1
|
Montenegro-Idrogo J, Chiappe-Gonzalez A, Vicente-Lozano E, Cornejo-Venegas G, Resurrección-Delgado C. Case Report: Disseminated Paracoccidioidomycosis and Strongyloides Hyperinfection in a Patient with Human T-Lymphotropic Virus Type 1/2 Infection. Am J Trop Med Hyg 2024; 110:961-964. [PMID: 38531110 PMCID: PMC11066361 DOI: 10.4269/ajtmh.23-0171] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 01/21/2024] [Indexed: 03/28/2024] Open
Abstract
Co-occurrence of paracoccidioidomycosis and strongyloidiasis in immunosuppressed patients, particularly those infected with human T-lymphotropic virus type 1/2, is infrequent. We describe the case of a Peruvian farmer from the central jungle with human T-lymphotropic virus type 1/2 infection, with 2 months of illness characterized by respiratory and gastrointestinal symptoms associated with fever, weight loss, and enlarged lymph nodes. Strongyloides stercoralis and Paracoccidioides brasiliensis were isolated in sputum and bronchoalveolar lavage samples, respectively. The clinical evolution was favorable after the patient received ivermectin and amphotericin B. We hypothesize that autoinfestation by S. stercoralis in human T-lymphotropic virus type 1/2-infected patients may contribute to the disseminated presentation of Paracoccidioides spp. Understanding epidemiological context is crucial for suspecting opportunistic regional infections, particularly those that may coexist in immunosuppressed patients.
Collapse
Affiliation(s)
| | - Alfredo Chiappe-Gonzalez
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| | | | | | - Cristhian Resurrección-Delgado
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| |
Collapse
|
2
|
Mussin J, Giusiano G, Porras JC, Corredor Sanguña LH, Pividori MI. Carbon nanoparticle-based lateral flow assay for the detection of specific double-tagged DNA amplicons of Paracoccidioides spp. Mikrochim Acta 2024; 191:287. [PMID: 38671236 DOI: 10.1007/s00604-024-06367-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
To overcome the limitations of current methods for diagnosing paracoccidioidomycosis (PCM), it is critical to develop novel diagnostic strategies that can be implemented in low-resource settings and dramatically improve turnaround times. This study focused on the development of a portable molecular test to screen for Paracoccidioides spp. The proposed approach integrated double-tagging polymerase chain reaction (PCR) and a paper-based lateral flow assay (LFA) for readout, using carbon nanoparticles as a signal generation system. Primers tagged with biotin and digoxigenin were employed to conduct the double-tagging PCR, which can be conveniently carried out on portable thermocyclers. This method can generate billions of tagged DNA copies from a single target molecule, which can be rapidly detected by the LFA platform, providing results within minutes. Avidin-modified carbon nanoparticles served as a signal generation system, enabling detection in the immunochromatographic assay. The LFA demonstrated the capability to detect double-tagged amplicons as low as 0.21 ng or 0.10 ng, depending on whether the results were assessed visually or with a smartphone equipped with an image processor. These findings suggest that the proposed approach holds great promise as a point-of-care diagnostic tool for the early and accurate detection of PCM in low-resource settings. The diagnostic test is rapid and inexpensive, requires minimal handling and can be easily introduced into the general practitioner's armoury for ambulatory screening of infection. This innovative approach has the potential to make a substantial contribution to PCM diagnosis, ultimately reducing morbidity and mortality associated with this disease.
Collapse
Affiliation(s)
- Javier Mussin
- Institute of Biotechnology and Biomedicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
- Instituto de Medicina Regional, Universidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Av. Las Heras 727, 3500, Resistencia, Chaco, Argentina.
| | - Gustavo Giusiano
- Instituto de Medicina Regional, Universidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Av. Las Heras 727, 3500, Resistencia, Chaco, Argentina
| | - Juan Carlos Porras
- Grup de Sensors I Biosensors, Departament de Química, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Luis Hernando Corredor Sanguña
- Instituto de Medicina Regional, Universidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Av. Las Heras 727, 3500, Resistencia, Chaco, Argentina
| | - María Isabel Pividori
- Institute of Biotechnology and Biomedicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
- Grup de Sensors I Biosensors, Departament de Química, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
| |
Collapse
|
3
|
de Souza CAT, Ponce CC, Klautau GB, Costa AN, Queiroz W, Patzina RA, Benard G, Lindoso JAL. Can COVID-19 impact the natural history of paracoccidioidomycosis? Insights from an atypical chronic form of the mycosis. Rev Inst Med Trop Sao Paulo 2023; 65:e57. [PMID: 38055375 PMCID: PMC10691805 DOI: 10.1590/s1678-9946202365057] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 12/08/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic form (CF) and rarely as a mixed form combining the features of the two aforementioned forms in an immunocompromised patient. Here, we report a 56-year-old male patient with CF-PCM who presented with atypical manifestations, including the development of an initial esophageal ulcer, followed by central nervous system (CNS) lesions and cervical and abdominal lymphatic involvement concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its mycotic etiology. He was hospitalized for treatment of COVID-19 and required supplemental oxygen in the intensive unit. The patient recovered without the need for invasive ventilatory support. Investigation of the extent of disease during hospitalization revealed severe lymphatic involvement typical of A/SAF, although the patient`s long history of high-risk exposure to PCM, and lung involvement typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM patients. CNS involvement is also rare. We suggest that the immunological imbalance caused by the severe COVID-19 infection may have contributed to the patient developing atypical severe CF, which resembles the PCM mixed form of immunosuppressed patients. Severe COVID-19 infection is known to impair the cell-mediated immune response, including the antiviral response, through T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize that these alterations would also impair antifungal defenses. Our case highlights the potential influence of COVID-19 on the course of PCM. Fortunately, the patient was timely treated for both diseases, evolving favorably.
