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melanin biosynthesis in madurella mycetomatis and its effect on susceptibility to itraconazole and ketoconazole.one of the hallmarks of eumycetoma is the formation of fungal grains, which are secreted by multiple sinuses in infected tissues. madurella mycetomatis grains are black. this black colour was shown to be due to the presence of melanin. melanin can be produced through various biochemical pathways. it appeared that m. mycetomatis melanisation could be blocked by inhibitors of the pyo- and dihydroxynaphthalene (dhn)-melanin pathways but not by inhibitors of the dihydroxyphenylalanine (l-dopa)-melan ...200717644456
abdominal wall mycetoma presented as obstructed incisional hernia of cesarean section in eastern sudan.mycetoma a worldwide disease frequently occurs in the tropics with the highest prevalence being in africa. madurella mycetomatis is the main causative organism of human eumycetoma in sudan. the legs and feet were commonly the sites of the infection. a 22-year-old lady was presented with painful abdominal swelling around a previous caesarian section scar. a provisional diagnosis of obstructed incisional hernia was put. histopathological examination revealed macroscopically four masses of soft tis ...200917485822
madurella mycetoma-a rare case with cranial extension.background: madurella species of fungus causes chronic subcutaneous infection of lower extremities; the infection is commonly labeled as madura foot. we report a case of madurella infection involving the cranial cavity. such an involvement by madurella fungal infection is not recorded in the literature. case description: a 31-year-old nonimmunocompromised male patient presented with complaints of left hemifacial pain for 1 year and diplopia on looking toward left side for a period of 2 weeks. on ...200919818480
difficult mycoses of the skin: advances in the epidemiology and management of eumycetoma, phaeohyphomycosis and chromoblastomycosis.eumycetoma, phaeohyphomycosis and chromoblastomycosis are subcutaneous mycoses having in common the fact that they are acquired as a result of penetrating trauma to the skin and may be caused by a large variety of fungi. this article will review recent data regarding the epidemiology and treatment of these infections.200919773651
eumycotic mycetoma caused by madurella mycetomatis successfully treated with antifungals, surgery, and topical negative pressure therapy.we report a 21-year-old farmer with a 4-year history of a nodular plaque with fistulas and induration of adjacent skin. the lesion had been treated surgically at another hospital, but recurred 2 years later. black, charcoal-like grains were observed draining through the fistulas. a biopsy specimen showed brown grains with filaments in an abscess surrounded by macrophages, giant cells, and lymphocytes. culture demonstrated small white colonies of madurella mycetomatis. the patient was treated wit ...200919335427
paecilomyces lilacinus eumycetoma.eumycetoma is a chronic granulomatous infection of the skin, subcutaneous tissue, fascia, and bone caused by true fungi. most commonly, it affects the foot or hand. fungi commonly reported to cause eumycetoma are madurella mycetomatis, madurella grisea, phialophora jeanselmei, cephalosporium recifei, etc. there have been several previous reports of human invasive infections by paecilomyces lilacinus causing endophthalmitis, keratitis, chronic sinusitis, skin and soft tissue infections, and cathe ...200919659864
eumycetoma caused by madurella mycetomatis in a mare.a case of equine eumycotic mycetoma caused by madurella mycetomatis is described. this is the first report of m. mycetomatis as the etiologic agent of human or animal infections in israel. the definitive identification of the isolate was established by molecular methods. in addition the mold was cultured on various media through which we found that its growth rate was significantly augmented on incubation on trypticase soy agar, more so if horse serum was added to this medium. sixteen previously ...201019886776
madurella mycetomatis is not susceptible to the echinocandin class of antifungal agents.eumycetoma caused by madurella mycetomatis is treated surgically and with high doses of ketoconazole. therapeutic responses are poor, and recurrent infections are common. in search of therapeutic alternatives in the treatment of mycetoma, we determined the in vitro susceptibilities of m. mycetomatis isolates against caspofungin, anidulafungin, and micafungin. as a comparator fungus, aspergillus fumigatus was used. minimal effective concentrations (mecs) and mics were assessed and compared to tho ...201020350944
