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Guevara A, Nery AF, de Souza Carvalho Melhem M, Bonfietti L, Rodrigues AM, Hagen F, de Carvalho J, de Camargo ZP, de Souza Lima B, Vicente VA, Hahn RC. Molecular epidemiology and clinical-laboratory aspects of chromoblastomycosis in Mato Grosso, Brazil. Mycoses 2022; 65:1146-1158. [PMID: 35869803 PMCID: PMC9828117 DOI: 10.1111/myc.13505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Chromoblastomycosis is a disease caused by melanized fungi, primarily belonging to the genera Fonsecaea and Cladophialophora, mainly affecting individuals who are occupationally exposed to soil and plant products. This research aimed to determine the clinical, epidemiological and laboratory characteristics of chromoblastomycosis in the state of Mato Grosso, Brazil. MATERIALS AND METHODS Patients diagnosed with chromoblastomycosis treated at the Júlio Müller University Hospital, Cuiabá, Brazil, from January 2015 to December 2020, whose isolates were preserved in the Research Laboratory of the Faculty of Medicine of the Federal University of Mato Grosso. Isolates were identified by partly sequencing the Internal Transcribed Spacer (ITS) and β-tubulin (BT2) loci. AFLP fingerprinting was used to explore the genetic diversity. Susceptibility to itraconazole, voriconazole, 5-fluorocytosine, terbinafine and amphotericin B was determined by the broth microdilution technique. RESULTS Ten patients were included, nine were male (mean age = 64.1 years). Mean disease duration was 8.6 years. Lesions were mainly observed in the lower limbs. Predominant clinical forms were verrucous and scarring. Systemic arterial hypertension and type II diabetes mellitus were the predominant comorbidities. Leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi was the unique aetiological agent identified with moderate genetic diversity (H = 0.3934-0.4527; PIC = 0.3160-0.3502). Antifungal agents with the highest activity were terbinafine, voriconazole and itraconazole. CONCLUSION Chromoblastomycosis is affecting the poor population in rural and urban areas, mainly related to agricultural activities, with F. pedrosoi being the dominant aetiologic agent. All isolates had low MICs for itraconazole, voriconazole and terbinafine, confirming their importance as therapeutic alternatives for chromoblastomycosis.
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Affiliation(s)
- Armando Guevara
- Laboratory of Mycology/Research, Faculty of MedicineFederal University of Mato GrossoCuiabáMato GrossoBrazil
| | - Andréia Ferreira Nery
- Júlio Muller University HospitalFederal University of Mato GrossoCuiabáMato GrossoBrazil
| | - Márcia de Souza Carvalho Melhem
- Health DepartmentMycology Nucleus of Instituto Adolfo LutzSão PauloSPBrazil,School of MedicineFederal University of Mato Grosso do SulCampo Grande, MSBrazil
| | - Lucas Bonfietti
- Health DepartmentMycology Nucleus of Instituto Adolfo LutzSão PauloSPBrazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular BiologyFederal University of São Paulo (UNIFESP)São PauloBrazil,Department of Medicine, Discipline of Infectious DiseasesFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity InstituteUtrechtThe Netherlands,Institute for Biodiversity and Ecosystem Dynamics (IBED)University of AmsterdamThe Netherlands,Department of Medical MicrobiologyUtrecht University Medical CenterUtrechtThe Netherlands
| | - Jamile Ambrósio de Carvalho
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular BiologyFederal University of São Paulo (UNIFESP)São PauloBrazil,Department of Medicine, Discipline of Infectious DiseasesFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular BiologyFederal University of São Paulo (UNIFESP)São PauloBrazil,Department of Medicine, Discipline of Infectious DiseasesFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Bruna Jacomel F. de Souza Lima
- Microbiology, Parasitology and Pathology Post‐Graduation Program, Department of PathologyFederal University of ParanáCuritibaParanáBrazil
| | | | - Rosane Christine Hahn
- Laboratory of Mycology/Research, Faculty of MedicineFederal University of Mato GrossoCuiabáMato GrossoBrazil,Júlio Muller University HospitalFederal University of Mato GrossoCuiabáMato GrossoBrazil
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Guevara A, Vicente VA, de Souza Lima BJF, Nery AF, Hagen F, Hahn RC. Chromoblastomycosis-Leprosy Co-Infection in Central West Brazil. Presentation of Three Cases and Literature Review. Mycopathologia 2022; 187:363-374. [PMID: 35764905 PMCID: PMC9325793 DOI: 10.1007/s11046-022-00646-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Abstract
Chromoblastomycosis and leprosy are chronic diseases with high prevalence in tropical and subtropical regions. Brazil is one of the countries with the highest incidence and prevalence for both diseases, however, reports of co-infections are scarce. The aim of this study was to describe three cases of chromoblastomycosis-leprosy co-infection in patients from Mato Grosso state, Brazil. A review of chromoblastomycosis-leprosy co-infection was performed of English, Portuguese and Spanish publications in LILACS, SciELO, PubMed and Web of Science databases using the descriptors (chromoblastomycosis OR cromoblastomicose OR cromoblastomicosis) AND (leprosy OR hanseníase OR lepra), without time period delimitation. Nineteen cases were included, 16 cases were published in 11 articles, plus the three cases reported in the current study. Most reported coninfection cases came from Brazil. Majority of the patients were male with a mean age of 52.2 years. Farmer was the main occupational activity reported. In 12 patients, the clinical signs and symptoms of leprosy started first. No contacts with patients affected by leprosy, armadillos or history of injuries at the anatomical site of chromoblastomycosis lesions were reported. Five leprosy patients who received steroid treatment for leprosy reactions or neuropathies, were diagnosed with chromoblastomycosis during immunosuppressive therapy. Four cases (21.1%) were reported among the elderly patients. Co-infections in patients with chromoblastomycosis or leprosy are uncommon, but the possibility should always be considered, especially if the patient is undergoing immunosuppressive treatment or is elder.
