Mycetoma Research Centre, University of Khartoum, PO Box 102, Khartoum, Sudan.
Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan.
Trans R Soc Trop Med Hyg. 2021 Apr 14;115(4):426-430. doi: 10.1093/trstmh/trab010.
Species of the genus Microascus are uncommon agents of human diseases despite their ubiquitous presence in the environment. In this communication, the first case of white grain eumycetoma caused by the fungus Microascus gracilis is reported. The patient was initially misdiagnosed as having actinomycetoma based on the grains morphological and cytological features and was treated with antimicrobial therapy with no clinical improvement. She underwent wide local surgical excision to improve the response to medical treatment and further grain cultural, molecular and taxonomy techniques were conducted and the diagnosis of mycetoma due to M. gracilis was established. The antifungal susceptibilities of this isolate to nine drugs were tested in vitro and they showed poor activity. Combination therapy with surgery and itraconazole led to complete recovery. A medical literature search revealed no previous report on M. gracilis as a causative agent of eumycetoma and hence we are reporting this new causative agent of human eumycetoma. Also, the difficulty in the management of this patient emphasizes the need for accurate and appropriate diagnostic tests for the identification of mycetoma-causative organisms and thus proper management.
尽管环境中普遍存在，但属于 Microascus 属的真菌通常不会引起人类疾病。本通讯首次报道了由 Microascus gracilis 引起的白色颗粒状外源性真菌病。该患者最初根据颗粒的形态学和细胞学特征误诊为放线菌病，并接受了抗菌治疗，但无临床改善。为了提高对药物治疗的反应，进行了广泛的局部手术切除，并进一步进行了颗粒培养、分子和分类学技术，诊断为 M. gracilis 引起的真菌病。该分离株对九种药物的体外药敏试验显示活性较差。联合手术和伊曲康唑治疗导致完全康复。文献检索未发现 M. gracilis 以前是外源性真菌病的病原体，因此我们报告了这种新的人类外源性真菌病的病原体。此外，该患者的管理困难强调了需要进行准确和适当的诊断测试以识别真菌病病原体，从而进行适当的管理。
