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Molecular Phylogenetic Analysis of Paracoccidioides Species Complex Present in Paracoccidioidomycosis Patient Tissue Samples. Microorganisms 2023; 11:microorganisms11030562. [PMID: 36985136 PMCID: PMC10055015 DOI: 10.3390/microorganisms11030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is the main and most prevalent systemic mycosis in Latin America, that until recently, it was believed to be caused only by Paracoccidioides brasiliensis (P. brasiliensis). In 2006, researchers described three cryptic species: S1, PS2, PS3, and later, another one, PS4. In 2009, Paracoccidioides lutzii (Pb01-like) was described, and in 2017, a new nomenclature was proposed for the different agents: P. brasiliensis (S1), P. americana (PS2), P. restrepiensis (PS3), and P. venezuelensis (PS4). These species are not uniformly distributed throughout Latin America and, knowing that more than one cryptic species could coexist in some regions, we aimed to identify those species in patients’ biopsy samples for a better understanding of the distribution and occurrence of these recently described species in Botucatu region. The Hospital of Medical School of Botucatu—UNESP, which is a PCM study pole, is located in São Paulo State mid-west region and is classified as a PCM endemic area. Genotyping analyses of clinical specimens from these patients that have been diagnosed and treated in our Hospital could favor a possible correlation between genetic groups and mycological and clinical characteristics. For this, molecular techniques to differentiate Paracoccidioides species in these biopsies, such as DNA extraction, PCR, and sequencing of three target genes (ITS, CHS2, and ARF) were conducted. All the sequences were analyzed at BLAST to testify the presence of P. brasiliensis. The phylogenetic trees were constructed using Mega 7.0 software and showed that 100% of our positive samples were from S1 cryptic species, therefore P. brasiliensis. This is important data, demonstrating the predominance of this species in the São Paulo State region.
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Ricci G, Campanini EB, Nishikaku AS, Puccia R, Marques M, Bialek R, Rodrigues AM, Batista WL. PbGP43 Genotyping Using Paraffin-Embedded Biopsies of Human Paracoccidioidomycosis Reveals a Genetically Distinct Lineage in the Paracoccidioides brasiliensis Complex. Mycopathologia 2021; 187:157-168. [PMID: 34870754 DOI: 10.1007/s11046-021-00608-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022]
Abstract
Paracoccidioidomycosis (PCM) is a systemic mycosis caused by a group of cryptic species embedded in the Paracoccidioides brasiliensis complex and Paracoccidioides lutzii. Four species were recently inferred to belong to the P. brasiliensis complex, but the high genetic diversity found in both human and environmental samples have suggested that the number of lineages may be higher. This study aimed to assess the 43-kilodalton glycoprotein genotypes (PbGP43) in paraffin-embedded samples from PCM patients to infer the phylogenetic lineages of the P. brasiliensis complex responsible for causing the infection. Formalin-fixed, paraffin-embedded (FFPE) tissue samples from patients with histopathological diagnosis of PCM were analyzed. DNAs were extracted and amplified for a region of the second exon of the PbGP43 gene. Products were sequenced and aligned with other PbGP43 sequences available. A haplotype network and the phylogenetic relationships among sequences were inferred. Amino acid substitutions were investigated regarding the potential to modify physicochemical properties in the proteins. Six phylogenetic lineages were identified as belonging to the P. brasiliensis complex. Two lineages did not group with any of the four recognized species of the complex, and, interestingly, one of them comprised only FFPE samples. A coinfection involving two lineages was found. Five parsimony-informative sites were identified and three of them showed radical non-synonymous substitutions with the potential to promote changes in the protein. This study expands the knowledge regarding the genetic diversity existing in the P. brasiliensis complex and shows the potential of FFPE samples in species identification and in detecting coinfections.
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Affiliation(s)
- Giannina Ricci
- Centro de Diagnóstico e Pesquisa em Biologia Molecular Dr Ivo Ricci, São Carlos, SP, Brazil.
- Departamento de Patologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Emeline Boni Campanini
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Angela Satie Nishikaku
- Centro de Diagnóstico e Pesquisa em Biologia Molecular Dr Ivo Ricci, São Carlos, SP, Brazil
| | - Rosana Puccia
- Disciplina de Biologia Celular, Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mariângela Marques
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP, Brazil
| | - Ralf Bialek
- LADR GmbH MVZ Dr, Kramer & Kollegen, Lauenburger Straße 67, 21502, Geesthacht, Germany
| | - Anderson Messias Rodrigues
- Disciplina de Biologia Celular, Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Wagner Luiz Batista
- Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo, Campus Diadema, São Paulo, SP, Brazil
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de Souza Scramignon-Costa B, Almeida-Silva F, Wanke B, Weksler M, Moratelli R, do Valle ACF, Zancopé-Oliveira RM, Almeida-Paes R, Bueno C, de Macedo PM. Molecular eco-epidemiology of Paracoccidioides brasiliensis in road-killed mammals reveals Cerdocyon thous and Cuniculus paca as new hosts harboring this fungal pathogen. PLoS One 2021; 16:e0256668. [PMID: 34428263 PMCID: PMC8384157 DOI: 10.1371/journal.pone.0256668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022] Open
Abstract
Wild animals infected with Paracoccidioides brasiliensis represent important indicators of this fungal agent presence in the environment. The detection of this pathogen in road-killed wild animals has shown to be a key strategy for eco-epidemiological surveillance of paracoccidioidomycosis (PCM), helping to map hot spots for human infection. Molecular detection of P. brasiliensis in wild animals from PCM outbreak areas has not been performed so far. The authors investigated the presence of P. brasiliensis through nested-PCR in tissue samples obtained from road-killed animals collected nearby a human PCM outbreak spot, Rio de Janeiro state, Brazil and border areas. Eighteen species of mammals were analyzed: Dasypus novemcinctus (nine-banded armadillo, n = 6), Cerdocyon thous (crab-eating fox, n = 4), Coendou spinosus (hairy dwarf porcupine, n = 2), Lontra longicaudis (Neotropical river otter, n = 1), Procyon cancrivorus (crab-eating raccoon, n = 1), Galactis cuja (lesser grison, n = 1), Tamandua tetradactyla (collared anteater, n = 1), Cuniculus paca (paca, n = 1), and Bradypus variegatus (brown-throated three-toed sloth, n = 1). Specific P. brasiliensis sequences were detected in the liver, spleen, and lymph node samples from 4/6 (66.7%) D. novemcinctus, reinforcing the importance of these animals on Paracoccidioides ecology. Moreover, lymph nodes samples from two C. thous, as well as lung samples from the C. paca were also positive. A literature review of Paracoccidioides spp. in vertebrates in Brazil indicates C. thous and C. paca as new hosts for the fungal pathogen P. brasiliensis.
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Affiliation(s)
- Bruno de Souza Scramignon-Costa
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Fernando Almeida-Silva
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Bodo Wanke
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcelo Weksler
- Departamento de Vertebrados, Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Moratelli
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Antonio Carlos Francesconi do Valle
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rosely Maria Zancopé-Oliveira
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Cecília Bueno
- Núcleo de Estudos de Vertebrados Silvestres, Universidade Veiga de Almeida, Rio de Janeiro, Brazil
| | - Priscila Marques de Macedo
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- * E-mail:
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de Souza Suguiura IM, Macagnan R, Omori AM, Buck EL, Scarpassa JA, Pretto-Giordano LG, Vilas-Boas LA, de Camargo ZP, Itano EN, Ono MA. First report of Paracoccidioides brasiliensis infection in fish. Med Mycol 2021; 58:737-743. [PMID: 31773156 DOI: 10.1093/mmy/myz120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/01/2019] [Accepted: 11/08/2019] [Indexed: 11/14/2022] Open
Abstract
The thermodimorphic fungus Paracoccidioides brasiliensis is the etiological agent of paracoccidioidomycosis (PCM), a deep mycosis endemic in Latin American countries that affects mainly male rural workers. Infection by P. brasiliensis has also been reported in several species of terrestrial animals; however, the capacity of the fungus to infect aquatic organisms is poorly known. The aim of this study was to detect P. brasiliensis in a fish species, Nile tilapia (Oreochromis niloticus), the most farmed and widely distributed fish in endemic areas for human PCM in Brazil. As a first step, the humoral immune response against the fungus was evaluated in an experimental group of three fish immunized with inactivated P. brasiliensis yeast cells. For the seroepidemiological study, serum samples of Nile tilapia raised in cages (n = 109) and in ponds (n = 105), collected from a fish slaughterhouse, were analyzed for P. brasiliensis antibodies by ELISA using gp43 as antigen. All the inoculated fish produced antibodies against the fungus. The seropositivity observed in fish raised in cages and ponds was 17.4 and 5.7%, respectively. Due to the higher seropositivity observed in caged fish, 100 tissue samples (encephalon, liver, and kidney), from another group of tilapia raised in cages, were analyzed by polymerase chain reaction (PCR; Pb-ITSR and Pb-ITSE). Three tissue samples (liver n = 1, kidney n = 1, and enchepahlon n = 1) from three different fish resulted positive to PCR. This is the first report to show serological and molecular evidence of P. brasiliensis infection in a fish species.