madurella mycetoma--a rare case with cranial extension.madurella species of fungus causes chronic subcutaneous infection of lower extremities; the infection is commonly labeled as madura foot. we report a case of madurella infection involving the cranial cavity. such an involvement by madurella fungal infection is not recorded in the literature.201020452871
[mycetoma in tunisia: a 15-case series].mycetoma is a chronic infection of cutaneous and subcutaneous tissue that can be caused by fungi or bacteria. it is endemic in tropical and subtropical areas but rare in tunisia.201020734597
mycetoma in south india: retrospective analysis of 13 cases and description of two cases caused by unusual pathogens: neoscytalidium dimidiatum and aspergillus flavus.mycetoma is a chronic suppurative and/or granulomatous inflammatory lesion of skin, subcutaneous tissue, fascia, and tendons caused by the traumatic inoculation of either fungal (eumycotic) or bacterial (actinomycotic) organisms present in the soil. the disease is characterized by triad of tumefaction, discharging sinuses, and grains.201020964650
mycetoma (madura foot): a case report.mycetoma is a chronic disease, which is endemic in tropical and subtropical countries. we report a rare case of mycetoma located on the foot of a patient living in a temperate-climate country followed by a short discussion.201021126936
polymorphisms in catechol-o-methyltransferase and cytochrome p450 subfamily 19 genes predispose towards madurella mycetomatis-induced mycetoma susceptibility.mycetoma caused by madurella mycetomatis is a devastating and neglected disease which primarily affects males. since this predominance cannot be easily explained by behaviour differences between men and women, other factors, including sex hormones, could be the cause. to monitor for possible deficiencies in hormone synthesis among mycetoma patients, we investigated the types and allele frequencies of the genes encoding for catechol-o-methyltransferase (comt), cytochrome p450 subfamily 1 (cyp1b1) ...201020184498
eumycetoma versus actinomycetoma: diagnosis on cytology.eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi producing specific colored granules known as grains. a 45-year-old farmer presented clinically with a left foot mass with multiple discharging sinuses existing for last 3 years. clinical and radiological findings suggested a diagnosis of chronic osteomyelitis with suspicion of tuberculosis. imprints plus fine needle aspiration cytology (fnac) smears exhibited distinct brown-black colonies of a fungus h ...201021157564
a chronic, destructive mycetoma infection in a diabetic foot in saudi arabia.this case study describes the presentation of a tropical foot infection that presented in a 38-year-old male farm worker from the eastern province of saudi arabia who contracted the fungal infection that is madurella mycetomatis. mycetomas or madura foot is characterized by a slow progressive infection that can result in severe soft tissue and muscle involvement along with destruction of the underlying bone. this foot pathology is rare in the united states and across europe; however, the increas ...201121444606
fructose-bisphosphate aldolase and pyruvate kinase, two novel immunogens in madurella mycetomatis.eumycetoma, a chronic granulomatous disease characterized by a subcutaneous mass, multiple sinuses and purulent discharge containing grains, remains difficult to diagnose and treat. madurella mycetomatis is the most common causative agent of eumycetoma. using a serum pool from patients with active mycetoma, we screened a m. mycetomatis-specific ++gt11 cdna library which was shown to contain 8% of cdna inserts encoding proteins involved in glycolysis. two of these enzymes, fructose-bisphosphate a ...201121728753
New species in Madurella, causative agents of black-grain mycetoma.A new species of a non-sporulating fungus, isolated from a case of black-grain mycetoma in Sudan, is described as Madurella fahalii. The species is characterized by phenotypic and molecular criteria. Multi-gene phylogenies based on the rDNA internal transcribed spacer (ITS), the partial ß-tubulin (BT2) and RNA polymerase II subunit 2 (RPB2) genes indicate that M. fahalii is closely related to Madurella mycetomatis and M. pseudomycetomatis; the latter name is validated according to the rules of b ...201122205798
[mycetomas diagnosed in senegal from 2008 to 2010].mycetomas are inflammatory pseudotumours of subcutaneous and possibly osseous soft fabrics, generally polyfistulas with chronic mode of evolution.201124451559
madurella mycetomatis mycetoma treated successfully with oral posaconazole. 201121803706
