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Giron F, Vanegas M, Rodriguez LM, Hernandez-Santamaria V, Rey Chaves CE, Ortega J. Intestinal Paracoccidioidomycosis: Case report and literature review. Int J Surg Case Rep 2022; 91:106801. [PMID: 35121286 PMCID: PMC8816657 DOI: 10.1016/j.ijscr.2022.106801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Paracoccidioidomycosis (PCM) is a systemic fungal infection, primarily affecting the respiratory tract. Extra pulmonary presentation is rare, representing less than 1% of cases (about 1 in every 200 cases). Case presentation We present a case of a 73-year-old male with acute surgical abdomen secondary to Intestinal Paracoccidioidomycosis requiring intestinal resection and postoperative antifungal therapy. Conclusion Intestinal Paracoccidioidomycosis represents a rare pathology with challenging diagnostic approach due to its frequency and nonspecific clinical manifestations. Extra pulmonary presentation is rare, but it should be considered in endemic regions. Extrapulmonary presentation of PC it's a rare entity, reaching just 1% of the cases. Fungal infection should be in the knowledge of general surgeon IP, represents a surgical challenge, a multidisciplinary approach needs to be done in order to achieve good outcomes.
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Monocyte-Derived Dendritic Cells Can Revert In Vitro Antigen-Specific Cellular Anergy in Active Human Paracoccidioidomycosis. J Fungi (Basel) 2021; 7:jof7030201. [PMID: 33802081 PMCID: PMC8000053 DOI: 10.3390/jof7030201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 12/03/2022] Open
Abstract
We investigated the in vitro effects of two Paracoccidioides brasiliensis antigens on monocyte-derived dendritic cells (moDCs) from patients with paracoccidioidomycosis (PCM). MoDCs from patients with active or treated PCM and non-PCM subjects were generated, stimulated with TNF-α, and P. brasiliensis antigens, 43 kDa glycoprotein (gp43) and cell-free antigen (CFA), and analyzed by flow cytometry and enzyme-linked immunosorbent assays (ELISA). Our data revealed that patients with PCM had a high frequency of HLA-DR+ cells, but the treated group had more CD86+ cells with increased IL-12p40. Patients with active PCM had more CD80+ moDCs, and as a novel finding, large amounts of chemokine (C-C motif) ligand 18 (CCL18) in the supernatants from their in vitro moDC cultures. Both gp43- and CFA-stimulated moDCs from the patients with PCM successfully reverted the in vitro antigen-specific anergy, inducing a proliferative response. However, CFA-stimulated moDCs led to higher lymphoproliferation, with increased IFN-γ and TNF-α in the cells from the patients with active PCM compared with gp43. These original results combined with constant IL-10 and increased IL-12p40 levels suggest that a more complex antigen, such as CFA, may be a better inducer of the protective Th1 immune response than purified gp43 is, and a suitable target for future studies on anti-P. brasiliensis dendritic cell (DC)-based vaccines.
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Breda LCD, Menezes IG, Paulo LNM, de Almeida SR. Immune Sensing and Potential Immunotherapeutic Approaches to Control Chromoblastomycosis. J Fungi (Basel) 2020; 7:jof7010003. [PMID: 33375204 PMCID: PMC7822212 DOI: 10.3390/jof7010003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022] Open
Abstract
Chromoblastomycosis (CBM) is a neglected, chronic, and progressive subcutaneous mycosis caused by different species of fungi from the Herpotrichiellaceae family. CBM disease is usually associated with agricultural activities, and its infection is characterized by verrucous, erythematous papules, and atrophic lesions on the upper and lower limbs, leading to social stigma and impacts on patients' welfare. The economic aspect of disease treatment is another relevant issue. There is no specific treatment for CBM, and different anti-fungal drug associations are used to treat the patients. However, the long period of the disease and the high cost of the treatment lead to treatment interruption and, consequently, relapse of the disease. In previous years, great progress had been made in the comprehension of the CBM pathophysiology. In this review, we discuss the differences in the cell wall composition of conidia, hyphae, and muriform cells, with a particular focus on the activation of the host immune response. We also highlight the importance of studies about the host skin immunology in CBM. Finally, we explore different immunotherapeutic studies, highlighting the importance of these approaches for future treatment strategies for CBM.
