Fine needle aspiration cytology utility in the identification of Mycetoma causative agents: The Mycetoma Research Center experience.

Sahar Mubarak Bakhiet, Emmanuel Edward Siddig, Omnia Babekir Abdallah, EL Samani Wadaa Mohamed, Ahmed Hassan Fahal


Mycetoma is a serious neglected tropical disease, characterised by various disabilities and high morbidity. Numerous causative organisms of fungal or bacterial origin are implicated in causing mycetoma. Accurate identification of the causative organism is mandatory for proper treatment and management.  Currently, the available diagnostic tests for mycetoma are invasive, tedious, of low sensitivity and specificity and not available in the mycetoma endemic areas. In this communication, we report the Mycetoma Research Centre (MRC), Khartoum, Sudan experience on the fine needle aspiration for cytology (FNAC) technique for the identification of the mycetoma causative organisms based on the cytological reports at the MRC Biobank in the period between 1991-2017. The sensitivity and specificity of the technique for the identification of Madurella mycetomatis was 88.7% and 57.3 %, respectively. For Actinomadura madurae it was 28.7% and 96.6%, respectively. Furthermore, it was 74.1% and 88.9%, respectively for Streptomyces somaliensis and 46.7% and 99.5%, respectively for Actinomadura pelletieri. From this study, it can be concluded that the technique is reasonably accurate in the identification of mycetoma causative organisms, rapid, minimally invasive, and cost-effective procedure. It can be used for the diagnosis of mycetoma in rural areas. The use of the ultrasound-guided aspiration may improve its accuracy

Full Text:



Fahal AH. Mycetoma thorn on the flesh. Trans R Soc Trop Med Hyg. 2004; 98:3–11. 2. Fahal AH, Hassan MA. Mycetoma. Br J Surg. 1992; 79: 1138–1141. 3. Bonifaz A, Tirado-Sánchez A, Calderón L et al. Mycetoma: experience of 482 cases in a single center in Mexico. PLoS Negl Trop Dis. 2014; 21: 8:e3102. 4. Ahmed AO, van Leeuwen W, Fahal A et al. Mycetoma caused by Madurella mycetomatis: a neglected infectious burden. Lancet Infect Dis. 2004; 4:566–74. 5. Fahal AH, van de Sande WW. The Epidemiology of mycetoma.Current Fungal Infection Reports. 2012; 6: 320–326. 6. Fahal AH. Mycetoma in Richard, Guerrant, Walker, Peter, Tropical Infectious Diseases: Principles, Pathogens and Practice. Third edition, Elsevier Publisher; 83: 565–568 (2011). 7. Fahal AH Mycetoma in Williams, Bulstrode, O’Connell, Bailey and Love’s Short Practice of Surgery 26E: 26th Edition, Oxford University Press, pp 84–88. (2013).

Fahal AH. Mycetoma: Clinico-pathological Monograph, University of Khartoum Press, pp 40–49 (2006).

Sahar Mubarak Bakhiet, Emmanuel Edward Siddig, Omnia Babekir Abdallah, EL Samani Wadaa Mohamed , Ahmed Hassan Fahal

Ahmed AOA, van de Sande WW, Fahal A, et al. Management of mycetoma: major challenge in tropical mycoses with limited international recognition Curr Opin Infect Dis. . 2007; 20:146–51. 10. van Belkum A, Fahal AH, van de Sande WW. Mycetoma by Madurella mycetomatis: A completely neglected medico-social dilemma. In Hot Topics in Infection and Immunity in Children IX. Springer Science & Business Media,New York. (2012) 11. Fahal AH, Suliman SH, Gadir AFA, et al. Abdominal wall mycetoma: an unusual presentation. Trans R Soc Trop Med Hyg. 1994; 88:78–80. 12. Hassan MA, Fahal AH. Mycetoma: in Tropical Surgery, Kamil R, Lumbly J, Westminster Publication LTD, pp 30–45. (2004). 13. Fahal AH, Suliman SH. Clinical presentation of mycetoma. Sudan Med J. 1994; 32: 46–66. 14. López-Martínez R, Méndez Tovar LJ, Lavalle P, Welsh O, Saúl A, Epidemiology of mycetoma in Mexico: study of 2105 cases. Gac Med Mex. 1992;128:477–81. 15. Mexico. A review of 3933 cases. Gac Med Mex. 2013;149: 586–92. 16. Ahmed AOA, Adelmann D, Fahal AH, et al. Environmental occurrence of Madurella mycetomatis, major agent of human eumycetoma in Sudan. J Clin Microbiol. 2002;40: 1031–1036. 17. van de Sande WW. Global burden of human mycetoma: a systematic review and metaanalysis. PLoS Negl Trop Dis 2013; 7: e2550. 18. Scolding PS, Abbas MAQ, Omer RF, Fahal AH. Madurella mycetomatis-Induced Massive Shoulder Joint Destruction: A Management Challenge PLoS Negl Trop Dis. 2016; 10: e0004849. 19. Omer RF, Seif EL Din N, Abdel Rahim FA, Fahal AH Hand Mycetoma: The Mycetoma Research