the safety and efficacy of itraconazole for the treatment of patients with eumycetoma due to madurella mycetomatis.this prospective study aimed to determine the safety and efficacy of itraconazole for the treatment of patients with mycetoma due to madurella mycetomatis. the study consisted of 13 patients with confirmed disease; all were treated with oral itraconazole in a dose of 400mg daily for three months after which the dose was reduced to 200mg daily for nine months. all patients showed good clinical response to 400mg itraconazole daily, but when the dose was reduced to 200mg daily, the clinical respons ...201121247608
in vitro susceptibility of madurella mycetomatis to posaconazole and terbinafine.presently, therapy of eumycetoma in sudan is still based on surgery combined with prolonged ketoconazole therapy. this usually results in a poor clinical outcome. to determine if posaconazole and terbinafine could offer better therapeutic alternatives, the in vitro susceptibilities of 34 madurella mycetomatis strains were determined. it appeared that posaconazole was highly active against m. mycetomatis but terbinafine was only moderately active. since posaconazole has an excellent safety profil ...201121263050
in vitro antifungal activity of isavuconazole against madurella mycetomatis.currently, therapy of black-grain mycetoma caused by madurella mycetomatis consists of extensive debridement of the infected tissue combined with prolonged antifungal therapy with ketoconazole or itraconazole. in the present study, the in vitro activity of the new triazole isavuconazole toward m. mycetomatis was evaluated. isavuconazole appeared to have high activity against m. mycetomatis, with mics ranging from ≤0.016 to 0.125 μg/ml. due to its favorable pharmacokinetics, isavuconazole could b ...201222964246
madurella mycetomatis infection following allogenic stem cell transplantation for aplastic anemia. 201222811787
phylogenetic analysis of the complete mitochondrial genome of madurella mycetomatis confirms its taxonomic position within the order sordariales.madurella mycetomatis is the most common cause of human eumycetoma. the genus madurella has been characterized by overall sterility on mycological media. due to this sterility and the absence of other reliable morphological and ultrastructural characters, the taxonomic classification of madurella has long been a challenge. mitochondria are of monophyletic origin and mitochondrial genomes have been proven to be useful in phylogenetic analyses.201222701687
eumycetoma.eumycetoma is caused by different fungi. madurella mycetomatis, madurella grisae, and scedosporium apiospermum are the most common causative agents. this disease is more frequent on the lower extremities but can also be present in other areas. the diagnosis is made by direct microscopic examination and histologic study, which should show hyphae and vesicles characteristic of the fungi. etiologic identification of the species of the fungus is sometimes difficult by culture and biopsy specimen; in ...201322682186
madurella mycetomatis as an agent of brain abscess: case report and review of literature.fungal cerebral abscesses are rare and usually seen in immunocompromised individuals. we report a case and review published literature of madurella mycetomatis as an agent of cerebral abscess. we found contiguous head and neck infections to be the principal cause of cerebral maduromycosis caused by m. mycetomatis. early recognition of madurella spp. as the causative agent is essential to avoid cerebral spread.201324085615
phylogenetic findings suggest possible new habitat and routes of infection of human eumyctoma.eumycetoma is a traumatic fungal infection in tropical and subtropical areas that may lead to severe disability. madurella mycetomatis is one of the prevalent etiologic agents in arid northeastern africa. the source of infection has not been clarified. subcutaneous inoculation from plant thorns has been hypothesized, but attempts to detect the fungus in relevant material have remained unsuccessful. the present study aims to find clues to reveal the natural habitat of madurella species using a ph ...201323696914
mycetoma caused by madurella mycetomatis: a completely neglected medico-social dilemma.mycetoma is a debilitating disease with a highly particular geographical distribution. the mycetoma belt circles the entire world just above the equator and defines the region with the highest prevalence and incidence. although the disease is seen in central america, india and all across africa, sudan seems to be the homeland of mycetoma. mycetoma is an infectious disease caused either by bacteria (actinomycetoma) or true fungi (eumycetoma). in sudan most cases are caused by the fungal species m ...201323654067
peripheral blood mononuclear cells of mycetoma patients react differently to madurella mycetomatis antigens than healthy endemic controls. 201323634233
[madura foot]. 201323504196