Collapse
Affiliation(s)
| | - Cesar Cilento Ponce
- Instituto de Infectologia Emilio Ribas, São Paulo, São Paulo,
Brazil
- Instituto Adolfo Lutz, São Paulo, São Paulo, Brazil
| | - Gisele Burlamaqui Klautau
- Instituto de Infectologia Emilio Ribas, São Paulo, São Paulo,
Brazil
- Santa Casa de São Paulo, Faculdade de Medicina, São Paulo, São
Paulo, Brazil
| | - André Nathan Costa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de
Cardio-Pneumologia, São Paulo, São Paulo, Brazil
| | - Wladimir Queiroz
- Instituto de Infectologia Emilio Ribas, São Paulo, São Paulo,
Brazil
| | | | - Gil Benard
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Micologia Médica (LIM-53), São Paulo,
São Paulo, Brazil
| | - José Angelo Lauletta Lindoso
- Instituto de Infectologia Emilio Ribas, São Paulo, São Paulo,
Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Protozoologia (LIM-49), São Paulo,
São Paulo, Brazil
| |
Collapse
|
4
|
Gualtero DEA, Diaz DAM, Rivero JEF, Mantilla JC, Valsangiacomo S. Bronchial stenosis secondary to systemic paracoccidioidomycosis. Rev Soc Bras Med Trop 2023; 56:e03432023. [PMID: 37792840 PMCID: PMC10550091 DOI: 10.1590/0037-8682-0343-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
| | | | | | - Julio Cesar Mantilla
- Facultad de Medicina de la Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - Stefano Valsangiacomo
- Facultad de Medicina de la Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| |
Collapse
|
5
|
Kruschewsky WLL, Patricio SA, Bahiense IC, Maifrede SB, Pôssa AP, de Camargo ZP, Rodrigues AM, Peçanha PM, Falqueto A, Grão-Velloso TR, Gonçalves SS. Paracoccidioidomycosis cases by Paracoccidioides lutzii in southeastern Brazil. Braz J Microbiol 2023; 54:1761-1767. [PMID: 37289316 PMCID: PMC10485217 DOI: 10.1007/s42770-023-01019-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Paracoccidioidomycosis (PCM) is a systemic fungal disease caused by the thermodimorphic fungi Paracoccidioides spp. Their distribution is highly variable. Paracoccidioides lutzii is predominantly found in North and Middle-West Brazil and Ecuador. This study evaluated the clinicopathological characteristics of 10 patients diagnosed with PCM caused by P. lutzii in a reference center located in southeastern Brazil. DESIGN Double immunodiffusion assay (DID) was used to investigate 35 patients' sera with negative serology for P. brasiliensis against a P. lutzii CFA (cell-free antigen). RESULTS Out of the 35 retested patients, 10 (28.6%) were positive for P. lutzii CFA. Four patients did not report any displacement to P. lutzii endemic areas. Our results reinforce the importance of using different antigens when testing patients with clinical manifestations of PCM and negative serological tests for P. brasiliensis, primarily in cases of the report of displacement to or former residence in P. lutzii endemic regions. CONCLUSIONS The availability of tests for different Paracoccidioides species antigens is fundamental for reaching an adequate diagnosis, patient follow-up, and definition of prognosis.
