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Dib Ferreira Gremião I, Pereira-Oliveira GR, Pereira SA, Corrêa ML, Borba-Santos LP, Viçosa AL, Garg A, Haranahalli K, Dasilva D, Pereira de Sa N, Matos GS, Silva V, Lazzarini C, Fernandes CM, Miranda K, Artunduaga Bonilla JJ, Nunes AL, Nimrichter L, Ojima I, Mallamo J, McCarthy JB, Del Poeta M. Combination therapy of itraconazole and an acylhydrazone derivative (D13) for the treatment of sporotrichosis in cats. Microbiol Spectr 2024; 12:e0396723. [PMID: 38647345 DOI: 10.1128/spectrum.03967-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Acylhydrazone (AH) derivatives represent a novel category of anti-fungal medications that exhibit potent activity against Sporothrix sp., both in vitro and in a murine model of sporotrichosis. In this study, we demonstrated the anti-fungal efficacy of the AH derivative D13 [4-bromo-N'-(3,5-dibromo-2-hydroxybenzylidene)-benzohydrazide] against both planktonic cells and biofilms formed by Sporothrix brasiliensis. In a clinical study, the effect of D13 was then tested in combination with itraconazole (ITC), with or without potassium iodide, in 10 cats with sporotrichosis refractory to the treatment of standard of care with ITC. Improvement or total clinical cure was achieved in five cases after 12 weeks of treatment. Minimal abnormal laboratory findings, e.g., elevation of alanine aminotransferase, were observed in four cats during the combination treatment and returned to normal level within a week after the treatment was ended. Although highly encouraging, a larger and randomized controlled study is required to evaluate the effectiveness and the safety of this new and exciting drug combination using ITC and D13 for the treatment of feline sporotrichosis. IMPORTANCE This paper reports the first veterinary clinical study of an acylhydrazone anti-fungal (D13) combined with itraconazole against a dimorphic fungal infection, sporotrichosis, which is highly endemic in South America in animals and humans. Overall, the results show that the combination treatment was efficacious in ~50% of the infected animals. In addition, D13 was well tolerated during the course of the study. Thus, these results warrant the continuation of the research and development of this new class of anti-fungals.
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Affiliation(s)
- Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Gabriela Reis Pereira-Oliveira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Maria Lopes Corrêa
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | | | - Alessandra Lifsitch Viçosa
- Laboratory of Experimental Pharmacotechnics, Institute of Drug Technology - Farmanguinhos, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Ashna Garg
- Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, New York, USA
| | - Krupanandan Haranahalli
- Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, New York, USA
- Department of Chemistry, Stony Brook University, Stony Brook, New York, USA
| | - Deveney Dasilva
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Nivea Pereira de Sa
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Gabriel S Matos
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Vanessa Silva
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Cristina Lazzarini
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Caroline Mota Fernandes
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Kildare Miranda
- Laboratory of Cellular Ultrastructure Hertha Meyer, Carlos Chagas Filho Institute of Biophysics and National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jhon Jhamilton Artunduaga Bonilla
- Laboratory of Eukaryotic Glycobiology (LaGE), Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anna Letícia Nunes
- Laboratory of Eukaryotic Glycobiology (LaGE), Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Nimrichter
- Laboratory of Eukaryotic Glycobiology (LaGE), Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Iwao Ojima
- Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, New York, USA
- Department of Chemistry, Stony Brook University, Stony Brook, New York, USA
| | - John Mallamo
- MicroRid Technologies Inc., Dix Hills, New York, USA
| | | | - Maurizio Del Poeta
- Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, New York, USA
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
- MicroRid Technologies Inc., Dix Hills, New York, USA
- Division of Infectious Diseases, School of Medicine, Stony Brook University, Stony Brook, New York, USA
- Veterans Administration Medical Center, Northport, New York, USA
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Poester VR, Munhoz LS, Trápaga MR, Esperon BM, Stevens DA, Xavier MO. Humane Endpoint: Example from a Murine Model of Disseminated Sporotrichosis. Curr Microbiol 2024; 81:175. [PMID: 38755455 DOI: 10.1007/s00284-024-03692-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/07/2024] [Indexed: 05/18/2024]
Abstract
Vertebrate animal models are essential in research; however, efforts need to be made to decrease animal suffering as much as possible. It could be useful to determine humane endpoints that could serve as surrogates for a fatal outcome. We address this issue with respect to infectious diseases. We propose a humane endpoint for studies of Sporothrix brasiliensis infection. BALB/c mice were inoculated subcutaneously in the footpad. To define a humane endpoint, we considered two groups: animals who died during the experiment, and those euthanized at the end of the experiment. The groups were compared for colony-forming units (CFU) in internal organs, clinical condition, and body weight. Thirteen (22%) animals died before the end of the experiment due to the progression of local infection to severe and disseminated sporotrichosis. Analyzing data of the groups, we propose the following future criteria for euthanasia as a humane endpoint: neurological impairment OR necrosis of the footpad OR loss of ≥ 20% body weight AND moderate to severe dehydration. In view of the current global epidemiological impact of zoonotic sporotrichosis caused by S. brasiliensis, our data could facilitate the utility of models used to study the disease, particularly therapy.