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Affiliation(s)
- Igor Massahiro de Souza Suguiura
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, PR 445 Km 380, Londrina, Paraná, Brazil
| | - Rafaela Macagnan
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, PR 445 Km 380, Londrina, Paraná, Brazil
| | - Aline Myuki Omori
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, PR 445 Km 380, Londrina, Paraná, Brazil
| | - Elder Luis Buck
- Departamento de Zootecnia, Centro de Ciências Agrárias, Universidade Estadual de Londrina, PR 445 Km 380, Londrina, Paraná, Brazil
| | - Josiane Aniele Scarpassa
- Departamento de Biologia Geral, Centro de Ciências Biológicas, Universidade Estadual de Londrina, PR 445 Km 380, Londrina, Paraná, Brazil
| | - Lucienne Garcia Pretto-Giordano
- Departamento de Medicina Veterinária Preventiva, Centro de Ciências Agrárias, Universidade Estadual de Londrina, PR 445 Km 380, Londrina, Paraná, Brazil
| | - Laurival Antônio Vilas-Boas
- Departamento de Biologia Geral, Centro de Ciências Biológicas, Universidade Estadual de Londrina, PR 445 Km 380, Londrina, Paraná, Brazil
| | | | - Eiko Nakagawa Itano
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, PR 445 Km 380, Londrina, Paraná, Brazil
| | - Mario Augusto Ono
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, PR 445 Km 380, Londrina, Paraná, Brazil
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Rodrigues TF, Mantellatto AMB, Superina M, Chiarello AG. Ecosystem services provided by armadillos. Biol Rev Camb Philos Soc 2020; 95:1-21. [PMID: 31448491 DOI: 10.1111/brv.12551] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 01/24/2023]
Abstract
Awareness of the natural ecological processes provided by organisms that benefit human well-being has significantly progressed towards the goal of making conservation a mainstream value. Identifying different services and the species that provide them is a vital first step for the management and maintenance of these so-called ecosystem services. Herein, we specifically address the armadillos, which play key functional roles in terrestrial ecosystems, including as ecosystem engineers, predators, and vectors of invertebrates and nutrients, although these roles have often been overlooked. Armadillos can control pests, disperse seeds, and be effective sentinels of potential disease outbreaks or bioindicators of environmental contaminants. They also supply important material (meat, medicines) and non-material (learning, inspiration) contributions all over the Americas. We identify key gaps in the understanding of ecosystem services provided by armadillos and areas for future research required to clarify their functional role in terrestrial ecosystems and the services they supply. Such information will produce powerful arguments for armadillo conservation.
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Affiliation(s)
- Thiago F Rodrigues
- Applied Ecology Program, Luiz de Queiroz College of Agriculture, University of São Paulo, Piracicaba, 13418-900, SP, Brazil
| | - Aline M B Mantellatto
- Universidade Federal do Sul da Bahia, Campus Sosígenes Costa, Porto Seguro, 45810-000, BA, Brazil
| | - Mariella Superina
- Laboratorio de Medicina y Endocrinología de la Fauna Silvestre, IMBECU - CCT CONICET Mendoza, Mendoza, 5500, Argentina
| | - Adriano G Chiarello
- Department of Biology, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14040-901, SP, Brazil
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Romaneli MTDN, Tardelli NR, Tresoldi AT, Morcillo AM, Pereira RM. Acute-subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non-survival predictor. Mycoses 2019; 62:999-1005. [PMID: 31408548 DOI: 10.1111/myc.12984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 11/27/2022]
Abstract
The acute-subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute-subacute PCM, to determine a mortality risk factor and to propose a test for non-survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15 years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P < .05). Through a period of 38 years, 141 children and adolescents were diagnosed with acute-subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole-trimethoprim (SMX-TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut-off for serum albumin was 2.18 g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute-subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage ≤ 2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard.
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Mendes JF, Von Groll A, Poester VR, Brasil CL, Brandolt TM, Klafke GB, Nogueira CEW, Meireles MCA, Xavier MO. Paracoccidioides spp. in Soil from the Pampa Biome in Southern Brazil. Curr Microbiol 2019; 76:258-262. [PMID: 30600363 DOI: 10.1007/s00284-018-1621-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
High rates of paracoccidioidomycosis disease and infection have been recently reported in southern Brazil. However, the knowledgment about the ecoepidemiology of Paracoccidioides spp. in the region is limited, therefore, this study aimed to evaluate the presence of Paracoccidioides spp. DNA in soil samples from a rural area in Southern Rio Grande do Sul, Brazil. Thirty pools of soil samples from Bagé, RS (31º19'53"S 54º06'25"W) were submitted to physicochemical analysis, and to fungal DNA extraction by Norgen Biotek® Kit (Thorold, Canada), followed by Nested PCR technique with ITS4 and ITS5 as external primers, and PBITS-E and PBITS-T as internal primers. DNA amplification products of about 424 bp compatible with Paracoccidioides spp. were detected in eight (26.7%) of the 30 pools of samples, being three were sequenced and identified as P. brasiliensis. Positive soils were characterized by high levels of humidity, organic matter, basic saturation, and pH. This study shows for the first time the presence of Paracoccidioides spp. DNA at soils from the Brazilian Pampa Biome, proving that people living in those areas are exposed to the main agent of paracoccidioidomycosis.
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Affiliation(s)
- Josiara Furtado Mendes
- Post-Graduation Program in Veterinary, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Andrea Von Groll
- Post-Graduation Program in Health Science, Federal University of Rio Grande (FURG), Rio Grande, Brazil
| | - Vanice Rodrigues Poester
- Post-Graduation Program in Health Science, Federal University of Rio Grande (FURG), Rio Grande, Brazil.,Mycology Lab, Faculty of Medicine, Federal University of Rio Grande (FAMED-FURG), Health Campus, Visconde de Paranaguá 102, Centro, Rio Grande, RS, CEP 96201-900, Brazil
| | | | - Tchana Martinez Brandolt
- Post-Graduation Program in Health Science, Federal University of Rio Grande (FURG), Rio Grande, Brazil.,Mycology Lab, Faculty of Medicine, Federal University of Rio Grande (FAMED-FURG), Health Campus, Visconde de Paranaguá 102, Centro, Rio Grande, RS, CEP 96201-900, Brazil
| | - Gabriel Baracy Klafke
- Mycology Lab, Faculty of Medicine, Federal University of Rio Grande (FAMED-FURG), Health Campus, Visconde de Paranaguá 102, Centro, Rio Grande, RS, CEP 96201-900, Brazil
| | | | | | - Melissa Orzechowski Xavier
- Post-Graduation Program in Health Science, Federal University of Rio Grande (FURG), Rio Grande, Brazil. .,Mycology Lab, Faculty of Medicine, Federal University of Rio Grande (FAMED-FURG), Health Campus, Visconde de Paranaguá 102, Centro, Rio Grande, RS, CEP 96201-900, Brazil. .,Post-Graduation Program in Parasitology UFPel, Pelotas, RS, Brazil.
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Seyedmousavi S, Bosco SDMG, de Hoog S, Ebel F, Elad D, Gomes RR, Jacobsen ID, Jensen HE, Martel A, Mignon B, Pasmans F, Piecková E, Rodrigues AM, Singh K, Vicente VA, Wibbelt G, Wiederhold NP, Guillot J. Fungal infections in animals: a patchwork of different situations. Med Mycol 2018. [PMID: 29538732 DOI: 10.1093/mmy/myx104] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The importance of fungal infections in both human and animals has increased over the last decades. This article represents an overview of the different categories of fungal infections that can be encountered in animals originating from environmental sources without transmission to humans. In addition, the endemic infections with indirect transmission from the environment, the zoophilic fungal pathogens with near-direct transmission, the zoonotic fungi that can be directly transmitted from animals to humans, mycotoxicoses and antifungal resistance in animals will also be discussed. Opportunistic mycoses are responsible for a wide range of diseases from localized infections to fatal disseminated diseases, such as aspergillosis, mucormycosis, candidiasis, cryptococcosis and infections caused by melanized fungi. The amphibian fungal disease chytridiomycosis and the Bat White-nose syndrome are due to obligatory fungal pathogens. Zoonotic agents are naturally transmitted from vertebrate animals to humans and vice versa. The list of zoonotic fungal agents is limited but some species, like Microsporum canis and Sporothrix brasiliensis from cats, have a strong public health impact. Mycotoxins are defined as the chemicals of fungal origin being toxic for warm-blooded vertebrates. Intoxications by aflatoxins and ochratoxins represent a threat for both human and animal health. Resistance to antifungals can occur in different animal species that receive these drugs, although the true epidemiology of resistance in animals is unknown, and options to treat infections caused by resistant infections are limited.