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Affiliation(s)
- Armando Guevara
- Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Vânia Aparecida Vicente
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Bruna Jacomel F de Souza Lima
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Andréia Ferreira Nery
- Júlio Muller University Hospital - Ebserh, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584CT, Utrecht, The Netherlands.
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Rosane Christine Hahn
- Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.
- Júlio Muller University Hospital - Ebserh, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.
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Alves-Junior ER, Gomes LT, Dombroski TCD, Nery AF, Vandresen-Filho S, Nakazato L, Fontes CJF, Rios-Santos F. New laboratory perspectives for evaluation of vivax malaria infected patients: a useful tool for infection monitoring. Braz J Infect Dis 2020; 24:120-129. [PMID: 32335079 PMCID: PMC9392044 DOI: 10.1016/j.bjid.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 01/08/2023] Open
Abstract
In recent years, the number of cases with severe Plasmodium vivax malaria has shown an increasing trend. It is, therefore, important to identify routine laboratory markers that best characterize the acute disease phase and can serve as a tool for clinical follow-up of patients. In a cohort study, we followed 87 patients with acute P. vivax monoinfection acquired in an endemic region of the Brazilian Amazon. Forty-two different biochemical and hematological parameters frequently tested in clinical routine were evaluated at the acute phase and the convalescent phase. A total of 42 laboratory tests were performed: biochemical parameters measured were serum lipids levels, aminotransferases, bilirubin, amylase, glucose, urea, creatinine, albumin, globulin, uric acid, C-reactive protein, and alpha-1-acid glycoprotein. Hematological parameters included total and differential white blood cell and platelet counts, hemoglobin concentration, mean platelet volume, platelet width distribution, and plateletcrit. Our results show that several biochemical and hematological parameters were associated with acute phase P. vivax malaria and these parameters reverted to normal values in the convalescent phase. The use of these parameters during diagnosis and follow-up of the infection is a useful clinical tool to evaluate the clinical course and therapeutic response of patients with uncomplicated vivax malaria.
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Affiliation(s)
- Eduardo Rodrigues Alves-Junior
- Universidade Federal de Mato Grosso, Faculdade de Medicina, Cuiabá, MT, Brazil; Centro Universitário de Várzea Grande, Departamento de Ciencias da Saúde, Varzea Grande, MT, Brazil.