Collapse
Affiliation(s)
- Wdson Luis Lima Kruschewsky
- Cassiano Antônio Moraes University Hospital (HUCAM), Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Suzana Alves Patricio
- Department of General and Specialized Surgery, Federal Fluminense University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Isabela Cruz Bahiense
- Infectious Diseases Postgraduate Program, Center for Research in Medical Mycology, Federal University of Espírito Santo (UFES), Espírito Santo, Brazil
| | - Simone Bravim Maifrede
- Center for Research in Medical Mycology, Department of Pathology, Federal University of Espírito Santo (UFES), Vitoria - ES, Brazil
| | - Ana Paula Pôssa
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Paulo Mendes Peçanha
- Cassiano Antônio Moraes University Hospital (HUCAM), Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
- Department of Clinical Medicine, Espírito Santo Federal University – UFES, Avenue Marechal Campos, 1468, Maruípe, Espírito Santo, Vitória CEP 29047-105 Brazil
| | - Aloísio Falqueto
- Cassiano Antônio Moraes University Hospital (HUCAM), Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
- Department of Social Medicine, Espírito Santo Federal University – UFES, Avenue Marechal Campos, Maruípe, Vitória, Espírito Santo 1468, CEP 29047-105 Brazil
| | - Tânia Regina Grão-Velloso
- Department of Clinical Dentistry Federal, University of Espírito Santo - UFES, Marechal Campos Avenue, CEP 29, Vitória-ES, 1468040-090 Brazil
| | - Sarah Santos Gonçalves
- Infectious Diseases Postgraduate Program, Center for Research in Medical Mycology, Federal University of Espírito Santo (UFES), Espírito Santo, Brazil
- Center for Research in Medical Mycology, Department of Pathology, Federal University of Espírito Santo (UFES), Vitoria - ES, Brazil
| |
Collapse
|
6
|
Osorio-Cock LM, Jaramillo-Pulgarín SC, Ferrín-Bastidas AP, Molina-Colorado DY, Gómez-Guzmán ÓM, Zuluaga A, McEwen-Ochoa JG, Urán-Jiménez ME, Jiménez-Alzate MDP. Pseudoepitheliomatous hyperplasia: Squamous cell carcinoma versus oral paracoccidioidomycosis, a case from a dermatological perspective. Biomedica 2023; 43:69-76. [PMID: 37721905 PMCID: PMC10586879 DOI: 10.7705/biomedica.6899] [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] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/13/2023] [Indexed: 09/20/2023]
Abstract
Paracoccidioidomycosis is a systemic mycosis endemic in Latin America. The most frequent form involves a chronic compromise of the lungs, skin, and mucosa. The patient started with a single oral lesion that lasted for several years. The absence of other symptoms pointed out a possible malignant neoplasm, specifically a squamous cell carcinoma. Differentiation between both diagnoses –fungal infection and carcinoma– depends on the results of the direct examination, the histopathological study, and the initial and subsequent cultures. However, in this case, those findings were not conclusive. The coexistence of both diagnoses is frequent and increases the diagnostic challenge. After several consultations and tests, direct examination, immunodiffusion and real-time PCR findings the multifocal chronic paracoccidioidomycosis diagnosis was confirmed. This case warns about a systematical absence of clinical suspicion of endemic mycoses before the appereance of mucocutaneous lesions, which can be produced by fungi like Paracoccidioides spp, and the importance of considering those mycoses among the differential diagnoses.
Collapse
Affiliation(s)
- Lina M Osorio-Cock
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia..
| | | | | | - Diana Y Molina-Colorado
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Óscar M Gómez-Guzmán
- Grupo de Biología Celular y Molecular, Corporación para Investigaciones Biológicas, Medellín, Colombia.
| | - Alejandra Zuluaga
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas, Medellín, Colombia.
| | - Juan G McEwen-Ochoa
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Biología Celular y Molecular, Corporación para Investigaciones Biológicas, Medellín, Colombia.
| | - Martha E Urán-Jiménez
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - María Del Pilar Jiménez-Alzate
- Grupo Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| |
Collapse
|
7
|
Fernandes-Beraldo KR, Santos de Freitas-Xavier R, Pardini-Vicentini A. Fast and cost-effective protocol to produce Paracoccidioides spp. antigens. Biomedica 2023; 43:170-180. [PMID: 37721912 PMCID: PMC10594581 DOI: 10.7705/biomedica.6874] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/10/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION The existing methods for Paracoccidioides spp. antigen production are problematic in terms of standardization, specificity, stability, repeatability, and reproducibility. OBJECTIVE To optimize the methodology for Paracoccidioides spp. antigen production and evaluate its applicability in paracoccidioidomycosis immunodiagnosis. MATERIALS AND METHODS The antigens were obtained from Paracoccidioides lutzii isolates (01, 66, and 8334), Paracoccidioides brasiliensis sensu stricto (113), and Paracoccidioides restripiensis (B-339). These fungi were grown at 36 °C ± 1 °C, on modified Fava-Netto agar, according to Freitas et al. (2018). Paracoccidioides lutzii antigens were obtained after , 10, and 20 days of culture, whereas P. brasiliensis and P. restripiensis antigens were obtained after 10 days. Antigens were evaluated in natura, 10 and 20 times concentrated. Antigenic capacity was evaluated using a double immunodiffusion assay against serum samples from patients with paracoccidioidomycosis, histoplasmosis, and aspergillosis, and random blood donors. RESULTS Cross-reactivity between Paracoccidioides spp. antigens was observed when P. brasiliensis, P. restrepiensis antigens, and P. lutzii antigens were evaluated with the polyclonal antibodies against P. lutzii and P. brasiliensis, respectively. No cross-reactivity was obtained for polyclonal antibodies against Histoplasma capsulatum, Aspergillus fumigatus, and random blood donors. The proposed protocol allowed stable, repeatable, and reproducible genus-specific antigen production at a low cost and in a short cultivation time. CONCLUSION The proposed protocol allowed us to obtain genus-specific antigens that can be developed and reproduced in all laboratories in Brazil and South America, where paracoccidioidomycosis is a neglected disease, contributing to an early diagnosis, especially in endemic regions, regardless of the species.