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Affiliation(s)
- Seyedmojtaba Seyedmousavi
- Molecular Microbiology Section, Laboratory of Clinical Microbiology and Immunology (LCMI), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Sandra de M G Bosco
- Department of Microbiology and Immunology, Institute of Biosciences-UNESP Univ Estadual Paulista Botucatu, São Paulo, Brazil
| | - Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, and Center of Expertise in Mycology of Radboudumc/CWZ, Nijmegen, The Netherlands
| | - Frank Ebel
- Institut für Infektionsmedizin und Zoonosen, Munich, Germany
| | - Daniel Elad
- Department of Clinical Bacteriology and Mycology, Kimron Veterinary Institute, Veterinary Services, Ministry of Agriculture, Beit Dagan, Israel
| | - Renata R Gomes
- Microbiology, Parasitology and Pathology Graduate Programme, Curitiba Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Ilse D Jacobsen
- Research Group Microbial Immunology, Hans Knöll Institute, Jena, Germany
| | | | - An Martel
- Department of Pathology, Bacteriology and Avian Diseases. Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bernard Mignon
- Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, FARAH (Fundamental and Applied Research for Animals & Health), University of Liège, Liège, Belgium
| | - Frank Pasmans
- Department of Pathology, Bacteriology and Avian Diseases. Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Elena Piecková
- Faculty of Medicine, Slovak Medical University, Faculty of Chemical and Food Technology, Slovak University of Technology, Bratislava, Slovakia
| | - Anderson Messias Rodrigues
- Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil
| | - Karuna Singh
- Department of Zoology, Mahila Mahavidyalaya, Banaras Hindu University, Varanasi, India
| | - Vania A Vicente
- Research Group Microbial Immunology, Hans Knöll Institute, Jena, Germany
| | - Gudrun Wibbelt
- Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jacques Guillot
- Department of Parasitology, Mycology and Dermatology, EA Dynamyc UPEC, EnvA, Ecole nationale vétérinaire d'Alfort, Maisons-Alfort, France
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da Paz GS, Adorno BMV, Richini-Pereira VB, Bosco SMG, Langoni H. Infection byHistoplasma capsulatum, Cryptococcusspp. andParacoccidioides brasiliensisin bats collected in urban areas. Transbound Emerg Dis 2018; 65:1797-1805. [DOI: 10.1111/tbed.12955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 06/07/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Giselle S. da Paz
- Department of Veterinary Hygiene and Public Health; School of Veterinary Medicine and Animal Science; UNESP Univ Estadual Paulista; Botucatu Brazil
| | - Brunna Mayla V. Adorno
- Department of Veterinary Hygiene and Public Health; School of Veterinary Medicine and Animal Science; UNESP Univ Estadual Paulista; Botucatu Brazil
| | - Virgínia B. Richini-Pereira
- Center of Regional Laboratories II - Bauru; Center of Biomedical Science; Adolfo Lutz Institute; Bauru Brazil
| | - Sandra M. G. Bosco
- Department of Microbiology and Immunology; Biosciences Institute; UNESP Univ Estadual Paulista; Botucatu Brazil
| | - Helio Langoni
- Department of Veterinary Hygiene and Public Health; School of Veterinary Medicine and Animal Science; UNESP Univ Estadual Paulista; Botucatu Brazil
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Evidence of zoonotic leprosy in Pará, Brazilian Amazon, and risks associated with human contact or consumption of armadillos. PLoS Negl Trop Dis 2018; 12:e0006532. [PMID: 29953440 PMCID: PMC6023134 DOI: 10.1371/journal.pntd.0006532] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/15/2018] [Indexed: 11/19/2022] Open
Abstract
Mycobacterium leprae (M. leprae) is a human pathogen and the causative agent for leprosy, a chronic disease characterized by lesions of the skin and peripheral nerve damage. Zoonotic transmission of M. leprae to humans by nine-banded armadillos (Dasypus novemcinctus) has been shown to occur in the southern United States, mainly in Texas, Louisiana, and Florida. Nine-banded armadillos are also common in South America, and residents living in some areas in Brazil hunt and kill armadillos as a dietary source of protein. This study examines the extent of M. leprae infection in wild armadillos and whether these New World mammals may be a natural reservoir for leprosy transmission in Brazil, similar to the situation in the southern states of the U.S. The presence of the M. leprae-specific repetitive sequence RLEP was detected by PCR amplification in purified DNA extracted from armadillo spleen and liver tissue samples. A positive RLEP signal was confirmed in 62% of the armadillos (10/16), indicating high rates of infection with M. leprae. Immunohistochemistry of sections of infected armadillo spleens revealed mycobacterial DNA and cell wall constituents in situ detected by SYBR Gold and auramine/rhodamine staining techniques, respectively. The M. leprae-specific antigen, phenolic glycolipid I (PGL-I) was detected in spleen sections using a rabbit polyclonal antibody specific for PGL-I. Anti-PGL-I titers were assessed by ELISA in sera from 146 inhabitants of Belterra, a hyperendemic city located in western Pará state in Brazil. A positive anti-PGL-I titer is a known biomarker for M. leprae infection in both humans and armadillos. Individuals who consumed armadillo meat most frequently (more than once per month) showed a significantly higher anti-PGL-I titer than those who did not eat or ate less frequently than once per month. Armadillos infected with M. leprae represent a potential environmental reservoir. Consequently, people who hunt, kill, or process or eat armadillo meat are at a higher risk for infection with M. leprae from these animals.
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Losnak DO, Rocha FR, Almeida BS, Batista KZS, Althoff SL, Haupt J, Ruiz LS, Anversa L, Lucheis SB, Paiz LM, Donalisio MR, Richini Pereira VB. Molecular detection of fungi of public health importance in wild animals from Southern Brazil. Mycoses 2018; 61:455-463. [PMID: 29575049 DOI: 10.1111/myc.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 01/28/2023]
Abstract
Some animals have an important relationship with fungal infections, and searching for pathogens in animal samples may be an opportunity for eco-epidemiological research. Since studies involving wildlife are generally restricted, using samples from road kills is an alternative. The aim of this study was to verify whether pathogenic fungi of public health importance occur in wildlife road kills from Santa Catarina State, Brazil. Organ samples (n = 1063) from 297 animals were analysed according to Polymerase Chain Reaction (PCR) using universal primers to detect fungi in general and, subsequently, using primers specific to Paracoccidioides brasiliensis, Histoplasma capsulatum and Cryptococcus spp. There were 102 samples positive for fungal species. Eight samples were positive for P. brasiliensis, three samples were positive for Cryptococcus spp. and one sample had coinfection by these two fungi. No sample was positive for Histoplasma spp. according to the molecular detection. Genetic sequencing allowed the identification of Fungal sp. in 89 samples, Cryptococcus neoformans in two samples and Aspergillus penicillioides in three samples. This study shows the importance of wild animals in the epidemiology of fungal infections and assists in the mapping of pathogen occurrence in a region that was not previously evaluated.
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Affiliation(s)
- Debora O Losnak
- Department of Tropical Diseases and Imaging Diagnosis, Botucatu Medical School, Unesp - Univ Estadual Paulista, São Paulo, Brazil
| | - Francielle R Rocha
- Adolfo Lutz Institute, Center of Regional Laboratories II - Bauru, Center of Biomedical Science, São Paulo, Brazil
| | - Barbara S Almeida
- Adolfo Lutz Institute, Center of Regional Laboratories II - Bauru, Center of Biomedical Science, São Paulo, Brazil
| | - Keila Z S Batista
- Laboratory of Immunology, Department of Natural Sciences, Regional University of Blumenau, Blumenau-SC, Brazil
| | - Sérgio L Althoff
- Laboratory of Animal Biology, Department of Natural Sciences, Regional University of Blumenau, Blumenau-SC, Brazil
| | | | - Luciana S Ruiz
- Adolfo Lutz Institute, Center of Regional Laboratories II - Bauru, Center of Biomedical Science, São Paulo, Brazil
| | - Laís Anversa
- Adolfo Lutz Institute, Center of Regional Laboratories II - Bauru, Center of Biomedical Science, São Paulo, Brazil
| | | | - Laís M Paiz
- Department of Public Health, School of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Maria Rita Donalisio
- Department of Public Health, School of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
| | - Virginia B Richini Pereira
- Adolfo Lutz Institute, Center of Regional Laboratories II - Bauru, Center of Biomedical Science, São Paulo, Brazil
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12
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Hrycyk MF, Garcia Garces H, Bosco SDMG, de Oliveira SL, Marques SA, Bagagli E. Ecology of Paracoccidioides brasiliensis, P. lutzii and related species: infection in armadillos, soil occurrence and mycological aspects. Med Mycol 2018; 56:950-962. [DOI: 10.1093/mmy/myx142] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/16/2017] [Indexed: 11/14/2022] Open
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13
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Mendes RP, Cavalcante RDS, Marques SA, Marques MEA, Venturini J, Sylvestre TF, Paniago AMM, Pereira AC, da Silva JDF, Fabro AT, Bosco SDMG, Bagagli E, Hahn RC, Levorato AD. Paracoccidioidomycosis: Current Perspectives from Brazil. Open Microbiol J 2017; 11:224-282. [PMID: 29204222 PMCID: PMC5695158 DOI: 10.2174/1874285801711010224] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This review article summarizes and updates the knowledge on paracoccidioidomycosis. P lutzii and the cryptic species of P. brasiliensis and their geographical distribution in Latin America, explaining the difficulties observed in the serological diagnosis. OBJECTIVES Emphasis has been placed on some genetic factors as predisposing condition for paracoccidioidomycosis. Veterinary aspects were focused, showing the wide distribution of infection among animals. The cell-mediated immunity was better characterized, incorporating the recent findings. METHODS Serological methods for diagnosis were also compared for their parameters of accuracy, including the analysis of relapse. RESULTS Clinical forms have been better classified in order to include the pictures less frequently observesiod. CONCLUSION Itraconazole and the trimethoprim-sulfamethoxazole combination was compared regarding efficacy, effectiveness and safety, demonstrating that azole should be the first choice in the treatment of paracoccidioidomycosis.
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Affiliation(s)
- Rinaldo Poncio Mendes
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Ricardo de Souza Cavalcante
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Sílvio Alencar Marques
- Department of Dermatology, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | | | - James Venturini
- Laboratory of Experimental Immunology, Department of Biological Science, Faculty of Science, São Paulo State University – UNESP, São Paulo, Brazil
| | - Tatiane Fernanda Sylvestre
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Anamaria Mello Miranda Paniago
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina – Federal University of Mato Grosso do Sul – UFMS, Brazil
| | | | - Julhiany de Fátima da Silva
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Alexandre Todorovic Fabro
- Unit of Experimental Research, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Sandra de Moraes Gimenes Bosco
- Department of Microbiology and Immunology – Instituto de Biociências de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Eduardo Bagagli
- Department of Microbiology and Immunology – Instituto de Biociências de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Rosane Christine Hahn
- Laboratory of Investigation and Mycology, Federal University of Mato Grosso, Faculty of Medicine Cuiabá, Mato Grosso, Brazil
| | - Adriele Dandara Levorato
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
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Mendes JF, Klafke GB, Albano APN, Cabana ÂL, Teles AJ, de Camargo ZP, Xavier MO, Meireles MCA. Paracoccidioidomycosis infection in domestic and wild mammals by Paracoccidioides lutzii. Mycoses 2017; 60:402-406. [PMID: 28295653 DOI: 10.1111/myc.12608] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 11/30/2022]
Abstract
Paracoccidioidomycosis (PCM) is a systemic mycosis that occurs in several Latin American countries, especially in Brazil. It is caused by the thermo-dimorphic fungus Paracoccidioides spp. Serological studies to detect animal infection represent an excellent strategy for data on the agent's ecology. Although the state of Rio Grande do Sul (RS) is an endemic area for PCM in humans, there is scarce information available on the ecology of the agent in the region. This study aimed to investigate the infection by Paracoccidioides lutzii in animals living in RS, Brazil. A total of 85 wild mammals, 200 horses and 196 domestic dogs, previously tested for infection by P. brasiliensis, were included in this study. Serum samples from the animals were tested by ELISA to detect anti- P. lutzii antibodies. From the 481 animals tested, 105 (21.8%) were seropositive for IgG anti-P. lutzii. Of these, 54 were also positive for P. brasiliensis. A total of 11 horses (10.5%), 30 dogs (28.8%) and 10 wild mammals (9.5%) were positive only for P. lutzii (n=51). The detection of anti-P. lutzii antibodies in animals of RS suggests that the fungus can be found in southern Brazil, despite being described mainly in the midwest and southeast of the country.