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Reis APC, Correia FF, Jesus TM, Pagliari C, Sakai-Valente NY, Belda Júnior W, Criado PR, Benard G, Sousa MGT. In situ immune response in human dermatophytosis: possible role of Langerhans cells (CD1a+) as a risk factor for dermatophyte infection. Rev Inst Med Trop Sao Paulo 2019; 61:e56. [PMID: 31618376 PMCID: PMC6792354 DOI: 10.1590/s1678-9946201961056] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/21/2019] [Indexed: 11/22/2022] Open
Abstract
Dermatophytosis is a cutaneous mycosis caused by a plethora of keratinophilic fungi, but Trichophyton rubrum is the most common etiological agent. Despite its high prevalence worldwide, little is known about the host defense mechanisms in this infection, particularly the in situ immune response. Using an immunohistochemistry approach, we investigated the density of CD1a+, factor XIIIa+ and CD68+ cells in the skin of dermatophytosis patients. Langerhans cells (CD1a+ cells) were significantly decreased in the epidermis of patients, both in affected and unaffected areas. In the dermis, however, no differences in the density of macrophages (CD68+ cells) and dermal dendrocytes (factor XIIIa+ cells) were observed. These results suggest that the decreased number of Langerhans cells may be a risk factor for development of dermatophytosis.
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Affiliation(s)
- Ana Paula Carvalho Reis
- Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Micologia Médica, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Dermatológica, Laboratório de Investigação Médica LIM 53, São Paulo, São Paulo, Brazil
| | - Franciele Fernandes Correia
- Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Micologia Médica, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Dermatológica, Laboratório de Investigação Médica LIM 53, São Paulo, São Paulo, Brazil
| | - Thais Martins Jesus
- Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Micologia Médica, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Dermatológica, Laboratório de Investigação Médica LIM 53, São Paulo, São Paulo, Brazil
| | - Carla Pagliari
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, Laboratório da Disciplina de Patologia de Moléstias Transmissíveis, São Paulo, São Paulo, Brazil
| | - Neusa Y Sakai-Valente
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Dermatológica, Laboratório de Investigação Médica LIM 53, São Paulo, São Paulo, Brazil
| | - Walter Belda Júnior
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Dermatológica, Laboratório de Investigação Médica LIM 53, São Paulo, São Paulo, Brazil
| | | | - Gil Benard
- Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Micologia Médica, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Dermatológica, Laboratório de Investigação Médica LIM 53, São Paulo, São Paulo, Brazil
| | - Maria Gloria Teixeira Sousa
- Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Micologia Médica, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Clínica Dermatológica, Laboratório de Investigação Médica LIM 53, São Paulo, São Paulo, Brazil
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Organization of the Skin Immune System and Compartmentalized Immune Responses in Infectious Diseases. Clin Microbiol Rev 2019; 32:32/4/e00034-18. [PMID: 31366611 DOI: 10.1128/cmr.00034-18] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The skin is an organ harboring several types of immune cells that participate in innate and adaptive immune responses. The immune system of the skin comprises both skin cells and professional immune cells that together constitute what is designated skin-associated lymphoid tissue (SALT). In this review, I extensively discuss the organization of SALT and the mechanisms involved in its responses to infectious diseases of the skin and mucosa. The nature of these SALT responses, and the cellular mediators involved, often determines the clinical course of such infections. I list and describe the components of innate immunity, such as the roles of the keratinocyte barrier and of inflammatory and natural killer cells. I also examine the mechanisms involved in adaptive immune responses, with emphasis on new cytokine profiles, and the role of cell death phenomena in host-pathogen interactions and control of the immune responses to infectious agents. Finally, I highlight the importance of studying SALT in order to better understand host-pathogen relationships involving the skin and detail future directions in the immunological investigation of this organ, especially in light of recent findings regarding the skin immune system.
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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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