Centre Experience and Literature Review PloS Negl Trop Dis . 2016; 10: e0004886. 20. Mahgoub ES, Murray IG. Mycetoma. London. William Heinemann. Medical Books. pp. 2–25. (1973). 21. van de Sande W, Fahal A, Ahmed SA, et al. Closing the mycetoma knowledge gap. Med Mycol. 2017; 9. doi: 10.1093/mmy/myx061. [Epub ahead of print]. 22. Hay RJ, Fahal AH Mycetoma: an old and still neglected tropical disease. Trans R Soc Trop Med Hyg. . 2015 ;109:169–70. 23. Lynch JB. Mycetoma in the Sudan. Ann R Coll Surg Engl. 1964;35: 319–24. 24. Fahal A, Mahgoub ES, EL Hassan AM, et al A New Model for Management of Mycetoma in the Sudan. PLoS Negl Trop Dis. 2014 ; 8: e3271. 25. Aounallah A, Boussofara L, Ben Saïd Z et al. Analysis of 18 Tunisian cases of mycetoma at the Sousse hospital (1974–2010). Bull Soc Pathol Exot. 2013;106: 5–8. 26. Dieng MT, Niang SO, Diop B, Ndiaye B. Actinomycetomas in Senegal: study of 90 cases. Bull Soc Pathol Exot. 2005; 98:18–20. 27. Marc S, Meziane M, Hamada S, Hassam B, Benzekri L. Clinical and epidemiological features of mycetoma in Morocco. Med Mal Infect.2011;41:163–4. 28. Nenoff P, van de Sande WW, Fahal AH, Reinel D, Schöfer H. Eumycetoma and actinomycetoma—an update on causative agents, epidemiology, pathogenesis, diagnostics and therapy. J Eur Acad Dermatol Venereol. 2015; 29:1873– 83. 29. Fahal A, Mahgoub ES, EL Hassan AM, Jacoub AO, Hassan D. Head and Neck Mycetoma: The Mycetoma Research Centre Experience. PloS Negl Trop Dis 2015; 9: e0003587. 30. Fahal AH, EL Hassan AM, Mahgoub ES,

Fine needle aspiration cytology utility in the identification of Mycetoma causative agents: The Mycetoma Research Center experience

Rahman ME. Mycetoma in the Sudan: The Mycetoma Research Centre Update PLoS Negl Trop Dis. 2015 ; 9:e0003679. eCollection 2015 Mar. 31. Taha Hala, Fahal Ahmed, van de Sande Wendy WJ. Mycetoma:epidemiology, treatment challenges and progress. Res Rep Trop Med. 2015;6; 31– 32.Lacroix C, de Kerviler E, Morel P, Derouin F, Feuilhade de Chavin M. Madurella mycetomatis mycetoma treated successfully with oral Voriconazole Br J Dermatol. . 2005 ;152: 1067–68. pmid:15888176 33. Fahal AH, Shaheen S, Jones DH The orthopaedic aspects of mycetoma. Bone Joint J 2014; 96-B: 420–425. 34. Maiti PK, Ray A, Bandyopadhyay S. Epidemiological aspects of mycetoma from a retrospective study of 264 cases in West Bengal. Trop Med Int Health. 2002; 7: 788–92. 35. Fahal AH, el Toum EA, el Hassan AM, Mahgoub ES, Gumaa SA. The host tissue reaction to Madurella mycetomatis: new classification. J Med Vet Mycol 1995; 33: 15–17. 36. Ahmed AO, Mukhtar MM, Kools-Sijmons M, et al. Development of a species-specific PCRrestriction fragment length polymorphism analysis procedure for identification of Madurella mycetomatis. J Clin Microbiol 1999; 37: 3175–3178. 37. Baveja C. Medical Mycology In: Arora DR, Arora BB, editors. Textbook of Microbiology for Dental Students. 3rd ed. Delhi, India: Arya Publications; 322–323 (2010). 38. Yousif BM, Fahal AH, Shakir MY. a new technique for the diagnosis of mycetoma using fixed blocks of aspirated material. Trans R Soc Trop Med Hyg 2010; 104 : 6–9. 39. Wendy WJ van de Sande, Ahmed H Fahal, et al. The merits and pitfalls of the currently used diagnostic tools in mycetoma PLoS Negl Trop