Collapse
Affiliation(s)
- Karolina Rosa Fernandes-Beraldo
- Laboratório Central, Universidade Federal de São Paulo, São Paulo, Brasil; Programa de Pós-Graduação em Ciências, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brasil.
| | - Roseli Santos de Freitas-Xavier
- Laboratório de Micologia Médica (LIM53), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.
| | - Adriana Pardini-Vicentini
- Programa de Pós-Graduação em Ciências, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brasil; Laboratório de Imunodiagnóstico das Micoses, Centro de Imunologia, Instituto Adolfo Lutz, São Universidade de São Paulo, São Paulo, Brasil.
| |
Collapse
|
8
|
Zerbato V, Di Bella S, Pol R, D’Aleo F, Angheben A, Farina C, Conte M, Luzzaro F, Luzzati R, Principe L. Endemic Systemic Mycoses in Italy: A Systematic Review of Literature and a Practical Update. Mycopathologia 2023; 188:307-334. [PMID: 37294504 PMCID: PMC10386973 DOI: 10.1007/s11046-023-00735-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/02/2023] [Indexed: 06/10/2023]
Abstract
Endemic systemic mycoses such as blastomycosis, coccidioidomycosis, histoplasmosis, talaromycosis, paracoccidioidomycosis are emerging as an important cause of morbidity and mortality worldwide. We conducted a systematic review on endemic systemic mycoses reported in Italy from 1914 to nowadays. We found out: 105 cases of histoplasmosis, 15 of paracoccidioidomycosis, 10 of coccidioidomycosis, 10 of blastomycosis and 3 of talaromycosis. Most cases have been reported in returning travelers and expatriates or immigrants. Thirtytwo patients did not have a story of traveling to an endemic area. Fortysix subjects had HIV/AIDS. Immunosuppression was the major risk factor for getting these infections and for severe outcomes. We provided an overview on microbiological characteristics and clinical management principles of systemic endemic mycoses with a focus on the cases reported in Italy.
Collapse
Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Riccardo Pol
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Francesco D’Aleo
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST “Papa Giovanni XXIII”, 24127 Bergamo, Italy
| | - Marco Conte
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Francesco Luzzaro
- Clinical Microbiology and Virology Unit, “A. Manzoni” Hospital, 23900 Lecco, Italy
| | | | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
| |
Collapse
|
9
|
Rodrigues AM, Hagen F, Puccia R, Hahn RC, de Camargo ZP. Paracoccidioides and Paracoccidioidomycosis in the 21st Century. Mycopathologia 2023; 188:129-133. [PMID: 36633737 DOI: 10.1007/s11046-022-00704-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023]
Abstract
Paracoccidioidomycosis (PCM) defines a broad spectrum of human and animal diseases caused by Paracoccidioides species (Onygenales). In the twenty-first century, Paracoccidioides advanced from a monotypic taxon to a genus that harbors seven species, including P. brasiliensis sensu stricto, P. americana, P. restrepiensis, P. venezuelensis, P. lutzii, P. loboi, and P. cetii. Classic PCM, acquired upon inhalation of propagules from P. brasiliensis sensu stricto, P. americana, P. restrepiensis, P. venezuelensis, and P. lutzii, affects the human lungs and may progress to systemic granulomatous disease with tegumentary and visceral involvement. On the other hand, PCM loboi and PCM ceti caused by the unculturable P. loboi and P. cetii are subcutaneous mycoses, typically observed as keloid lesions in humans and dolphins. Such heterogeneity highlights the importance of recognizing species boundaries in Paracoccidioides to gain insights into the ecology, evolution, clinical features, and mitigation strategies to tackle the advance of PCM.
Collapse
Affiliation(s)
- Anderson Messias Rodrigues
- Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil.
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil.
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - Rosana Puccia
- Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
| | - Rosane Christine Hahn
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, MT, 78060900, Brazil
- Júlio Muller Hospital, EBSERH, Cuiabá, MT, Brazil
| | - Zoilo Pires de Camargo
- Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
| |
Collapse
|
10
|
Lazzaretti GS, Sena LMDC, Corrêa A, Navarini D, Marcolan AM, Reichert PR. Paracoccidioidomycosis and Addison's syndrome - case report. Trop Doct 2023; 53:325-326. [PMID: 36718536 DOI: 10.1177/00494755231153197] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Paracoccidioidomycosis is caused by a fungus (Paracoccidioides brasiliensis), which is endemic to Brazil. It is most frequently found in the lungs, with haematogenous and lymphatic spread. The condition is more prevalent in men, between 30 and 60 years old, commonly rural workers. It is the third leading cause of death among chronic infectious diseases today. The systemic disease has an insidious and nonspecific course, with adrenal involvement being observed in 5% of cases and requiring the destruction of 80% of the glands for symptoms of adrenal insufficiency to appear. Isolated involvement of this gland is quite rare. In this case report, however, our patient presented wasting and adrenal insufficiency with isolated adrenal involvement by the fungus.