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Affiliation(s)
- Josiara F Mendes
- Center of Diagnosis in Veterinary Mycology, Department of Veterinary Preventive, Faculty of Veterinary, University Federal of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Gabriel B Klafke
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande (FURG), Rio Grande, RS, Brazil
| | - Ana Paula N Albano
- Faculty of Veterinary, Hospital of Veterinary Practice, UFPel, Pelotas, RS, Brazil
| | - Ângela L Cabana
- Center of Diagnosis in Veterinary Mycology, Department of Veterinary Preventive, Faculty of Veterinary, University Federal of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Alessandra J Teles
- Center of Diagnosis in Veterinary Mycology, Department of Veterinary Preventive, Faculty of Veterinary, University Federal of Pelotas (UFPel), Pelotas, RS, Brazil
| | - Zoilo P de Camargo
- Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, Federal University of São Paulo (UNIFESP) São Paulo, São Paulo, Brazil
| | - Melissa O Xavier
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande (FURG), Rio Grande, RS, Brazil
| | - Mário Carlos A Meireles
- Center of Diagnosis in Veterinary Mycology, Department of Veterinary Preventive, Faculty of Veterinary, University Federal of Pelotas (UFPel), Pelotas, RS, Brazil
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Martinez R. New Trends in Paracoccidioidomycosis Epidemiology. J Fungi (Basel) 2017; 3:jof3010001. [PMID: 29371520 PMCID: PMC5715958 DOI: 10.3390/jof3010001] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/22/2016] [Accepted: 12/28/2016] [Indexed: 12/02/2022] Open
Abstract
Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America and more prevalent in South America. The disease is caused by the dimorphic fungus Paracoccidioides spp. whose major hosts are humans and armadillos. The fungus grows in soil and its infection is associated with exposure to the rural environment and to agricultural activities, with a higher risk in coffee and tobacco plantations. Population studies assessing the reactivity to Paracoccidioides spp. antigens by intradermal reaction or serological tests have detected previous subclinical infections in a significant proportion of healthy individuals living in various endemic countries. Paracoccidioidomycosis-disease is manifested by a small minority of infected individuals. The risk of developing the disease and its type of clinical form are related to the personal and life style characteristics of infected individuals, including genetic background, age, sex, ethnicity, smoking habit, alcohol drinking, and eventual cellular immunosuppression. Brazil, Colombia, Venezuela, Argentina, and Ecuador have endemic areas that had already been defined in the 20th century. The incidence of paracoccidioidomycosis can be altered by climate phenomena and mainly by human migration and occupation of poorly explored territories. In Brazil, the endemy tends to expand towards the North and Center-West around the Amazon Region.
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Affiliation(s)
- Roberto Martinez
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School, Universidade de São Paulo, Sao Paulo 14049-900, Brazil.
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16
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Paracoccidioides brasiliensis-associated dermatitis and lymphadenitis in a dog. Mycopathologia 2016; 182:425-434. [PMID: 27757778 DOI: 10.1007/s11046-016-0075-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/02/2016] [Indexed: 01/09/2023]
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17
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Arantes TD, Theodoro RC, Teixeira MDM, Bosco SDMG, Bagagli E. Environmental Mapping of Paracoccidioides spp. in Brazil Reveals New Clues into Genetic Diversity, Biogeography and Wild Host Association. PLoS Negl Trop Dis 2016; 10:e0004606. [PMID: 27045486 PMCID: PMC4821608 DOI: 10.1371/journal.pntd.0004606] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/13/2016] [Indexed: 12/21/2022] Open
Abstract
Background Paracoccidioides brasiliensis and Paracoccidioides lutzii are the etiological agents of Paracoccidioidomycosis (PCM), and are easily isolated from human patients. However, due to human migration and a long latency period, clinical isolates do not reflect the spatial distribution of these pathogens. Molecular detection of P. brasiliensis and P. lutzii from soil, as well as their isolation from wild animals such as armadillos, are important for monitoring their environmental and geographical distribution. This study aimed to detect and, for the first time, evaluate the genetic diversity of P. brasiliensis and P. lutzii for Paracoccidioidomycosis in endemic and non-endemic areas of the environment, by using Nested PCR and in situ hybridization techniques. Methods/Principal Findings Aerosol (n = 16) and soil (n = 34) samples from armadillo burrows, as well as armadillos (n = 7) were collected in endemic and non-endemic areas of PCM in the Southeastern, Midwestern and Northern regions of Brazil. Both P. brasiliensis and P. lutzii were detected in soil (67.5%) and aerosols (81%) by PCR of Internal Transcribed Spacer (ITS) region (60%), and also by in situ hybridization (83%). Fungal isolation from armadillo tissues was not possible. Sequences from both species of P. brasiliensis and P. lutzii were detected in all regions. In addition, we identified genetic Paracoccidioides variants in soil and aerosol samples which have never been reported before in clinical or armadillo samples, suggesting greater genetic variability in the environment than in vertebrate hosts. Conclusions/Significance Data may reflect the actual occurrence of Paracoccidioides species in their saprobic habitat, despite their absence/non-detection in seven armadillos evaluated in regions with high prevalence of PCM infection by P. lutzii. These results may indicate a possible ecological difference between P. brasiliensis and P. lutzii concerning their wild hosts. Paracoccidioides brasiliensis and Paracoccidioides lutzii are the fungal species responsible for one of the most important mycoses of Latin America, Paracoccidioidomycosis (PCM). These fungi can grow in soil from forests, deforested areas, sugarcane, coffee, and rice plantations, as well as pasturelands, and they are strongly associated to armadillo burrows, which can explain their frequent isolation from this mammal’s tissues. The environmental detection of these pathogens in endemic and non-endemic areas of PCM is important for mapping risk areas, as well as for understanding the infection ability and clinical manifestations of these fungi. These pieces of information are not provided by isolates obtained from human patients, because these fungi have a long latency period and the human host can migrate, leading to a misinterpretation of the actual geographic distribution of these pathogens. By using two different molecular methodologies (Nested PCR and in situ fluorescence), we detected both species of P. brasiliensis and P. lutzii in soil and in aerosol samples, even in areas where PCM is only associated to one of these two species. These data might indicate different habitat maintenance strategies between the species, which means that the infection ability may change according to the climatic and soil conditions. Despite contributing new information about the ecology of these important fungal pathogens, our molecular approach for the environmental detection of Paracoccidioides species may also be applied for their detection and differentiation in clinical samples, improving the diagnosis of this important systemic mycosis.
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Affiliation(s)
- Thales Domingos Arantes
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista/UNESP, Botucatu, Brazil.,Instituto de Medicina Tropical-IMT/RN, Universidade Federal do Rio Grande do Norte/UFRN, Natal, Brazil
| | - Raquel Cordeiro Theodoro
- Instituto de Medicina Tropical-IMT/RN, Universidade Federal do Rio Grande do Norte/UFRN, Natal, Brazil.,Departamento de Biologia Celular e Genética, Centro de Biociências, Universidade Federal do Rio Grande do Norte/UFRN, Natal, Brazil
| | - Marcus de Melo Teixeira
- Departamento de Biologia Celular, Universidade de Brasília-UnB, Brasília, Brazil.,Northern Arizona Center for Valley Fever Research, Translational Genomics Research Institute-Tgen North, Flagstaff, Arizona, United States of America
| | - Sandra de Moraes Gimenes Bosco
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista/UNESP, Botucatu, Brazil
| | - Eduardo Bagagli
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista/UNESP, Botucatu, Brazil
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Gonzalez A, Hernandez O. New insights into a complex fungal pathogen: the case of Paracoccidioides spp. Yeast 2016; 33:113-28. [PMID: 26683539 DOI: 10.1002/yea.3147] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 01/31/2023] Open
Abstract
Paracoccidioidomycosis is a systemic mycosis endemic to Latin America, with Paracoccidioides brasiliensis and P. lutzii being the causal agents of this disorder. Several issues have been raised in the 100 years since its discovery and in this article we discuss features of this fascinating fungal pathogen, including its biology, eco-epidemiology and aspects of its pathogenicity. We also consider some of its virulence determinants, the most recent advances in the study of its metabolic pathways and the molecular and genetic research tools developed for this research. We also review the animal models used to study host-fungal interactions and how the host defence mechanisms against this pathogen work.