a histopathological exploration of the madurella mycetomatis grain.although the madurella mycetomatis grains seem to interfere with the host defense mechanisms and impede the antifungal drugs penetration, yet their histological features are not fully known and hence this study was set out to determine that. the study included 80 patients with confirmed m. mycetomatis eumycetoma. after informed written consent, surgical biopsies were obtained from the excised tissues during the patients' surgical treatment. all sections were stained with haematoxylin and eosin, ...201323483927
global burden of human mycetoma: a systematic review and meta-analysis.mycetoma is a chronic infectious disease of the subcutaneous tissue with a high morbidity. this disease has been reported from countries between 30°n and 15°s since 1840 but the exact burden of disease is not known. it is currently unknown what the incidence, prevalence and the number of reported cases per year per country is. in order to estimate what the global burden of mycetoma is, a meta-analysis was performed. in total 50 studies were included, which resulted in a total of 8763 mycetoma ca ...201324244780
[analysis of 18 tunisian cases of mycetoma at the sousse hospital (1974-2010)].mycetoma are inflammatory pseudotumors, due to infection by bacterial (actinomycetoma) or fungal (eumycetoma) agent. a retrospective study was conducted during 34 years. our aim was to study epidemiologic, clinic, therapeutic and microbiologic characteristics. eighteen patients were assessed. sex-ratio h/f was 2. the mean age was 43.6 years. principal localization was the feet. our study was characterized by majority of actinomycetoma found in 15 cases (actinomadura madurae in 14 cases and nocar ...201322552715
mycetoma: experience of 482 cases in a single center in mexico.mycetoma is a chronic granulomatous disease. it is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. mycetoma can be found in geographic areas in close proximity to the tropic of cancer. mexico is one of the countries in which this disease is highly endemic. in this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the general hospital of mexico in a 33 year-period (1980 to 2013). a total of 482 case ...201425144462
roussoella percutanea, a novel opportunistic pathogen causing subcutaneous mycoses.we report the isolation of a novel agent of subcutaneous mycosis from a 45-year-old indian male immigrant in the united states. phylogenetic analysis of partial small ribosomal subunit and large ribosomal subunit, internal transcribed spacer, partial translation elongation factor (tef1), and rna polymerase second largest subunit (rpb2) loci revealed that the strain was identical to another isolate previously reported as "madurella mycetomatis." both strains clustered in the order pleosporales, n ...201424969729
[thoracic tumor-like fungal mycetoma: interest of large surgery with terbinafine].fungal mycetoma are inflammatory pseudo-tumors of subcutaneous tissues and possibly bones due to exogenous fungi. they have a chronic course, often poly-fistulated with an emission of fungal grains. we report the case of a 65-year-old farmer with a thoracic fungal mycetoma discovered incidentally, associated with bone involvement. the diagnosis was confirmed by the positive culture to madurella mycetomatis. the outcome was favorable with terbinafine 1g per day for 12 months associated with compl ...201425467818
autochthonous cases of mycetoma in europe: report of two cases and review of literature.mycetoma is a chronic granulomatous infection involving cutaneous and subcutaneous tissues. it is endemic in tropical and subtropical areas, but sporadic cases have been reported also in countries of temperate climate. the purpose of this paper is to review the cases of mycetoma in european subjects (and presumably acquired in europe), to give an insight in the main factors associated with this condition, and to describe two previously unpublished cases observed at our centre.201424963778
madurella mycetomatis is highly susceptible to ravuconazole.the current treatment of eumycetoma utilizing ketoconazole is unsatisfactory because of high recurrence rates, which often leads to complications and unnecessary amputations, and its comparatively high cost in endemic areas. hence, an effective and affordable drug is required to improve therapeutic outcome. e1224 is a potent orally available, broad-spectrum triazole currently being developed for the treatment of chagas disease. e1224 is a prodrug that is rapidly converted to ravuconazole. plasma ...201424945848
the combination of amoxicillin-clavulanic acid and ketoconazole in the treatment of madurella mycetomatis eumycetoma and staphylococcus aureus co-infection.eumycetoma is a chronic progressive disabling and destructive inflammatory disease which is commonly caused by the fungus madurella mycetomatis. it is characterized by the formation of multiple discharging sinuses. it is usually treated by antifungal agents but it is assumed that the therapeutic efficiency of these agents is reduced by the co-existence of staphylococcus aureus co-infection developing in these sinuses. this prospective study was conducted to investigate the safety, efficacy and c ...201424945499
