before we can implement molecular diagnostics for mycetoma in different clinical settings.
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    The Accuracy of Histopathological and Cytopathological Techniques in the Identification of the Mycetoma Causative Agents
    (University of Khartoum, 2019) Emmanuel Edwar Siddig ; Najwa Adam Mhmoud ; Sahar Mubarak BakhietI ; Omnia Babekir Abdallah ; Salwa Osman Mekki ; Nadia I. El Dawi ; Van de Sande,Wendy ; Ahmed Hassan Fahal
    ycetoma is a devastating neglected tropical disease, caused by various fungal and bacte rial pathogens. Correct diagnosis to the species level is mandatory for proper treatment. In endemic areas, various diagnostic tests and techniques are in use to achieve that, and that includes grain culture, surgical biopsy histopathological examination, fine needle aspiration cytological (FNAC) examination and in certain centres molecular diagnosis such as PCR. In this retrospective study, the sensitivity, specificity and diagnostic accuracy of grain culture, surgical biopsy histopathological examination and FNAC to identify the mycetoma causative organisms were determined. The histopathological examination appeared to have better sensitivity and specificity. The histological examination results were correct in 714 (97.5%) out of 750 patients infected with Madurella mycetomatis, in 133 (93.6%) out of 142 patients infected with Streptomyces somaliensis, in 53 (74.6%) out of 71 patients infected with Acti nomadura madurae and in 12 (75%) out of 16 patients infected with Actinomadura pelletierii. FNAC results were correct in 604 (80.5%) out of 750 patients with Madurella mycetomatis eumycetoma, in 50 (37.5%) out of 133 Streptomyces somaliensis patients, 43 (60.5%) out of 71 Actinomadura madurae patients and 11 (68.7%) out of 16 Actinomadura pelletierii. The mean time required to obtain the FNAC result was one day, and for the histopatholog ical examinations results it was 3.5 days, and for grain it was a mean of 16 days. In conclu sion, histopathological examination and FNAC are more practical techniques for rapid species identification than grain culture in many endemic regions
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    Systematic whole-genome sequencing reveals an unexpected diversity among actinomycetoma pathogens and provides insights into their antibacterial susceptibilities
    (University of Khartoum, 2022) Andrew Keith Watson ; Bernhard Kepplinger ; Sahar Mubarak Bakhiet ; Najwa Adam Mhmoud ; Jonathan Chapman ; EE Allenby,Nick ; Mickiewicz,Katarzyna ; Goodfellow,Michael ; Ahmed Hassan Fahal ; Errington,Jeff
    Mycetoma is a neglected tropical chronic granulomatous inflammatory disease of the skin and subcutaneous tissues. More than 70 species with a broad taxonomic diversity have been implicated as agents of mycetoma. Understanding the full range of causative organ isms and their antibiotic sensitivity profiles are essential for the appropriate treatment of infections. The present study focuses on the analysis of full genome sequences and antibi otic inhibitory concentration profiles of actinomycetoma strains from patients seen at the Mycetoma Research Centre in Sudan with a view to developing rapid diagnostic tests. Sev enteen pathogenic isolates obtained by surgical biopsies were sequenced using MinION and Illumina methods, and their antibiotic inhibitory concentration profiles determined. The results highlight an unexpected diversity of actinomycetoma causing pathogens, including three Streptomyces isolates assigned to species not previously associated with human acti nomycetoma and one new Streptomyces species. Thus, current approaches for clinical and histopathological classification of mycetoma may need to be updated. The standard treat ment for actinomycetoma is a combination of sulfamethoxazole/trimethoprim and amoxicil lin/clavulanic acid. Most tested isolates had a high IC (inhibitory concentration) to sulfamethoxazole/trimethoprim or to amoxicillin alone. However, the addition of the β-lacta mase inhibitor clavulanic acid to amoxicillin increased susceptibility, particularly for Strepto myces somaliensis and Streptomyces sudanensis. Actinomadura madurae isolates appear to have a particularly high IC under laboratory conditions, suggesting that alternative agents, such as amikacin, could be considered for more effective treatment. The results obtained will inform future diagnostic methods for the identification of actinomycetoma and treatment.