| | - Luciano Teixeira Gomes
- Universidade Federal de Mato Grosso, Faculdade de Medicina, Cuiabá, MT, Brazil; Hospital Universitário Julio Muller, Cuiabá, MT, Brazil
| | | | - Andréia Ferreira Nery
- Universidade Federal de Mato Grosso, Faculdade de Medicina, Cuiabá, MT, Brazil; Hospital Universitário Julio Muller, Cuiabá, MT, Brazil; Faculdade de Ciências Biomédicas, Cacoal, RO, Brazil
| | | | - Luciano Nakazato
- Universidade Federal de Mato Grosso, Hospital Veterinário e Laboratório de Microbiologia e Biologia Molecular Veterinária, Cuiabá, MT, Brazil
| | - Cor Jesus Fernandes Fontes
- Universidade Federal de Mato Grosso, Faculdade de Medicina, Cuiabá, MT, Brazil; Hospital Universitário Julio Muller, Cuiabá, MT, Brazil; Faculdade de Ciências Biomédicas, Cacoal, RO, Brazil
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Hahn RC, Rodrigues AM, Della Terra PP, Nery AF, Hoffmann-Santos HD, Góis HM, Fontes CJF, de Camargo ZP. Clinical and epidemiological features of paracoccidioidomycosis due to Paracoccidioides lutzii. PLoS Negl Trop Dis 2019; 13:e0007437. [PMID: 31163028 PMCID: PMC6548353 DOI: 10.1371/journal.pntd.0007437] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The fungus Paracoccidioides lutzii was recently included as a new causative species of paracoccidioidomycosis (PCM) and most cases have been reported from Brazil. According to available epidemiological information, P. lutzii is concentrated in the Middle-West region in Brazil, mainly in the state of Mato Grosso. However, clinical and laboratorial data available on patients infected with P. lutzii remain extremely limited. METHODOLOGY/MAIN FINDINGS This work describes the clinical manifestations of 34 patients suffering from PCM caused by P. lutzii, treated along 5 years (2011-2017) at a reference service center for systemic mycoses in Mato Grosso, Brazil. Adult rural workers (men), aged between 28 and 67 predominated. All patients had the chronic form of the disease, and the oral mucosa (n = 19; 55.9%), lymph nodes (n = 23; 67.7%), skin (n = 16; 47.1%) and lung (n = 28; 82.4%) were the most affected sites. Alcohol intake (n = 19; 55.9%) and smoking (n = 29; 85.3%) were frequent habits among the patients. No patient suffered from any other life-threatening disease, such as tuberculosis, cancer or other inflammatory or infectious parasitic diseases. The positivity in culture examination (97.1%) was higher than that found for the direct mycological examination (88.2%). Particularly, one patient presented fungemia at diagnosis, which lead to his death. The time elapsed between the initial symptoms and the initiation of treatment of PCM caused by P. lutzii was 19.7 (31.5) months, with most patients diagnosed 7 months after the symptoms' onset. CONCLUSIONS/SIGNIFICANCE Compared with the classical clinical-epidemiological profile of PCM caused by P. brasiliensis, the results of this descriptive study did not show significant clinical or epidemiological differences that could be attributed to the species P. lutzii. Future studies may confirm or refute the existence of clinical differences between the two fungal species.
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Affiliation(s)
- Rosane Christine Hahn
- Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Mycology/Research, Cuiabá, Mato Grosso, Brazil
- Federal University of Mato Grosso, Júlio Muller University Hospital, Mato Grosso, Brazil
- Federal University of São Paulo, Paulista School of Medicine, Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, São Paulo, São Paulo, Brazil
| | - Anderson Messias Rodrigues
- Federal University of São Paulo, Paulista School of Medicine, Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, São Paulo, São Paulo, Brazil
| | - Paula Portella Della Terra
- Federal University of São Paulo, Paulista School of Medicine, Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, São Paulo, São Paulo, Brazil
| | - Andréia Ferreira Nery
- Federal University of Mato Grosso, Júlio Muller University Hospital, Mato Grosso, Brazil
| | - Hugo Dias Hoffmann-Santos
- Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Mycology/Research, Cuiabá, Mato Grosso, Brazil
| | - Hellen Meira Góis
- Federal University of Mato Grosso, Júlio Muller University Hospital, Mato Grosso, Brazil
| | | | - Zoilo Pires de Camargo
- Federal University of São Paulo, Paulista School of Medicine, Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, São Paulo, São Paulo, Brazil
- * E-mail:
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Simões LR, Alves Jr ER, Ribatski-Silva D, Gomes LT, Nery AF, Fontes CJF. Factors associated with recurrent Plasmodium vivax malaria in Porto Velho, Rondônia State, Brazil, 2009. CAD SAUDE PUBLICA 2014; 30:1403-17. [DOI: 10.1590/0102-311x00169312] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 11/26/2013] [Indexed: 12/20/2022] Open
Abstract
This open retrospective cohort study aimed to describe the incidence of recurrent Plasmodium vivax malaria and associated factors in Porto Velho, Rondônia State, Brazil, in 2009. Data were collected from the National Information System for Malaria Epidemiological Surveillance. There were 23,365 reported P. vivax malaria cases in 2009, 23% of which were classified as relapses. Incidence density of P. vivax recurrence was 45.1/100 patient-years, mostly occurring between the 4th and 13th week after initiating treatment. Male gender, shorter time since onset of symptoms, and higher parasitemia in the initial infection increased the risk of relapse during the year, with a 10% reduction in relative risk for longer symptoms and 11% and 15% increases in relative risk for males and higher initial parasitemia, respectively. However, the results show low clinical relevance for these associations, thereby limiting their applicability to decision-making at the public health level.