Dis. 2014; 03, 2014. 40. de Hoog GS, Adelmann D, Ahmed AO, van Belkum A. Phylogeny and typification of Madurella mycetomatis, with a comparison of other agents of eumycetoma Mycoses. 2004; 47:121–30. 41. Abd El-Bagi ME, Fahal AH. Mycetoma revisited. Incidence of various radiographic signs. Saudi Med J 2009; 30: 529–533. 42. El Shamy ME, Fahal AH, Shakir MY, Homeida MM. New MRI grading system for the diagnosis and management of mycetoma. Trans R Soc Trop Med Hyg 2012;106 : 738–742. 43. Fahal AH, Sheikh HE, EL Lider MA et al. Ultrasonic imaging in mycetoma. Br J Surg. 1997; 78: 765–766. 44. Abd El Bagi ME. New radiographic classification of bone involvement in pedal mycetoma. Am J Roentgenol. 2003;180: 665–668 45. Welsh O, Al-Abdely HM, Salinas-Carmona MC, Fahal AH Mycetoma Medical Therapy. PLoS Negl Trop Dis 2014; 8: e3218. 46. van de Sande WWJ, Maghoub ES, Fahal AH, Goodfellow M, Welsh O, Zijlstra E The Mycetoma Knowledge Gap: Identification of Research Priorities PLoS Negl Trop Dis. 2014; 8: e2667. 47. Fahal AH Mycetoma: A global medical and socio-economic dilemma. PLoS Negl Trop Dis 2017;11: e0005509. 48. Fahal A, Mahgoub ES, Hassan AME, AbdelRahman ME Mycetoma in the Sudan: An Update from the Mycetoma Research Centre, University of Khartoum, Sudan PLoS Negl Trop Dis . 2015 ;9: e0003679. 49. King, DF, King, LA. A brief historical note on staining by hematoxylin and eosin. Am J Dermatopathol 1986; 8:168? 50. Webb A. J. Through a glass darkly (the development of needle aspiration biopsy)

Sahar Mubarak Bakhiet, Emmanuel Edwar Siddig, Omnia Babekir Abdallah, EL Samani Wadaa Mohamed , Ahmed Hassan Fahal

Bristol Med.. Chir. J. 1974;89:59–68. 51. Frable W. Thin needle aspiration biopsy. In Major problems in pathology. ed Bennington J. (The W. B. Saunders Co. Philadelphia, Pa), pp 1–5. (1983). 52. Grieg E. D. W., Gray A. C. H. Note on the lymphatic glands in sleeping sickness. Br. Med. J. 1904;1: 1252. 53. Silverman JF, Gay RM Fine-needle aspiration and surgical pathology of infectious lesions. Morphologic features and the role of the clinical microbiology laboratory for rapid diagnosis. Clin Lab Med .1995; 15: 251–278. 54. Bapat KC, Pandit AA. Actinomycotic mycetoma. Report of a case with diagnosis by fine needle aspiration Acta Cytol . 1991; 35:770-2. 55. Stanley MW, Deike M, Knoedler J, Iber C. Pulmonary mycetomas in immunocompetent patients: diagnosis by fine-needle aspiration. Diagn Cytopathol 1992;8 :577-9. 56. EL Hag IA, Fahal AH, Khalil EAG. Fine needle aspiration cytology of Mycetoma. Acta Cytologica. 1996; 40: 461–46. 57. Sangoi AR, Rogers WM, Longacre TA, Montoya JG, Baron EJ, Banaei N.Challenges and pitfalls of morphologic identification of fungal infections in histologic and cytologic specimens: a ten-year retrospective review at a single institution. Am J Clin Pathol 2009;131: 364-75.58. 58. Almarzooqi S, Leber A, Kahwash S. Artifacts and organism mimickers in pathology: case examples and review of literature Adv Anat Pathol. 2010;17: 277- 81. 59. Martínez-Girón R1, Ribas-Barceló A. Algae in cytologic smears. Acta 2001; 45: 936-40.


  • There are currently no refbacks.

ISSN: 1858-5345