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Affiliation(s)
- Angel Gonzalez
- Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Orville Hernandez
- Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
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Van Bressem MF, Simões-Lopes PC, Félix F, Kiszka JJ, Daura-Jorge FG, Avila IC, Secchi ER, Flach L, Fruet PF, du Toit K, Ott PH, Elwen S, Di Giacomo AB, Wagner J, Banks A, Van Waerebeek K. Epidemiology of lobomycosis-like disease in bottlenose dolphins Tursiops spp. from South America and southern Africa. DISEASES OF AQUATIC ORGANISMS 2015; 117:59-75. [PMID: 26575156 DOI: 10.3354/dao02932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report on the epidemiology of lobomycosis-like disease (LLD), a cutaneous disorder evoking lobomycosis, in 658 common bottlenose dolphins Tursiops truncatus from South America and 94 Indo-Pacific bottlenose dolphins T. aduncus from southern Africa. Photographs and stranding records of 387 inshore residents, 60 inshore non-residents and 305 specimens of undetermined origin (inshore and offshore) were examined for the presence of LLD lesions from 2004 to 2015. Seventeen residents, 3 non-residents and 1 inshore dolphin of unknown residence status were positive. LLD lesions appeared as single or multiple, light grey to whitish nodules and plaques that may ulcerate and increase in size over time. Among resident dolphins, prevalence varied significantly among 4 communities, being low in Posorja (2.35%, n = 85), Ecuador, and high in Salinas, Ecuador (16.7%, n = 18), and Laguna, Brazil (14.3%, n = 42). LLD prevalence increased in 36 T. truncatus from Laguna from 5.6% in 2007-2009 to 13.9% in 2013-2014, albeit not significantly. The disease has persisted for years in dolphins from Mayotte, Laguna, Salinas, the Sanquianga National Park and Bahía Málaga (Colombia) but vanished from the Tramandaí Estuary and the Mampituba River (Brazil). The geographical range of LLD has expanded in Brazil, South Africa and Ecuador, in areas that have been regularly surveyed for 10 to 35 yr. Two of the 21 LLD-affected dolphins were found dead with extensive lesions in southern Brazil, and 2 others disappeared, and presumably died, in Ecuador. These observations stress the need for targeted epidemiological, histological and molecular studies of LLD in dolphins, especially in the Southern Hemisphere.
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Affiliation(s)
- Marie-Françoise Van Bressem
- Cetacean Conservation Medicine Group (CMED), Peruvian Centre for Cetacean Research (CEPEC), Museo de Delfines, Pucusana, Peru
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ARANTES TD, BAGAGLI E, NIÑO-VEGA G, SAN-BLAS G, THEODORO RC. Paracoccidioides brasiliensis AND Paracoccidioides lutzii, A SECRET LOVE AFFAIR. Rev Inst Med Trop Sao Paulo 2015; 57 Suppl 19:25-30. [PMID: 26465366 PMCID: PMC4711194 DOI: 10.1590/s0036-46652015000700006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To commemorate Prof. Carlos da Silva Lacaz's centennial anniversary, the authors have written a brief account of a few, out of hundreds, biological, ecological, molecular and phylogenetic studies that led to the arrival of Paracoccidioides lutzii, hidden for more than a century within Paracoccidioides brasiliensis. Lacaz's permanent interest in this fungus, and particularly his conviction on the benefits that research on paracoccidioidomycosis would bring to patients, were pivotal in the development of the field.
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Affiliation(s)
- Thales Domingos ARANTES
- Universidade Estadual Paulista, Instituto de Biociências/UNESP, Depto.
Microbiologia e Imunologia, Botucatu, SP, Brasil
- Instituto de Medicina Tropical/IMT, Laboratório de Virologia e
Micologia, Campus Universitário Lagoa Nova, Natal, RN, Brasil
| | - Eduardo BAGAGLI
- Universidade Estadual Paulista, Instituto de Biociências/UNESP, Depto.
Microbiologia e Imunologia, Botucatu, SP, Brasil
| | - Gustavo NIÑO-VEGA
- Instituto Venezolano de Investigaciones Científicas (IVIC), Laboratorio
de Micología, Centro de Microbiología y Biología Celular, Caracas, Venezuela
| | - Gioconda SAN-BLAS
- Instituto Venezolano de Investigaciones Científicas (IVIC), Laboratorio
de Micología, Centro de Microbiología y Biología Celular, Caracas, Venezuela
| | - Raquel Cordeiro THEODORO
- Universidade Federal do Rio Grande do Norte, Depto. de Biologia Celular
e Genética, Campus Universitário Lagoa Nova, Natal, RN, Brasil
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da Silva JDF, de Oliveira HC, Marcos CM, Assato PA, Fusco-Almeida AM, Mendes-Giannini MJS. Advances and challenges in paracoccidioidomycosis serology caused by Paracoccidioides species complex: an update. Diagn Microbiol Infect Dis 2015; 84:87-94. [PMID: 26494541 DOI: 10.1016/j.diagmicrobio.2015.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/01/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
Abstract
Understanding the possible methodologies for the rapid and inexpensive identification of fungal infections is essential for disease diagnosis, but there are some limitations. To help with this problem, serological methods that detect antigens or antibodies are widely used and are useful for the diagnosis of paracoccidioidomycosis (PCM) through the detection of gp43, which is the main antigen employed for the immunodiagnosis of this disease caused by Paracoccidioides brasiliensis. However, the use of gp43 has become restricted because it was recently found that this marker is not identified in the infections caused by Paracoccidioides lutzii. Therefore, it is necessary to identify new antigens in both species or antigens specific for P. lutzii to decrease the morbidity and/or mortality associated with PCM. This review provides a discussion of new diagnostic challenges after the recent discoveries regarding the taxonomy of the Paracoccidioides genus.
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Affiliation(s)
- Julhiany de Fátima da Silva
- Faculdade de Ciências Farmacêuticas de Araraquara, FCFAr, UNESP - Univ Estadual Paulista, Araraquara, Departamento de Análises Clínicas, SP, Brazil
| | - Haroldo Cesar de Oliveira
- Faculdade de Ciências Farmacêuticas de Araraquara, FCFAr, UNESP - Univ Estadual Paulista, Araraquara, Departamento de Análises Clínicas, SP, Brazil
| | - Caroline Maria Marcos
- Faculdade de Ciências Farmacêuticas de Araraquara, FCFAr, UNESP - Univ Estadual Paulista, Araraquara, Departamento de Análises Clínicas, SP, Brazil
| | - Patricia Akemi Assato
- Faculdade de Ciências Farmacêuticas de Araraquara, FCFAr, UNESP - Univ Estadual Paulista, Araraquara, Departamento de Análises Clínicas, SP, Brazil
| | - Ana Marisa Fusco-Almeida
- Faculdade de Ciências Farmacêuticas de Araraquara, FCFAr, UNESP - Univ Estadual Paulista, Araraquara, Departamento de Análises Clínicas, SP, Brazil
| | - Maria José Soares Mendes-Giannini
- Faculdade de Ciências Farmacêuticas de Araraquara, FCFAr, UNESP - Univ Estadual Paulista, Araraquara, Departamento de Análises Clínicas, SP, Brazil.
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Matrix-assisted laser desorption ionization-time of flight mass spectrometry for differentiation of the dimorphic fungal species Paracoccidioides brasiliensis and Paracoccidioides lutzii. J Clin Microbiol 2015; 53:1383-6. [PMID: 25631803 DOI: 10.1128/jcm.02847-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Isolates of Paracoccidioides brasiliensis and Paracoccidioides lutzii, previously characterized by molecular techniques, were identified for the first time by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). All isolates were correctly identified, with log score values of >2.0. Thus, MALDI-TOF MS is a new tool for differentiating species of the genus Paracoccidioides.
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Teixeira MDM, Theodoro RC, Oliveira FFMD, Machado GC, Hahn RC, Bagagli E, San-Blas G, Soares Felipe MS. Paracoccidioides lutzii sp. nov.: biological and clinical implications. Med Mycol 2014; 52:19-28. [PMID: 23768243 DOI: 10.3109/13693786.2013.794311] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Paracoccidioides lutzii, formerly known as 'Pb01-like' strains in the P. brasiliensis complex, is proposed as a new species based on phylogenetic and comparative genomics data, recombination analysis, and morphological characteristics. Conidia of P. lutzii are elongated, different from those of P. brasiliensis. P. lutzii occurs in the central and northern regions of Brazil. Studies comparing P. brasiliensis and P. lutzii may have significant clinical consequences for the diagnosis and treatment of paracoccidioidomycosis.
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Epidemiology, Clinical, and Therapeutic Aspects of Paracoccidioidomycosis. CURRENT TROPICAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40475-014-0013-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Wild animals as sentinels of Paracoccidioides brasiliensis in the state of Rio Grande do Sul, Brazil. Mycopathologia 2014; 177:207-15. [PMID: 24570039 DOI: 10.1007/s11046-014-9731-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
Paracoccidioides brasiliensis, a dimorphic pathogenic fungus, causes the principal form of systemic mycosis in Brazil. The literature furnishes only limited data on the ecology of this fungus in the state of Rio Grande do Sul, the southernmost state of Brazil. The purpose of this study was to evaluate the prevalence of fungal infection in wild animals, using serological tests and using the animals as sentinels of the presence of P. brasiliensis in three specified mesoregions of Rio Grande do Sul. A total of 128 wild animals from the three mesoregions were included in the study. The serum samples were evaluated by immunodiffusion and the enzyme-linked immunosorbent assay (ELISA) technique to detect anti-gp43 antibodies from P. brasiliensis. Two conjugates were tested and compared with the ELISA technique. Although no positive samples were detected by immunodiffusion, 26 animals (20%), belonging to 13 distinct species, were found to be seropositive by the ELISA technique. The seropositive animals were from two mesoregions of the state. The results were similar according to the gender, age, and family of the animals, but differed significantly according to the conjugate used (p < 0.001), showing more sensitivity to protein A-peroxidase than to protein G-peroxidase. The finding that wild animals from the state of Rio Grande do Sul are exposed to P. brasiliensis suggests that the fungus can be found in this region despite the often-rigorous winters, which frequently include below-freezing temperatures.
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Detection of Antibodies Against Paracoccidioides brasiliensis in Free-Range Domestic Pigs (Sus scrofa). Mycopathologia 2014; 177:91-5. [DOI: 10.1007/s11046-013-9724-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
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Bocca AL, Amaral AC, Teixeira MM, Sato PK, Shikanai-Yasuda MA, Soares Felipe MS. Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues. Future Microbiol 2013; 8:1177-91. [DOI: 10.2217/fmb.13.68] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Acquired by inhalation of the thermal dimorphic fungi Paracoccidioides spp. conidia, paracoccidioidomycosis ranges from symptomatic to severe and potentially fatal disseminated disease. The main focus of this review is to highlight clinical aspects of paracoccidioidomycosis and, its pathogens’ diversity ecology and particularities. In addition, we present strategies for therapy, including DNA vaccines and nanostructured drugs. Molecular and morphological data supported the split of the Paracoccidioides genus into two species, Paracoccidioides brasiliensis and Paracoccidioides lutzii. An acute form of the disease affects approximately 5% of cases and involves the phagocytic mononuclear system, resulting in progressive lymphadenopathy. The chronic form affects adult men and frequently involves lungs, skin and mucous membranes, lymph nodes, and adrenal glands. The clinical manifestations depend on the ability of the host to control the fungal multiplication and dissemination. The long survival time of the fungus in the host tissues allows it to evade immune responses; therefore, successful treatment often requires long-time therapy. The consensus for treatment must consider the severity of the disease and includes sulfone derivatives, amphotericin B and azoles. Novel strategies for therapy, based on DNA vaccines and nanostructured drugs are also presented and discussed in this review.