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Alves-Junior ER, Gomes LT, Assis-Oliveira FB, Silvério-Silva LR, Nery AF, Fontes CJ. Quantification of parasite density in 200 microscopic fields underestimates the parasitemia level in malaria patients. Trop Biomed 2014; 31:387-391. [PMID: 25134910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The determination of parasitemia in the diagnosis of malaria is a routine practice because it assists the selection of treatment. The techniques used for estimating parasitemia are based on leukocyte counts or on a fixed volume of blood examined in a microscopic field. This study evaluated the concordance between parasitemia estimated by counting parasites in 200 microscopic fields and by counting parasites per 500 leukocytes using the automated leukocyte count as a reference. This study included 403 patients with acute malaria. The parasitemia levels obtained by each method varied greatly. A large discrepancy was observed between the 2 methods with respect to parasitemia results, with 17.6% and 82.4% of the values being overestimates and underestimates, respectively, compared to quantification by the automated leukocyte counts. Thus, these findings reveal the inaccuracy of this method and should be considered by health professionals involved in clinical management of the disease.
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Affiliation(s)
- E R Alves-Junior
- Federal University of Mato Grosso, Av Fernando Correa da Costa 2367, CEP: 78060-900, Cuiabá (MT), Brazil
| | - L T Gomes
- Federal University of Mato Grosso, Av Fernando Correa da Costa 2367, CEP: 78060-900, Cuiabá (MT), Brazil
| | - F B Assis-Oliveira
- Federal University of Mato Grosso, Av Fernando Correa da Costa 2367, CEP: 78060-900, Cuiabá (MT), Brazil
| | - L R Silvério-Silva
- Federal University of Mato Grosso, Av Fernando Correa da Costa 2367, CEP: 78060-900, Cuiabá (MT), Brazil
| | - A F Nery
- Federal University of Mato Grosso, Av Fernando Correa da Costa 2367, CEP: 78060-900, Cuiabá (MT), Brazil
| | - C J Fontes
- Federal University of Mato Grosso, Av Fernando Correa da Costa 2367, CEP: 78060-900, Cuiabá (MT), Brazil
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Cunha MAD, Nery AF, Lima FP, Diniz Junior J, Maciel Neto J, Calado NB, Luz KG, Milan EP. Rhinocerebral zygomycosis in a diabetic patient. Rev Soc Bras Med Trop 2011; 44:257-9. [DOI: 10.1590/s0037-86822011000200027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 11/17/2010] [Indexed: 11/21/2022] Open
Abstract
Rhinocerebral zygomycosis is the most frequent form of fungal infection caused by members of the Zygomycetes class. A fatal case of rhinocerebral zygomycosis caused by Rhizopus (oryzae) arrhizus with histopathological and mycological diagnosis is reported in a diabetic patient.
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Rodrigues AM, Hueb M, Nery AF, Fontes CJF. Possible cardioprotective effect of angiotensin-converting enzyme inhibitors during treatment of American tegumentary leishmaniasis with meglumine antimoniate. Acta Trop 2007; 102:113-8. [PMID: 17555699 DOI: 10.1016/j.actatropica.2007.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2006] [Revised: 03/07/2007] [Accepted: 04/17/2007] [Indexed: 11/17/2022]
Abstract
We conducted an observational retrospective study to identify factors associated with prolongation of corrected QT (QTc) interval during treatment of American tegumentary leishmaniasis with meglumine antimoniate. A group of 108 patients with normal ECG before treatment were included. Thirty-one patients (29%) developed increase of QTc interval beyond 0.44s in the second ECG performed after an average of (mean+/-S.D.) 12.6+/-4.9 days. After univariate and multivariate analysis, the age was associated with prolonged QTc interval, and the use of angiotensin-converting enzyme (ACE) inhibitors demonstrated a protective factor. These results identify elderly as a risk factor to develop prolonged QTc due to antimonial therapy (odds ratio: 1.1; 95% confidence interval: 1.01-1.12), and suggest that use of ACE inhibitors is a possible cardioprotective agent (odds ratio: 0.3; 95% confidence interval: 0.003-0.34). Further studies using prospective methodology are necessary to define the role of ACE inhibitors as prophylactic agent in high-risk patients.
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Affiliation(s)
- Alex Miranda Rodrigues
- Master in Health Sciences, School Medical Sciences, Federal University of Mato Grosso, Av. Fernando Corrêa da Costa s/n, Coxipó, 78060-900 Cuiabá, MT, Brazil.
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