Collapse
Affiliation(s)
| | | | - Allex Corrêa
- School of Medicine, 28129University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Daniel Navarini
- Department of Surgery, 28129University of Passo Fundo, School of Medicine, Passo Fundo, RS, Brazil
| | - Ana Maria Marcolan
- Department of Pathology, 28129University of Passo Fundo, School of Medicine, Passo Fundo, RS, Brazil
| | - Paulo Roberto Reichert
- Department of Surgery, 28129University of Passo Fundo, School of Medicine, Passo Fundo, RS, Brazil
| |
Collapse
|
11
|
Hahn RC, Hagen F, Mendes RP, Burger E, Nery AF, Siqueira NP, Guevara A, Rodrigues AM, de Camargo ZP. Paracoccidioidomycosis: Current Status and Future Trends. Clin Microbiol Rev 2022; 35:e0023321. [PMID: 36074014 PMCID: PMC9769695 DOI: 10.1128/cmr.00233-21] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Paracoccidioidomycosis (PCM), initially reported in 1908 in the city of São Paulo, Brazil, by Adolpho Lutz, is primarily a systemic and neglected tropical mycosis that may affect individuals with certain risk factors around Latin America, especially Brazil. Paracoccidioides brasiliensis sensu stricto, a classical thermodimorphic fungus associated with PCM, was long considered to represent a monotypic taxon. However, advances in molecular taxonomy revealed several cryptic species, including Paracoccidioides americana, P. restrepiensis, P. venezuelensis, and P. lutzii, that show a preference for skin and mucous membranes, lymph nodes, and respiratory organs but can also affect many other organs. The classical diagnosis of PCM benefits from direct microscopy culture-based, biochemical, and immunological assays in a general microbiology laboratory practice providing a generic identification of the agents. However, molecular assays should be employed to identify Paracoccidioides isolates to the species level, data that would be complemented by epidemiological investigations. From a clinical perspective, all probable and confirmed cases should be treated. The choice of treatment and its duration must be considered, along with the affected organs, process severity, history of previous treatment failure, possibility of administering oral medication, associated diseases, pregnancy, and patient compliance with the proposed treatment regimen. Nevertheless, even after appropriate treatment, there may be relapses, which generally occur 5 years after the apparent cure following treatment, and also, the mycosis may be confused with other diseases. This review provides a comprehensive and critical overview of the immunopathology, laboratory diagnosis, clinical aspects, and current treatment of PCM, highlighting current issues in the identification, treatment, and patient follow-up in light of recent Paracoccidioides species taxonomic developments.
Collapse
Affiliation(s)
- Rosane Christine Hahn
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
- Júlio Muller Hospital, EBSERH, Cuiabá, Mato Grosso, Brazil
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - Rinaldo Poncio Mendes
- Faculdade de Medicina de Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Faculdade de Medicina, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Eva Burger
- Department of Microbiology and Immunology, Federal University of Alfenasgrid.411180.d (UNIFAL), Alfenas, Minas Gerais, Brazil
| | - Andreia Ferreira Nery
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
- Júlio Muller Hospital, EBSERH, Cuiabá, Mato Grosso, Brazil
| | - Nathan Pereira Siqueira
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Armando Guevara
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| |
Collapse
|
12
|
Peruzzo J, Casagrande LC, Cartell AS, Maestri MK, Procianoy F, Procianoy PDDC. Paracoccidioidomycosis Simulating Eyelid Carcinoma. Arch Iran Med 2022; 25:194-195. [PMID: 35429963 DOI: 10.34172/aim.2022.33] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/31/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Juliano Peruzzo
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Andre Silva Cartell
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Fernando Procianoy
- Department of Ophtalmology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | |
Collapse
|
13
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
14
|
Corrêa LF, Fritscher CC, Fritscher RT, da Silva TKB, Fritscher LG. Exclusively Tracheobronchial Paracoccidioidomycosis: A Rare Presentation. Chest 2021; 160:e499-e501. [PMID: 34743852 DOI: 10.1016/j.chest.2021.06.077] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/20/2021] [Accepted: 06/27/2021] [Indexed: 11/19/2022] Open
Abstract
Paracoccidioidomycosis (PCM), or blastomycosis in South America, is a systemic granulomatous mycosis related to activities associated with soil management, especially agriculture. PCM restricted to tracheobronchial tree region has not yet been reported.
Collapse
Affiliation(s)
- Liana Ferreira Corrêa
- Health Sciences Doctorate Program, School of Medicine, Pontifcal Catholic University Rio Grande Do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, Brazil.
| | - Carlos Cezar Fritscher
- Pulmonology Division, School of Medicine, Pontifcal Catholic University Rio Grande Do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Renata Tramontin Fritscher
- Otorhinolaryngology Division, Pontifcal Catholic University Rio Grande Do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Thiago Krieger Bento da Silva
- Radiology Division, Pontifcal Catholic University Rio Grande Do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Leandro Genehr Fritscher
- Pulmonology Division, School of Medicine, Pontifcal Catholic University Rio Grande Do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| |
Collapse
|
15
|
Felipe BC, Bachesk AB, Quinto JHS, Pavan ÂJ. Different manifestations of paracoccidioidomycosis: case reports. Gen Dent 2021; 69:69-73. [PMID: 34678747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Paracoccidioidomycosis is an infectious disease caused by Paracoccidioides brasiliensis and is endemic in South America. A patient can be infected via fungus inhalation in the mycelium phase. Oral manifestations of paracoccidioidomycosis are often the first clinical sign of disease, but their appearance can vary. As a result, many clinicians are unable to identify this infection early. Late diagnosis can result in serious complications, such as pulmonary changes, or even death. This article reports 2 cases of paracoccidioidomycosis with different oral manifestations, reviews the literature, and discusses the various appearances of this infection and its differential diagnoses in order to emphasize the importance of performing a detailed clinical examination to make an accurate diagnosis and refer the patient for appropriate treatment.