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Affiliation(s)
| | - André Corrêa Amaral
- Biotechnology, Institute of Tropical Pathology & Public Health, Universidade Federal de Goiás, Goiania, GO, Brazil
| | | | - Paula Keiko Sato
- Laboratory of Clinical Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, Brazil
| | - Maria Aparecida Shikanai-Yasuda
- Laboratory of Clinical Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, Brazil
- Department of Infectious & Parasitic Diseases, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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Machado GC, Moris DV, Arantes TD, Silva LRF, Theodoro RC, Mendes RP, Vicentini AP, Bagagli E. Cryptic species of Paracoccidioides brasiliensis: impact on paracoccidioidomycosis immunodiagnosis. Mem Inst Oswaldo Cruz 2013; 108:637-43. [PMID: 23903981 PMCID: PMC3970600 DOI: 10.1590/0074-0276108052013016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/17/2013] [Indexed: 11/21/2022] Open
Abstract
We aimed to evaluate whether the occurrence of cryptic species of Paracoccidioides brasiliensis, S1, PS2, PS3 and Paracoccidioides lutzii, has implications in the immunodiagnosis of paracoccidioidomycosis (PCM). Small quantities of the antigen gp43 were found in culture filtrates of P. lutzii strains and this molecule appeared to be more variable within P. lutzii because the synonymous-nonsynonymous mutation rate was lower, indicating an evolutionary process different from that of the remaining genotypes. The production of gp43 also varied between isolates belonging to the same species, indicating that speciation events are important, but not sufficient to fully explain the diversity in the production of this antigen. The culture filtrate antigen AgEpm83, which was obtained from a PS3 isolate, showed large quantities of gp43 and reactivity by immunodiffusion assays, similar to the standard antigen (AgB-339) from an S1 isolate. Furthermore, AgEpm83 was capable of serologically differentiating five serum samples from patients from the Botucatu and Jundiaí regions. These patients had confirmed PCM but, were non-reactive to the standard antigen, thus demonstrating an alternative for serological diagnosis in regions in which S1 and PS2 occur. We also emphasise that it is not advisable to use a single antigen preparation to diagnose PCM, a disease that is caused by highly diverse pathogens.
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Affiliation(s)
| | - Daniela Vanessa Moris
- Departamento de Doenças Tropicais, Faculdade de Medicina de
Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP,
Brasil
| | | | | | | | - Rinaldo Pôncio Mendes
- Departamento de Doenças Tropicais, Faculdade de Medicina de
Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP,
Brasil
| | - Adriana Pardini Vicentini
- Laboratório de Imunodiagnóstico das Micoses, Centro de Imunologia,
Instituto Adolfo Lutz, São Paulo, SP, Brasil
| | - Eduardo Bagagli
- Departamento de Microbiologia e Imunologia, Instituto de
Biociências de Botucatu
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Arantes TD, Theodoro RC, Da Graça Macoris SA, Bagagli E. Detection of Paracoccidioides spp. in environmental aerosol samples. Med Mycol 2012; 51:83-92. [PMID: 22762209 DOI: 10.3109/13693786.2012.698444] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Taking into account that paracoccidioidomycosis infection occurs by inhalation of the asexual conidia produced by Paracoccidioides spp. in its saprobic phase, this work presents the collection of aerosol samples as an option for environmental detection of this pathogen, by positioning a cyclonic air sampler at the entrance of armadillo burrows. Methods included direct culture, extinction technique culture and Nested PCR of the rRNA coding sequence, comprising the ITS1-5.8S-ITS2 region. In addition, we evaluated one armadillo (Dasypus novemcinctus) as a positive control for the studied area. Although the pathogen could not be isolated by the culturing strategies, the aerosol sampling associated with molecular detection through Nested PCR proved the best method for discovering Paracoccidioides spp. in the environment. Most of the ITS sequences obtained in this investigation proved to be highly similar with the homologous sequences of Paracoccidioides lutzii from the GenBank database, suggesting that this Paracoccidioides species may not be exclusive to mid-western Brazil as proposed so far.
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Affiliation(s)
- Thales Domingos Arantes
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
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Theodoro RC, Teixeira MDM, Felipe MSS, Paduan KDS, Ribolla PM, San-Blas G, Bagagli E. Genus paracoccidioides: Species recognition and biogeographic aspects. PLoS One 2012; 7:e37694. [PMID: 22666382 PMCID: PMC3364295 DOI: 10.1371/journal.pone.0037694] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 04/24/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis is a systemic mycosis caused by Paracoccidioides brasiliensis (species S1, PS2, PS3), and Paracoccidioides lutzii. This work aimed to differentiate species within the genus Paracoccidioides, without applying multilocus sequencing, as well as to obtain knowledge of the possible speciation processes. METHODOLOGY/PRINCIPAL FINDINGS Single nucleotide polymorphism analysis on GP43, ARF and PRP8 intein genes successfully distinguished isolates into four different species. Morphological evaluation indicated that elongated conidia were observed exclusively in P. lutzii isolates, while all other species (S1, PS2 and PS3) were indistinguishable. To evaluate the biogeographic events that led to the current geographic distribution of Paracoccidioides species and their sister species, Nested Clade and Likelihood Analysis of Geographic Range Evolution (LAGRANGE) analyses were applied. The radiation of Paracoccidioides started in northwest South America, around 11-32 million years ago, as calculated on the basis of ARF substitution rate, in the BEAST program. Vicariance was responsible for the divergence among S1, PS2 and P. lutzii and a recent dispersal generated the PS3 species, restricted to Colombia. Taking into account the ancestral areas revealed by the LAGRANGE analysis and the major geographic distribution of L. loboi in the Amazon basin, a region strongly affected by the Andes uplift and marine incursions in the Cenozoic era, we also speculate about the effect of these geological events on the vicariance between Paracoccidioides and L. loboi. CONCLUSIONS/SIGNIFICANCE The use of at least 3 SNPs, but not morphological criteria, as markers allows us to distinguish among the four cryptic species of the genus Paracoccidioides. The work also presents a biogeographic study speculating on how these species might have diverged in South America, thus contributing to elucidating evolutionary aspects of the genus Paracoccidioides.
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Affiliation(s)
| | | | | | | | | | - Gioconda San-Blas
- Venezuelan Institute for Scientific Research, Center of Microbiology and Cell Biology, Caracas, Venezuela
| | - Eduardo Bagagli
- Universidade Estadual Paulista, Campus de Botucatu-UNESP, São Paulo, Brazil
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Abstract
Paracoccidioidomycosis, one of the most important endemic and systemic mycoses in Latin America, presents several clinical pictures. Epidemiological studies indicate a striking rarity of disease (but not infection) in females, but only during the reproductive years. This suggested a hormonal interaction between female hormones and the etiologic dimorphic fungus Paracoccidioides brasiliensis. Many fungi have been shown to use hormonal (pheromonal) fungal molecules for intercellular communication, and there are increasing numbers of examples of interactions between mammalian hormones and fungi, including the specific binding of mammalian hormones by fungal proteins, and suggestions of mammalian hormonal modulation of fungal behavior. This suggests an evolutionary conservation of hormonal receptor systems. We recount studies showing the specific hormonal binding of mammalian estrogen to proteins in P. brasiliensis and an action of estrogen to specifically block the transition from the saprophytic form to the invasive form of the fungus in vitro. This block has been demonstrated to occur in vivo in animal studies. These unique observations are consistent with an estrogen-fungus receptor-mediated effect on pathogenesis. The fungal genes responsive to estrogen action are under study.
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de Farias MR, Condas LAZ, Ribeiro MG, Bosco SDMG, Muro MD, Werner J, Theodoro RC, Bagagli E, Marques SA, Franco M. Paracoccidioidomycosis in a dog: case report of generalized lymphadenomegaly. Mycopathologia 2011; 172:147-52. [PMID: 21424604 DOI: 10.1007/s11046-011-9412-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 03/06/2011] [Indexed: 11/30/2022]
Abstract
Paracoccidioidomycosis (PCM) is a severe systemic mycosis, endemic in Latin America and highly prevalent in Brazil, where it ranks eighth as a mortality cause among infectious and parasitic diseases in humans. The disease in animals has been little explored. It is observed that armadillos can harbor the fungus at high frequencies, although the active disease has not been well documented in this wild mammal. Dogs are susceptible to experimental infection, and the naturally acquired PCM-disease was reported only recently in a dog from Brazil. The present work reports the second case of naturally acquired PCM in a 6-year-old female dog that presented emaciation, lymphadenomegaly, and hepatosplenomegaly. Biochemical and pulmonary radiographic evaluation did not reveal any abnormalities. PCM was diagnosed by clinical findings, culturing, immunohistochemistry, and histopathology of popliteal lymph node. The fungus was recovered from popliteal lymph node, and the molecular analysis showed respective sequencing similarities of 99 and 100% for 803 nucleotides of the Gp43 gene and 592 nucleotides from the ITS-5.8S region of Paracoccidioides brasiliensis. Immunohistochemistry revealed severe lymphadenitis and presented numerous yeasts, which reacted against the gp43 antibody. Histopathology revealed a severe granulomatous lymphadenitis associated with numerous single or multiple budding yeasts. After diagnosis, the dog was successfully treated with itraconazol for 2 years. Veterinarians should be aware of the importance of considering PCM for differential diagnosis, especially in dogs from PCM-endemic areas, whose monophagocytic system involvement is evident.