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Affiliation(s)
- Vanice Rodrigues Poester
- Programa de Pós-Graduação Em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal Do Rio Grande (FURG), Rio Grande, Rio Grande do Sul (RS), Brazil.
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal Do Rio Grande, Campus Saúde. Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brasil.
| | - Lívia Silveira Munhoz
- Programa de Pós-Graduação Em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal Do Rio Grande (FURG), Rio Grande, Rio Grande do Sul (RS), Brazil
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal Do Rio Grande, Campus Saúde. Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brasil
| | - Mariana Rodrigues Trápaga
- Programa de Pós-Graduação Em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal Do Rio Grande (FURG), Rio Grande, Rio Grande do Sul (RS), Brazil
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal Do Rio Grande, Campus Saúde. Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brasil
| | - Bruna Muradás Esperon
- Programa de Pós-Graduação Em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal Do Rio Grande (FURG), Rio Grande, Rio Grande do Sul (RS), Brazil
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal Do Rio Grande, Campus Saúde. Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brasil
| | - David A Stevens
- California Institute for Medical Research, San Jose, USA.
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, USA.
- Foundation for Research in Infectious Diseases, P.O. Box 2734, Saratoga, 95070, USA.
| | - Melissa Orzechowski Xavier
- Programa de Pós-Graduação Em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal Do Rio Grande (FURG), Rio Grande, Rio Grande do Sul (RS), Brazil.
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal Do Rio Grande, Campus Saúde. Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brasil.
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Poester VR, Xavier MO, Munhoz LS, Basso RP, Zancopé-Oliveira RM, Freitas DFS, Pasqualotto AC. Sporothrix brasiliensis Causing Atypical Sporotrichosis in Brazil: A Systematic Review. J Fungi (Basel) 2024; 10:287. [PMID: 38667958 PMCID: PMC11051268 DOI: 10.3390/jof10040287] [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: 03/09/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Zoonotic sporotrichosis, a subcutaneous mycosis caused by Sporothrix brasiliensis, has become hyperendemic and a serious public health issue in Brazil and an emerging disease throughout the world. Typical sporotrichosis is defined as fixed or lymphocutaneous lesion development, however, reports of atypical presentations have been described in hyperendemic areas, which may result in a worse prognosis. Thus, considering an increase in atypical cases and in more severe extracutaneous cases and hospitalizations reported in Brazil, we aimed to perform a systematic review to search for hypersensitivity reactions (HRs) and extracutaneous presentations associated with zoonotic sporotrichosis. A systematic review was performed, following the PRISMA guidelines to search for atypical/extracutaneous cases (mucosal, osteoarthritis, HRs, pulmonary, meningeal) of zoonotic sporotrichosis. A total of 791 published cases over 26 years (1998-2023) in eleven Brazilian states were reviewed. Most cases corresponded to a HR (47%; n = 370), followed by mucosal (32%; n = 256), multifocal (8%; n = 60), osteoarthritis (7%; n = 59), meningeal (4%; n = 32), and pulmonary (2%; n = 14) infections. When available (n = 607), the outcome was death in 7% (n = 43) of cases. Here, we show a frequent and worrisome scenario of zoonotic sporotrichosis in Brazil, with a high and dispersed incidence of atypical/extracutaneous cases throughout the Brazilian territory. Therefore, educational measures are necessary to make health professionals and the overall population aware of this fungal pathogen in Brazil as well as in other countries in the Americas.
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Affiliation(s)
- Vanice Rodrigues Poester
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, Rio Grande do Sul (RS), Brazil; (V.R.P.); (M.O.X.); (L.S.M.); (R.P.B.)
- Mycology Laboratory of FAMED-FURG, Rio Grande 96200-190, RS, Brazil
| | - Melissa Orzechowski Xavier
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, Rio Grande do Sul (RS), Brazil; (V.R.P.); (M.O.X.); (L.S.M.); (R.P.B.)
- Mycology Laboratory of FAMED-FURG, Rio Grande 96200-190, RS, Brazil
| | - Lívia Silveira Munhoz
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, Rio Grande do Sul (RS), Brazil; (V.R.P.); (M.O.X.); (L.S.M.); (R.P.B.)
- Mycology Laboratory of FAMED-FURG, Rio Grande 96200-190, RS, Brazil
| | - Rossana Patricia Basso
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, Rio Grande do Sul (RS), Brazil; (V.R.P.); (M.O.X.); (L.S.M.); (R.P.B.)
