The disabling consequences of Mycetoma

Mycetoma is a neglected tropical disease endemic in tropical and subtropical countries, particularly Sudan. The disease is characterised by the triad of painless subcutaneous mass, multiple sinuses and discharge that contain grains. It is a chronic, debilitating disease most commonly affecting the feet or hands and leads to substantial morbidity, loss of function and even amputation. It predominantly affects poor, rural populations and patients typically present late with advanced disease and complications. In this descriptive cross-sectional study, we characterise the disabling consequences of mycetoma. The study included 300 patients; 228 (76%) male and 72 (24%) female with confirmed mycetoma seen at the Mycetoma Research Centre, University of Khartoum, Sudan in the period May 2016 and January 2017. The study design was based upon the International Classification of Functioning, Disability and Health, examining the impact of mycetoma on eight life domains. Our major finding is that mycetoma is a significantly disabling disease. Over 60% of the study population (181 patients) had moderate impairment or difficulty in at least one domain variable. The important disability was mobility impairment and walking difficulty that was reported in 119 patients (39.7%). There was significant pain associated with mycetoma lesions in 103 patients (34%), challenging the traditional view of mycetoma as a painless disease. The economic burden was also found to be substantial, with 126 patients (46.7%) reporting barriers to their ability to sustain themselves. This is the first study evaluating the disabling consequences of mycetoma and shows clear areas for intervention and further research. Options for mitigating social and economic impacts include routine integration of analgesia and physiotherapy into treatment protocols, and adapting educational provision and working practices based on disability assessment. Our data show that mycetoma is a public health issue with direct implications on quality of life

Amyloids - A functional coat for microorganisms

Amyloids are filamentous protein structures ~10 nm wide and 0.1–10 µm long that share a structural motif, the cross-β structure. These fibrils are usually associated with degenerative diseases in mammals. However, recent research has shown that these proteins are also expressed on bacterial and fungal cell surfaces. Microbial amyloids are important in mediating mechanical invasion of abiotic and biotic substrates. In animal hosts, evidence indicates that these protein structures also contribute to colonization by activating host proteases that are involved in haemostasis, inflammation and remodelling of the extracellular matrix. Activation of proteases by amyloids is also implicated in modulating blood coagulation, resulting in potentially life-threatening complications.

Cell phenotypes, immunoglobulins and complement in lesions of eumycetoma caused by Madurella mycetomatis

Mycetoma (maduromycosis) is a common health problem in Sudan. The causative organisms are either true fungi (eumycetoma) or actinomycetes (actinomycetoma). The commonest eumycetoma in Sudan is caused by M mycetomatis. The cell phenotypes, immunoglobulins and complement in lesions of M mycetomatis were characterized by immunohistochemistry. In the H&E sections there were three types of inflammatory reactions. Type I reaction consisted of three zones: a neutrophil zone surrounding the grain, an intermediate zone of macrophages and giant cells and a peripheral zone consisting of lymphocytes and plasma cells. The neutrophils stained positively for CD15. The macrophages were positive for CD68. The majority of cells in the outermost zone were CD3 positive (T lymphocytes); they were rimmed by CD20 positive cells (B lymphocytes). In type II reaction there was no neutrophil zone, the grain being surrounded by macrophages and giant cells that stained positive for CD68. Type III reaction consisted of a discrete epithelioid granuloma without wellformed grains. IgG, IgM and C3 were found on the surface of the grain and the hyphae . Keywords: Madurella mycetomatis lesion, cell phenotypes, immunoglobulins, complement Sudanese Journal of Dermatology Vol. 4(1) 2006: 2-