active matrix metalloprotease-9 is associated with the collagen capsule surrounding the madurella mycetomatis grain in mycetoma.madurella mycetomatis is the main causative organism of eumycetoma, a persistent, progressive granulomatous infection. after subcutaneous inoculation m. mycetomatis organizes itself in grains inside a granuloma with excessive collagen accumulation surrounding it. this could be contributing to treatment failure towards currently used antifungal agents. due to their pivotal role in tissue remodelling, matrix metalloproteinases-2 (mmp-2) and 9 (mmp-9) or tissue inhibitor of metalloproteinases (timp ...201424675764
last generation triazoles for imported eumycetoma in eleven consecutive adults.optimal management of eumycetoma, a severely debilitating chronic progressive fungal infection of skin, disseminating to bone and viscera, remains challenging. especially, optimal antifungal treatment and duration are ill defined.201425299610
eumycetoma by madurella mycetomatis with 30 years of evolution: therapeutic challenge.we report a case of eumycetoma by madurella mycetomatis on the buttocks and thighs in an adult immunocompetent patient, diagnosed after 30 years of clinical development. he was treated over four years with fluconazol and itraconazol associated with five times surgical excisions of subcutaneous nodules. at the eighth year of follow-up, one nodule recurred on the right infragluteal region, which was excised surgically and has remained asymptomatic ever since.201524346887
in vitro activity of antiseptic solutions against madurella mycetomatis: implications for eumycetoma management. 201525429729
eumycetoma on the foot caused by madurella mycetomatis: amputation after significant worsening during pregnancy. 201525178425
mycetoma of the foot caused by madurella mycetomatis in immigrants from sudan.mycetoma is a chronic and destructive infection caused by either fungus or bacteria. mycetoma has a characteristic clinical presentation of a triad of tumor-like swelling, draining sinuses, and macroscopic grains. mycetoma infection is extremely rare in israel; however, in view of the recent immigration from mycetoma-hyperendemic regions of africa to israel, physicians in israel may encounter this infection.201526357716
a polymorphism in the chitotriosidase gene associated with risk of mycetoma due to madurella mycetomatis mycetoma--a retrospective study.madurella mycetomatis is the most prevalent causative agent of eumycetoma in sudan, an infection characterized by the formation of grains. many patients are exposed to the causative agent, however only a small number develop infection. m. mycetomatis contains chitin in its cell wall, which can trigger the human immune system. polymorphisms in the genes encoding for the chitin-degrading enzymes chitotriosidase and amcase were described, resulting in altered chitinase activity. we investigated the ...201526332238
application of isothermal amplification techniques for identification of madurella mycetomatis, the prevalent agent of human mycetoma.appropriate diagnosis and treatment of eumycetoma may vary significantly depending on the causative agent. to date, the most common fungus causing mycetoma worldwide is madurella mycetomatis. this species fails to express any recognizable morphological characteristics, and reliable identification can therefore only be achieved with the application of molecular techniques. recombinase polymerase amplification (rpa) and loop-mediated isothermal amplification (lamp) are proposed as alternatives to ...201526246484
a madurella mycetomatis grain model in galleria mellonella larvae.eumycetoma is a chronic granulomatous subcutaneous infectious disease, endemic in tropical and subtropical regions and most commonly caused by the fungus madurella mycetomatis. interestingly, although grain formation is key in mycetoma, its formation process and its susceptibility towards antifungal agents are not well understood. this is because grain formation cannot be induced in vitro; a mammalian host is necessary to induce its formation. until now, invertebrate hosts were never used to stu ...201526173126
amphotericin b but not itraconazole is able to prevent grain formation in experimental madurella mycetomatis mycetoma in mice. 201526150103
mycetoma in the sudan: an update from the mycetoma research centre, university of khartoum, sudan.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 mo ...201525816316