- Mycology Laboratory of FAMED-FURG, Rio Grande 96200-190, RS, Brazil
- Hospital Universitário Dr. Miguel Riet Correa Jr., FURG/Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio Grande 96200-190, RS, Brazil
| | - Rosely Maria Zancopé-Oliveira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Rio de Janeiro (RJ), Brazil; (R.M.Z.-O.); (D.F.S.F.)
| | - Dayvison Francis Saraiva Freitas
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Rio de Janeiro (RJ), Brazil; (R.M.Z.-O.); (D.F.S.F.)
| | - Alessandro Comarú Pasqualotto
- Molecular Biology Laboratory, Hospital Dom Vicente Scherer, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Medicine Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90035-075, RS, Brazil
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Reis EGD, Pereira SA, Miranda LHMD, Oliveira RDVCD, Quintana MDSB, Viana PG, Figueiredo ABF, Honorato CCDS, Pereira-Oliveira GR, Silva JN, Schubach TMP, Gremião IDF. A Randomized Clinical Trial Comparing Itraconazole and a Combination Therapy with Itraconazole and Potassium Iodide for the Treatment of Feline Sporotrichosis. J Fungi (Basel) 2024; 10:101. [PMID: 38392773 PMCID: PMC10889782 DOI: 10.3390/jof10020101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Feline sporotrichosis is an endemic disease with high occurrence in Brazil. Itraconazole (ITZ) remains the drug of choice for treating this disease in cats, despite the increasing reports of therapeutic failure. A controlled, randomized clinical trial was performed on 166 naive cats with sporotrichosis to assess the effectiveness and safety of the combination therapy with ITZ and potassium iodide (KI) compared with ITZ monotherapy. Cats were randomly allocated into two treatment groups: G1-ITZ 100 mg/cat/day-and G2-ITZ 100 mg/cat/day + KI 2.5-20 mg/kg/day. Cats treated in G2 presented 77% more risk of reaching a clinical cure (a positive effect) than those treated in G1, even when controlled by negative predictors. The survival curves of the two treatment protocols indicate that a clinical cure was achieved faster in G2. An increase in the KI dose was necessary in 28 cats due to the persistence of clinical signs. Adverse reactions were equally frequent in both groups and manageable with a temporary drug suspension and/or a hepatoprotective therapy. The combination therapy was associated with a higher cure rate and a shorter treatment time, suggesting that ITZ+KI arises as a better option for treating feline sporotrichosis and should be considered the first-line treatment, especially in the presence of negative predictors.
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Affiliation(s)
- Erica Guerino Dos Reis
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | | | | | - Marcel de Souza Borges Quintana
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-361, Brazil
| | - Paula Gonçalves Viana
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Anna Barreto Fernandes Figueiredo
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Cindy Caroline Dos Santos Honorato
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Gabriela Reis Pereira-Oliveira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Jéssica Nunes Silva
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Tânia Maria Pacheco Schubach
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
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Poester VR, Hidalgo JED, Jardim LS, Trápaga MR, Rabello VBDS, Almeida-Paes R, Zancope-Oliveira RM, Xavier MO. Amlodipine and lufenuron as repurposing drugs against Sporothrix brasiliensis. PeerJ 2023; 11:e16443. [PMID: 38050607 PMCID: PMC10693817 DOI: 10.7717/peerj.16443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/20/2023] [Indexed: 12/06/2023] Open
Abstract
Background Sporotrichosis caused by Sporothrix brasiliensis is a globally emerging infectious disease with limited therapeutic options. Thus, we aimed to evaluate the in vitro activity of amlodipine (AML) and lufenuron (LUF) alone and their interaction with itraconazole (ITZ), the first-choice drug against S. brasiliensis. Methods Twenty clinical isolates of S. brasiliensis from two hyperendemic regions were tested through a microdilution assay to evaluate the minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC) of AML and LUF. Checkerboard assay was performed with 10 isolates for both drug interactions with ITZ. Results AML showed inhibitory and fungicidal activity against all isolates included, with MIC values ranging from 32 to 256 µg/mL, and MFC from 64 to 256 µg/mL. However, none of the S. brasiliensis isolates were inhibited by the highest soluble concentration of LUF (MIC >64 µg/mL for all strains). Synergic interaction of AML and LUF with ITZ occurred in 50% and 40% of the isolates tested, without any antagonistic effects. Conclusion Both repurposing drugs evaluated in our study showed a promising in vitro activity, especially in synergy with ITZ against S. brasiliensis, warranting future in vivo investigations regarding its activity.
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Affiliation(s)
- Vanice Rodrigues Poester
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
- Laboratório de Micologia (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
| | | | - Lara Severo Jardim
- Laboratório de Micologia (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
| | - Mariana Rodrigues Trápaga
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
- Laboratório de Micologia (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
| | - Vanessa Brito de Souza Rabello
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro state, Brazil
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro state, Brazil
| | - Rosely Maria Zancope-Oliveira
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro state, Brazil
| | - Melissa Orzechowski Xavier
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
- Laboratório de Micologia (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
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