Collapse
|
16
|
Luna-Vilchez M, Chiara-Chilet C, Maquera-Afaray J, Portillo-Alvarez D, López JW. [Systemic paracoccidioidomycosis with compromise of the cecal appendix in a child: case report]. Rev Peru Med Exp Salud Publica 2021; 38:660-663. [PMID: 35385021 DOI: 10.17843/rpmesp.2021.384.9082] [Citation(s) in RCA: 1] [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: 07/20/2021] [Accepted: 10/10/2021] [Indexed: 10/03/2023] Open
Abstract
Paracoccidioidomycosis, the most prevalent systemic mycosis in Latin America. In children the most common clinical presentation is the juvenile or acute/subacute form, which mainly involves the lymph nodes and in a lesser proportion the gastrointestinal organs. We present the case of a 10-year-old patient, without comorbidities, who presented acute right iliac fossa pain; in addition to a history of 1 month of evolution of diarrhea, fever, weight loss, and hypereosinophilia. Was diagnosed of acute appendicitis due to systemic paracoccidioidomycosis, through histopathology of the cecal appendix and mesenteric lymph nodes. Although systemic paracoccidioidomycosis with involvement of the cecal appendix is rare, it should be considered as part of the differential diagnoses in children and young adults with generalized lymphadenomegaly from endemic areas.
Collapse
Affiliation(s)
| | | | - Julio Maquera-Afaray
- Instituto Nacional de Salud del Niño San Borja, Lima, Perú
- Universidad Privada de Tacna, Tacna, Perú
| | | | - José W López
- Instituto Nacional de Salud del Niño San Borja, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| |
Collapse
|
17
|
Maifrede SB, Kruschewsky WLL, Patrício SA, Falqueto A, Peçanha PM, Malaquias LCC, Pôssa AP, de Camargo ZP, Rodrigues AM, Gonçalves SS, Grão-Velloso TR. Screening paracoccidioidomycosis by double immunodiffusion test in a referred diagnostic center in Brazilian southeastern: an accessible tool. Infection 2021; 49:1257-1264. [PMID: 34580797 DOI: 10.1007/s15010-021-01704-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This article shows reports of the clinical-epidemiological characteristics and serological screening in patients assisted by a reference center for PCM care, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Brazil. METHODS The patient's sera with PCM were analyzed by DID test at the beginning and the end treatment. Clinical and demographic data were also collected to characterize the sample. RESULTS One hundred patients with a suspected diagnosis of PCM were evaluated. Serology by DID test was used as a screen in all patients. The test was positive for 79 patients (72 for Paracoccidioides brasiliensis and 7 for Paracoccidioides lutzii). Serology was negative in 21 sera, although all of them were diagnosed PCM by histopathologic or direct exam. Serological follow-up was performed during the treatment of all patients. After treatment, 58(58%) had negative serology and 33(33%) low levels of antibodies (≤ 1:16). CONCLUSION Our results indicate the importance of the DID test for the screening and monitoring of PCM and that the incidence of P. lutzii might be greater than expected in areas where it is not the predominant PCM species. Therefore, this article may contribute to improving the knowledge and clinical management about this disease.
Collapse
Affiliation(s)
- Simone Bravim Maifrede
- Center for Research in Medical Mycology, Pathology Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | | | - Suzana Alves Patrício
- Dentistry Department, Federal University of Espírito Santo (UFES), 1468, Marechal Campos Avenue, Vitória, ES, 29040-090, Brazil
| | - Aloísio Falqueto
- Medical Clinical Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | - Paulo Mendes Peçanha
- Medical Clinical Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | | | - Ana Paula Pôssa
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Sarah Santos Gonçalves
- Center for Research in Medical Mycology, Pathology Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | - Tânia Regina Grão-Velloso
- Dentistry Department, Federal University of Espírito Santo (UFES), 1468, Marechal Campos Avenue, Vitória, ES, 29040-090, Brazil.
| |
Collapse
|
18
|
Vilela R, Huebner M, Vilela C, Vilela G, Pettersen B, Oliveira C, Mendoza L. The taxonomy of two uncultivated fungal mammalian pathogens is revealed through phylogeny and population genetic analyses. Sci Rep 2021; 11:18119. [PMID: 34518564 PMCID: PMC8438014 DOI: 10.1038/s41598-021-97429-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 04/19/2021] [Accepted: 08/18/2021] [Indexed: 01/21/2023] Open
Abstract
Ever since the uncultivated South American fungal pathogen Lacazia loboi was first described 90 years ago, its etiology and evolutionary traits have been at the center of endless controversies. This pathogen infects the skin of humans and as long believed, dolphin skin. However, recent DNA analyses of infected dolphins placed its DNA sequences within Paracoccidioides species. This came as a surprise and suggested the human and dolphin pathogens may be different species. In this study, population genetic analyses of DNA from four infected dolphins grouped this pathogen in a monophyletic cluster sister to P. americana and to the other Paracoccidioides species. Based on the results we have emended the taxonomy of the dolphin pathogen as Paracoccidioides cetii and P. loboi the one infecting human. Our data warn that phylogenetic analysis of available taxa without the inclusion of unusual members may provide incomplete information for the accurate classification of anomalous species.