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Theodoro RC, Volkmann G, Liu XQ, Bagagli E. PRP8 intein in Ajellomycetaceae family pathogens: sequence analysis, splicing evaluation and homing endonuclease activity. Fungal Genet Biol 2010; 48:80-91. [PMID: 20682355 DOI: 10.1016/j.fgb.2010.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/28/2010] [Accepted: 07/22/2010] [Indexed: 12/25/2022]
Abstract
Inteins are intervening sequences that are transcribed and translated with flanking host protein sequences and then self-excised by protein splicing. Bi-functional inteins also contain a homing endonuclease responsible for their genetic mobility. The PRP8 intein, the most widespread among fungi, occurs in important pathogens such as Histoplasma capsulatum and Paracoccidioides brasiliensis, from the Ajellomycetaceae family. Herein, we describe the bi-functional PRP8 intein in two other Ajellomycetacean pathogens, Blastomyces dermatitidis and Emmonsia parva. Sequence analysis and experimental evidence suggest that the homing endonuclease from PbrPRP8 is inactive. The splicing activity of the PRP8 intein from the B. dermatitidis, E. parva and P. brasiliensis species complex was demonstrated in a non-native protein context in Escherichia coli. Since the PRP8 intein is located in a functionally essential nuclear protein, it can be considered a promising therapeutic target for anti-fungal drugs, because inhibition of intein splicing should inhibit proliferation of intein-containing pathogens.
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Affiliation(s)
- Raquel Cordeiro Theodoro
- Department of Microbiology and Immunology, Institute of Biosciences, UNESP, Botucatu, SP, Brazil
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Richini-Pereira VB, Bosco SDMG, Theodoro RC, Macoris SADG, Bagagli E. Molecular approaches for eco-epidemiological studies of Paracoccidioides brasiliensis. Mem Inst Oswaldo Cruz 2010; 104:636-43. [PMID: 19722090 DOI: 10.1590/s0074-02762009000400018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Accepted: 04/15/2009] [Indexed: 11/22/2022] Open
Abstract
Medical mycology has greatly benefited from the introduction of molecular techniques. New knowledge on molecular genetics has provided both theoretical and practical frameworks, permitting important advances in our understanding of several aspects of pathogenic fungi. Considering Paracoccidioides brasiliensis in particular, important eco-epidemiological aspects, such as environmental distribution and new hosts were clarified through molecular approaches. These methodologies also contributed to a better understanding about the genetic variability of this pathogen; thus, P. brasiliensis is now assumed to represent a species complex. The present review focuses on some recent findings about the current taxonomic status of P. brasiliensis, its phylogenetic and speciation processes, as well as on some practical applications for the molecular detection of this pathogen in environmental and clinical materials.
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Affiliation(s)
- Virgínia Bodelão Richini-Pereira
- Departamento de Microbiologia e Imunologia, Instituto de Biociências, Universidade Estadual Paulista, Botucatu, SP 18618-000, Brasil
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Abstract
Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidoides brasiliensis. The infection is endemic in subtropical areas of Latin America and has a high prevalence in Brazil. The disease is acquired by airborne inhalation of conidia and is frequently observed in adult male rural workers. The juvenile type of this mycosis is less prevalent (5-10% of clinical cases) and attacks both sexes. This clinical form occurs in children and adolescents and has a subacute course with fever, toxemia, loss of weight, adenopathy, hepatoesplenomegaly, anaemia and eosinophilia. Radiologic abnormalities in the lung fields may be seen. Mucous membrane lesions occasionally occur. The clinical presentation resembles severe tuberculosis, leukaemia or lymphoma. The diagnosis is confirmed by finding yeast-like elements of P. brasiliensis in microscopic examinations of wet preparations of specimens submitted for mycologic studies. The fungus grows slowly (20-30 days) and its isolation is difficult. Histologic and serologic studies may also assist in the diagnosis of this mycosis. Sulfonamides, ketoconazole, itraconazole, fluconazole and amphotericin B have been successfully used in the treatment of paracoccidioidomycosis. Itraconazole is the treatment of choice, being effective in more than 95% of cases. Co-trimoxazole is still frequently used especially in chronic progressive disease and as maintenance after a course of amphotericin B in severe cases of this mycosis.
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Richini-Pereira VB, Bosco SMG, Theodoro RC, Barrozo L, Pedrini SCB, Rosa PS, Bagagli E. Importance of xenarthrans in the eco-epidemiology of Paracoccidioides brasiliensis. BMC Res Notes 2009; 2:228. [PMID: 19919716 PMCID: PMC2784786 DOI: 10.1186/1756-0500-2-228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 11/17/2009] [Indexed: 11/26/2022] Open
Abstract
Background Several pathogens that cause important zoonotic diseases have been frequently associated with armadillos and other xenarthrans. This mammal group typically has evolved on the South American continent and many of its extant species are seriously threatened with extinction. Natural infection of armadillos with Paracoccidioides brasiliensis in hyperendemic areas has provided a valuable opportunity for understanding the role of this mammal in the eco-epidemiology of Paracoccidioidomycosis (PCM), one of the most important systemic mycoses in Latin America. Findings This study aimed to detect P. brasiliensis in different xenarthran species (Dasypus novemcinctus, Cabassous spp., Euphractus sexcinctus, Tamandua tetradactyla and Myrmecophaga tridactyla), by molecular and mycological approaches, in samples obtained by one of the following strategies: i) from road-killed animals (n = 6); ii) from naturally dead animals (n = 8); iii) from animals that died in captivity (n = 9); and iv) from living animals captured from the wild (n = 2). Specific P. brasiliensis DNA was detected in several organs among 7/20 nine-banded armadillos (D. novemcinctus) and in 2/2 anteaters (M. tridactyla). The fungus was also cultured in tissue samples from one of two armadillos captured from the wild. Conclusion Members of the Xenarthra Order, especially armadillos, have some characteristics, including a weak cellular immune response and low body temperature, which make them suitable models for studying host-pathogen interaction. P. brasiliensis infection in wild animals, from PCM endemic areas, may be more common than initially postulated and reinforces the use of these animals as sentinels for the pathogen in the environment.
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Affiliation(s)
- Virgínia B Richini-Pereira
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.
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Baumgardner DJ. Microecology ofBlastomyces dermatitidis: the Ammonia Hypothesis. Med Mycol 2009; 47:745-52. [DOI: 10.3109/13693780802572547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Theodoro RC, Bagagli E. Inteins in pathogenic fungi: a phylogenetic tool and perspectives for therapeutic applications. Mem Inst Oswaldo Cruz 2009; 104:497-504. [PMID: 19547879 DOI: 10.1590/s0074-02762009000300017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 03/13/2009] [Indexed: 01/18/2023] Open
Abstract
Inteins or 'internal proteins' are coding sequences that are transcribed and translated with flanking sequences (exteins). After translation, the inteins are excised by an autocatalytic process and the host protein assumes its normal conformation and develops its expected function. These parasitic genetic elements have been found in important, conserved proteins in all three domains of life. Most of the eukaryotic inteins are present in the fungi kingdom and the PRP8 intein is one of the most widespread inteins, occurring in important pathogens such as Cryptococcus neoformans (varieties grubii and neoformans), Cryptococcus gattii, Histoplasma capsulatum and Paracoccidioides brasiliensis. The knowledge of conserved and non-conserved domains in inteins have opened up new opportunities for the study of population variability in pathogenic fungi, including their phylogenetic relationships and recognition or diagnoses of species. Furthermore, inteins in pathogenic fungi should also be considered a promising therapeutic drug target, since once the autocatalytic splicing is inhibited, the host protein, which is typically vital, will not be able to perform its normal function and the fungal cell will not survive or reproduce.
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Affiliation(s)
- Raquel Cordeiro Theodoro
- Departamento de Microbiologia e Imunologia, Instituto de Biociências, UNESP, Botucatu, São Paulo, Brasil
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40
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Barrozo LV, Mendes RP, Marques SA, Benard G, Silva MES, Bagagli E. Climate and acute/subacute paracoccidioidomycosis in a hyper-endemic area in Brazil. Int J Epidemiol 2009; 38:1642-9. [PMID: 19433518 DOI: 10.1093/ije/dyp207] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is Latin America's most prevalent systemic mycosis, carrying an important social burden. Its agent, Paracoccidioides brasiliensis, has rarely been identified in nature. Studies characterizing acute/subacute PCM incidence and their relationship with climate variables are not available. This work analysed a series of acute/subacute cases that occurred in the Botucatu area, São Paulo State, Brazil, from 1969 to 1999, as an outcome of weather variability. METHODS Stepwise regression of annual data was applied to model incidence, calculated based on 91 cases, from lagged variables: antecedent precipitation, air temperature, soil water storage, absolute and relative air humidity, and Southern Oscillation Index (SOI). RESULTS Multiple regression analyses resulted in a model, which explains 49% of the incidence variance, taking into account the absolute air humidity in the year of exposure, soil water storage and SOI of the previous 2 years. CONCLUSIONS The correlations may reflect enhanced fungal growth after increase in soil water storage in the longer term and greater spore release with increase in absolute air humidity in the short term.
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Affiliation(s)
- Ligia V Barrozo
- Department of Geography, School of Philosophy, Literature and Human Sciences, University of São Paulo, CEP 05508-900, São Paulo, Brazil.