the in vitro antifungal activity of sudanese medicinal plants against madurella mycetomatis, the eumycetoma major causative agent.eumycetoma is a debilitating chronic inflammatory fungal infection that exists worldwide but it is endemic in many tropical and subtropical regions. the major causative organism is the fungus madurella mycetomatis. the current treatment of eumycetoma is suboptimal and characterized by low cure rate and high recurrence rates. hence, an alternative therapy is needed to address this. here we determined the antifungal activity of seven sudanese medicinal plant species against madurella mycetomatis. ...201525768115
in vitro interaction of currently used azoles with terbinafine against madurella mycetomatis. 201525487799
predictors of post-operative mycetoma recurrence using machine-learning algorithms: the mycetoma research center experience.post-operative recurrence in mycetoma after adequate medical and surgical treatment is common and a serious problem. it has health, socio-economic and psychological detrimental effects on patients and families. it is with this in mind, we set out to determine the predictors of post-operative recurrence in mycetoma. the study included 1013 patients with madurella mycetomatis causing eumycetoma who underwent surgical excision at the mycetoma research centre, khartoum, sudan in the period 1991-2015 ...201627798643
madurella mycetomatis-induced massive shoulder joint destruction: a management challenge. 201627490198
th-1, th-2 cytokines profile among madurella mycetomatis eumycetoma patients.eumycetoma is a progressive and destructive chronic granulomatous subcutaneous inflammatory disease caused by certain fungi, the most common being madurella mycetomatis. the host defence mechanisms against fungi usually range from an early non-specific immune response to activation and induction of specific adaptive immune responses by the production of th-1 and th-2 cytokines. the aim of this study is to determine the levels of th-1 and th-2 cytokines in patients infected with madurella mycetom ...201627434108
role of a nsaid in the apparent cure of a fungal mycetoma.we report the case of a fungal mycetoma due to madurella mycetomatis that failed to respond to surgery and antifungal treatment but responded strongly to the addition of a non-steroidal anti-inflammatory drug (nsaid). this african patient was born in mauritania in 1972. he was a herdsman, living close to the senegal river. the first nodules appeared on the left foot at the age of 13years (1985). the patient suffered frequent flare-ups with the appearance of black grains and underwent surgery in ...201627233662
genome sequence of madurella mycetomatis mm55, isolated from a human mycetoma case in sudan.we present the first genome sequence for a strain of the main mycetoma causative agent, madurella mycetomatis this 36.7-mb genome sequence will offer new insights into the pathogenesis of mycetoma, and it will contribute to the development of better therapies for this neglected tropical disease.201627231361
use of immunoblotting in testing madurella mycetomatis specific antigen.though serodiagnosis of actinomycetoma is established, that of eumycetoma due to madurella mycetomatis is limited because of lack of pure antigen. reliable rapid tests are needed to make an accurate timely diagnosis. the purpose of this study is to detect antigen parts of m. mycetomatis, which act specifically with m. mycetomatis antibodies.201627198216
a tropical diabetic foot.foot infections are a common problem and an important cause of morbidity in patients with diabetes. we report a patient with type 2 diabetes, presenting with a chronic foot wound resistant to standard care, in whom the diagnosis of eumycetoma was made through histopathological examination of a bone biopsy specimen and confirmed by polymerase chain reaction (pcr). diagnosis and treatment of eumycetoma are reviewed. eumycetoma caused by madurella mycetomatis is an uncommon cause of osteomyelitis i ...201623189544
combining two antifungal agents does not enhance survival of galleria mellonella larvae infected with madurella mycetomatis.to determine if combination therapy would improve therapeutic outcome in eumycetoma caused by madurella mycetomatis.201728342219
review of 21 cases of mycetoma from 1991 to 2014 in rio de janeiro, brazil.mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria that form grains in the tissue. the purpose of this study is to describe the epidemiologic, clinic, laboratory, and therapeutic characteristics of patients with mycetoma at the oswaldo cruz foundation in rio de janeiro, brazil, between 1991 and 2014. twenty-one cases of mycetoma were included in the study. there was a predominance of male patients (1.3:1) and the average patient age was 46 yea ...201728192433
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