Collapse
Affiliation(s)
- Raquel Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, 31270, Brazil
| | - Marianne Huebner
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, 48824, USA
| | - Camila Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
| | - Gabriella Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
| | - Bruno Pettersen
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
| | - Claudia Oliveira
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
| | - Leonel Mendoza
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA.
- Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, 48824, USA.
| |
Collapse
|
19
|
Sousa C, Alves J, Cordeiro M. Paracoccidioidomycosis: Endobronchial Involvement in a Rare Disease in Europe. Arch Bronconeumol 2021; 57:590. [PMID: 35698938 DOI: 10.1016/j.arbr.2020.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/14/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Cláudia Sousa
- Pulmonology Department, Hospital Central do Funchal, Portugal.
| | - José Alves
- Clinical Pathology Department, Hospital Central do Funchal, Portugal
| | - Michelle Cordeiro
- Anatomical Pathology Department, Hospital Central do Funchal, Portuga
| |
Collapse
|
20
|
Valentim FDO, Tsutsui GM, Abbade LPF, Marques SA. Disseminated paracoccidioidomycosis in a liver transplant patient. An Bras Dermatol 2021; 96:346-348. [PMID: 33775484 PMCID: PMC8178573 DOI: 10.1016/j.abd.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/23/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022] Open
Abstract
Paracoccidioidomycosis is an endemic systemic mycosis caused by Paracoccidioides brasiliensis complex and P. lutzii. It is a rare disease in non-HIV-induced immunosuppressed individuals. In organ transplant recipients, it is more frequently associated with immunosuppression after kidney transplantation. In a liver transplant patient, only one case has been published in the literature to date. The present report comprises the case of a 47-year-old female patient with disseminated skin lesions associated with signs and symptoms of systemic involvement of paracoccidioidomycosis that manifested one year after liver transplantation and under an immunosuppression regimen with tacrolimus and mycophenolate mofetil.
Collapse
|
21
|
Mattos K, Cocio TA, Chaves EGA, Borges CL, Venturini J, de Carvalho LR, Mendes RP, Paniago AMM, Weber SS. An update on the occurrence of Paracoccidioides species in the Midwest region, Brazil: Molecular epidemiology, clinical aspects and serological profile of patients from Mato Grosso do Sul State. PLoS Negl Trop Dis 2021; 15:e0009317. [PMID: 33826630 PMCID: PMC8055028 DOI: 10.1371/journal.pntd.0009317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/06/2020] [Revised: 04/19/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is a systemic and endemic fungal infection in Latin American, mainly in Brazil. The majority of PCM cases occur in large areas in Brazil, comprising the South, Southeast and Midwest regions, with the latter demonstrating a higher incidence of the species Paracoccidioides lutzii. METHODOLOGY AND MAIN FINDINGS This study presents clinical, molecular and serological data of thirteen new PCM cases during 2016 to 2019 from the state of Mato Grosso do Sul, located in the Midwest region, Brazil. From these thirteen cases, sixteen clinical isolates were obtained and their genomic DNAs were subjected to genotyping by tub1 -PCR-RFLP. Results showed Paracoccidioides brasiliensis sensu stricto (S1) (11/16; 68.8%), Paracoccidioides restrepiensis (PS3) (4/16; 25.0%) and P. lutzii (1/16; 6.2%) as Paracoccidiodes species. Therefore, in order to understand whether the type of phylogenetic species that are circulating in the state influence the reactivity profile of serological tests, we performed double agar gel immunodiffusion (DID), using exoantigens from genotyped strains found in this series of PCM cases. Overall, our DID tests have been false negative in about 30% of confirmed PCM cases. All patients were male, most with current or previous rural activity, with ages ranging from 17 to 59 years, with 11 patients (84.6%) over 40 years of age. No clinical or epidemiological differences were found between Paracoccidioides species. However, it is important to note that the only case of P. lutzii died as an outcome. CONCLUSIONS This study suggests P. brasiliensis sensu stricto (S1) as the predominant species, showing its wide geographic distribution in Brazil. Furthermore, our findings revealed, for the first time, the occurrence of P. restrepiensis (PS3) in the state of Mato Grosso do Sul, Brazil. Despite our setbacks, it would be interesting to provide the complete sequencing of these clinical isolates to complement the molecular information presented.