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Teixeira MM, Theodoro RC, de Carvalho MJA, Fernandes L, Paes HC, Hahn RC, Mendoza L, Bagagli E, San-Blas G, Felipe MSS. Phylogenetic analysis reveals a high level of speciation in the Paracoccidioides genus. Mol Phylogenet Evol 2009; 52:273-83. [PMID: 19376249 DOI: 10.1016/j.ympev.2009.04.005] [Citation(s) in RCA: 240] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 04/02/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
Abstract
Paracoccidioidomycosis (PCM) is a systemic disease endemic to most of Latin America, with greatest impact in rural areas. The taxonomic status of one of the best studied Paracoccidioides isolates (Pb01) as P. brasiliensis remains unresolved due to its genomic differences from the other three previously described phylogenetic species (S1, PS2 and PS3; Carrero et al., 2008. Fungal Genet. Biol. 45, 605). Using the genealogic concordance method of phylogenetic species recognition (GCPSR) via maximum parsimony and Bayesian analysis, we identified a clade of 17 genotypically similar isolates, including Pb01, which are distinct from the S1/PS2/P3 clade. Consistent with GCPSR, this "Pb01-like" group can be considered a new phylogenetic species, since it is strongly supported by all independent and concatenated genealogies. "Pb01-like" species exhibit great sequence and morphological divergence from the S1/PS2/PS3 species clade, and we estimate that these groups last shared a common ancestor approximately 32 million years ago. In addition, recombination analysis revealed independent events inside both main groups suggesting reproductive isolation. Consequently, we recommend the formal description of the "Pb01-like" cluster as the new species Paracoccidioides lutzii, a tribute to Adolpho Lutz, discoverer of P. brasiliensis in 1908.
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Affiliation(s)
- Marcus M Teixeira
- Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, DF, Brazil.
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42
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López-Hurtado M, Arteaga-Troncoso G, Escobedo-Guerra MR, Guerra-Infante FM. Evaluation of endocytic capacity and NADPH-oxidase activity from armadillo (Dasypus novemcinctus) eosinophils infected with microfilariae. Vet Immunol Immunopathol 2009; 127:181-5. [PMID: 18990455 DOI: 10.1016/j.vetimm.2008.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/07/2008] [Accepted: 09/17/2008] [Indexed: 10/21/2022]
Abstract
Endocytic activity of phagocytic cells from armadillos infected with viruses, parasites or bacteria is unknown. This report shows that eosinophils from armadillos infected with microfilaria act against these helmintic parasites but have deficiencies in their oxygen-dependent bacteriocidal mechanisms and also in endocytic capacity against yeast.
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Affiliation(s)
- Marcela López-Hurtado
- Laboratorio de Bioinmunología Molecular del Departamento de Infectología del Instituto Nacional de Perinatología, Montes Urales 800, México, DF, Mexico.
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43
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Clinical Usefulness of ELISPOT Assay on Pericardial Fluid in a Case of Suspected Tuberculous Pericarditis. Infection 2008; 36:601-4. [DOI: 10.1007/s15010-008-7402-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 03/03/2008] [Indexed: 11/26/2022]
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44
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Bagagli E, Theodoro RC, Bosco SMG, McEwen JG. Paracoccidioides brasiliensis: phylogenetic and ecological aspects. Mycopathologia 2008; 165:197-207. [PMID: 18777629 DOI: 10.1007/s11046-007-9050-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The knowledge on the biological aspects of Paracoccidioides brasiliensis has evolved greatly since the first description of the disease in 1908. From the pioneers, who were able to clearly demonstrate the fungal nature of the agent, to the recent genomic era, important advances have been achieved. P. brasiliensis is a true fungus, belonging to the Ascomycetous Division, although its sexual phase has not been demonstrated morphologically. A better understanding of the fundamental aspects of the agent, especially its phylogeny and evolutionary history, will provide us with valuable insights allowing a better comprehension of the disease and our capacity to deal with the problem. Concerning the fungus's ecology, although some progress had been observed, the ecological niche of the pathogen has not been determined yet. The aim of the present review is to focus on the biological aspects of P. brasiliensis from an evolutionary point of view, addressing the fungus's phylogenetic aspects, in those special points that might be relevant for the pathogen/host interactions, the biological forces that have been acting on its origin and maintenance of virulence, as well as in determining the fungus's ecology and epidemiology.
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Affiliation(s)
- Eduardo Bagagli
- Universidade Estadual Paulista, Campus de Botucatu-UNESP, Botucatu, SP, Brazil.
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45
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Theodoro RC, Bagagli E, Oliveira C. Phylogenetic analysis of PRP8 intein in Paracoccidioides brasiliensis species complex. Fungal Genet Biol 2008; 45:1284-91. [DOI: 10.1016/j.fgb.2008.07.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 06/24/2008] [Accepted: 07/06/2008] [Indexed: 01/24/2023]
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46
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Dimorphism, Thermal Tolerance, Virulence and Heat Shock Protein 70 Transcription in Different Isolates of Paracoccidioides brasiliensis. Mycopathologia 2008; 165:355-65. [DOI: 10.1007/s11046-008-9091-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 01/17/2008] [Indexed: 10/22/2022]
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47
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Richini-Pereira VB, Bosco SDMG, Griese J, Theodoro RC, Macoris SAG, da Silva RJ, Barrozo L, Tavares PMES, Zancopé-Oliveira RM, Bagagli E. Molecular detection ofParacoccidioides brasiliensisin road-killed wild animals. Med Mycol 2008; 46:35-40. [PMID: 17885959 DOI: 10.1080/13693780701553002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Paracoccidioides brasiliensis infections have been little studied in wild and/or domestic animals, which may represent an important indicator of the presence of the pathogen in nature. Road-killed wild animals have been used for surveillance of vectors of zoonotic pathogens and may offer new opportunities for eco-epidemiological studies of paracoccidiodomycosis (PCM). The presence of P. brasiliensis infection was evaluated by Nested-PCR in tissue samples collected from 19 road-killed animals; 3 Cavia aperea (guinea pig), 5 Cerdocyon thous (crab-eating-fox), 1 Dasypus novemcinctus (nine-banded armadillo), 1 Dasypus septemcinctus (seven-banded armadillo), 2 Didelphis albiventris (white-eared opossum), 1 Eira barbara (tayra), 2 Gallictis vittata (grison), 2 Procyon cancrivorus (raccoon) and 2 Sphiggurus spinosus (porcupine). Specific P. brasiliensis amplicons were detected in (a) several organs of the two armadillos and one guinea pig, (b) the lung and liver of the porcupine, and (c) the lungs of raccoons and grisons. P. brasiliensis infection in wild animals from endemic areas might be more common than initially postulated. Molecular techniques can be used for detecting new hosts and mapping 'hot spot' areas of PCM.
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Affiliation(s)
- Virgínia Bodelão Richini-Pereira
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
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48
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Terçarioli GR, Bagagli E, Reis GM, Theodoro RC, Bosco SDMG, Macoris SADG, Richini-Pereira VB. Ecological study of Paracoccidioides brasiliensis in soil: growth ability, conidia production and molecular detection. BMC Microbiol 2007; 7:92. [PMID: 17953742 PMCID: PMC2180180 DOI: 10.1186/1471-2180-7-92] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 10/22/2007] [Indexed: 12/03/2022] Open
Abstract
Background Paracoccidioides brasiliensis ecology is not completely understood, although several pieces of evidence point to the soil as its most probable habitat. The present study aimed to investigate the fungal growth, conidia production and molecular pathogen detection in different soil conditions. Methods Soils samples of clayey, sandy and medium textures were collected from ground surface and the interior of armadillo burrows in a hyperendemic area of Paracoccidioidomycosis. P. brasiliensis was inoculated in soil with controlled humidity and in culture medium containing soil extracts. The molecular detection was carried out by Nested PCR, using panfungal and species specific primers from the ITS-5.8S rDNA region. Results The soil texture does not affect fungus development and the growth is more abundant on/in soil saturated with water. Some soil samples inhibited the development of P. brasiliensis, especially those that contain high values of Exchangeable Aluminum (H+Al) in their composition. Some isolates produced a large number of conidia, mainly in soil-extract agar medium. The molecular detection was positive only in samples collected from armadillo burrows, both in sandy and clayey soil. Conclusion P. brasiliensis may grow and produce the infectious conidia in sandy and clayey soil, containing high water content, mainly in wild animal burrows, but without high values of H+Al.
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Affiliation(s)
- Gisela Ramos Terçarioli
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Distrito de Rubião Júnior, s/n, 18618-000, Botucatu, São Paulo, Brasil.
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Conti Días IA. On the unknown ecological niche of Paracoccidioides brasiliensis: our hypothesis of 1989: present status and perspectives. Rev Inst Med Trop Sao Paulo 2007; 49:131-4. [PMID: 17505676 DOI: 10.1590/s0036-46652007000200014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 08/17/2006] [Indexed: 11/21/2022] Open
Abstract
In 1989, CONTI DÍAZ & RILLA published a hypothesis concerning the as yet unknown ecological niche of Paracoccidioides brasiliensis. The hypothesis proposed a highly efficient paracoccidioidal ecological strategy based on an important natural reservoir of the parasite, probably in heterothermic animals from fresh water environments. Further, the hypothesis proposed, a transient and variable residence in the soil with a wide aleuriospore dispersion throughout the environment together with an elevated capability of infecting humans, and domestic and wild animals. This paper analyzes scientific publications from the IX International Meeting on Paracoccidioidomycosis held in Águas de Lindoia, São Paulo, Brazil from 2-5 October 2005, providing a comparative study among this articles and with other recently published papers and the hypothesis' postulates. Since various findings and observations appear to agree with the postulates, the pursuit of novel, specific research projects in the supposed reservoirs is recommended partially or fully to confirm the hypothesis using classical laboratorial methods and modern molecular biology techniques.
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Affiliation(s)
- Ismael A Conti Días
- Department of Parasitology, School of Medicine, University of the Republic, Montevideo, Uruguay.
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50
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Abstract
Tropical mycoses vary from the commonplace to the rare and exotic but they are seen regularly even as imported conditions and it is important to consider the diagnosis, where possible, in individuals who have visited remote areas. Patients may present many years after they have left an endemic area with subcutaneous or endemic systemic mycoses. In establishing a diagnosis, it is always important to take an accurate travel history so that the movements of the individual can be correlated with the potential risk for exposure to infection.
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Affiliation(s)
- Roderick J Hay
- Faculty of Medicine and Health Sciences, Queens University Belfast, Northern Ireland, UK.
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