Collapse
Affiliation(s)
- Karine Mattos
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Tiago Alexandre Cocio
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto (FMRP/USP), Universidade de São Paulo, São Paulo, Ribeirão Preto, Brazil
| | - Edilânia Gomes Araújo Chaves
- Laboratório de Biologia Molecular, Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Clayton Luiz Borges
- Laboratório de Biologia Molecular, Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - James Venturini
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Lídia Raquel de Carvalho
- Universidade Estadual Paulista (UNESP), Departamento de Bioestatística do Instituto de Biociência de Botucatu, Botucatu, São Paulo, Brazil
| | - Rinaldo Poncio Mendes
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Universidade Estadual Paulista ‘Júlio Mesquita Filho’ (UNESP), Faculdade de Medicina de Botucatu, São Paulo, Brazil
| | - Anamaria Mello Miranda Paniago
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Simone Schneider Weber
- Laboratório de Biociência (LaBio), Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Instituto de Ciências Exatas e Tecnologia (ICET), Universidade Federal do Amazonas, Itacoatiara, Amazonas, Brazil
| |
Collapse
|
22
|
Zeminian de Oliveira LB, Della Coletta AM, Gardizani TP, Barrozo LV, Miot HA, De Faveri J, Dias-Melicio LA. Paracoccidioimycosis and white individuals: Susceptibility and biogeographic aspects in an important endemic area in Brazil. PLoS Negl Trop Dis 2021; 15:e0009086. [PMID: 33561154 PMCID: PMC7899320 DOI: 10.1371/journal.pntd.0009086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/27/2020] [Revised: 02/22/2021] [Accepted: 12/22/2020] [Indexed: 11/18/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is a neglected mycosis most commonly occurring in Latin America. The etiologic agents are thermo dimorphic fungi of the genus Paracoccidioides, and cause an important granulomatous response in affected tissues. The Botucatu Medical School, from São Paulo State University (UNESP), is a PCM study pole, located in São Paulo State Midwest region, which is classified as a hyperendemic area in the Southeast region in Brazil. This study aimed to perform a retrospective epidemiological, geographical, and clinical analysis by the information available in medical records. It was listed as socio-demographic data along with clinical characteristics from patients diagnosed and treated during a 10-year period in Botucatu, totaling 177 patients with Paracoccidioidomycosis confirmed by the histopathological test. It was observed that the main clinical presentation was the chronic type (76,3%), most commonly identified in white male individuals over the age of 29 years old, smokers, and alcoholics, providing evidences for the first time that white individuals were more affected by the disease, in comparison to non-white individuals that may be more resistant to infection. This data opens new avenues for study within ancestry, resistance and susceptibility in paracoccidioidomycosis.
Collapse
Affiliation(s)
- Luciana Bonome Zeminian de Oliveira
- São Paulo State University (UNESP), Medical School of Botucatu, Laboratory of Immunopathology and Infectious Agents—LIAI, UNIPEX—Experimental Research Unity, Sector 5, Botucatu, São Paulo State, Brazil
| | - Amanda Manoel Della Coletta
- São Paulo State University (UNESP), Medical School of Botucatu, Laboratory of Immunopathology and Infectious Agents—LIAI, UNIPEX—Experimental Research Unity, Sector 5, Botucatu, São Paulo State, Brazil
| | - Taiane Priscila Gardizani
- São Paulo State University (UNESP), Medical School of Botucatu, Laboratory of Immunopathology and Infectious Agents—LIAI, UNIPEX—Experimental Research Unity, Sector 5, Botucatu, São Paulo State, Brazil
| | - Ligia Vizeu Barrozo
- University of São Paulo (USP), Department of Geography, School of Philosophy, Literature and Human Sciences, São Paulo, São Paulo State, Brazil
| | - Hélio Amante Miot
- São Paulo State University (UNESP), Medical School of Botucatu, Division of Dermatology and Radiotherapy, Botucatu, São Paulo State, Brazil
| | - Julio De Faveri
- São Paulo State University (UNESP), Medical School of Botucatu, Department of Pathology, Botucatu/SP–Brazil
| | - Luciane Alarcão Dias-Melicio
- São Paulo State University (UNESP), Medical School of Botucatu, Laboratory of Immunopathology and Infectious Agents—LIAI, UNIPEX—Experimental Research Unity, Sector 5, Botucatu, São Paulo State, Brazil
- São Paulo State University (UNESP), Medical School of Botucatu, Department of Pathology, Botucatu/SP–Brazil
| |
Collapse
|
23
|
de Macedo PM, Freitas DFS, Varon AG, Lamas CDC, Ferreira LCF, Freitas AD, Ferreira MT, Nunes EP, Siqueira MM, Veloso VG, do Valle ACF. COVID-19 and acute juvenile paracoccidioidomycosis coinfection. PLoS Negl Trop Dis 2020; 14:e0008559. [PMID: 32776930 PMCID: PMC7417084 DOI: 10.1371/journal.pntd.0008559] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | | | - Andrea Gina Varon
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | | | | - Andrea d’Avila Freitas
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | | - Estevão Portela Nunes
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | | - Valdiléa G. Veloso
- Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | |
Collapse
|
24
|
de Oliveira Custódio JM, Enokida IM, Gonçalves DA, Leone de Oliveira SMDV, Venturini J, Carvalho LR, Mendes RP, Paniago AMM. Dynamics of plasma micronutrient concentrations and their correlation with serum proteins and thyroid hormones in patients with paracoccidioidomycosis. PLoS One 2019; 14:e0226609. [PMID: 31877169 PMCID: PMC6932777 DOI: 10.1371/journal.pone.0226609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/05/2019] [Accepted: 12/01/2019] [Indexed: 01/08/2023] Open
Abstract
Minerals, such as zinc, copper, and iron are reported to play roles in chronic infectious diseases; however, their role in paracoccidioidomycosis (PCM) remains unknown. This study aimed to examine the micronutrient dynamics and their correlation with serum proteins and thyroid hormones in patients with PCM. In 14 patients with PCM and 10 healthy subjects, we evaluated the body mass index (BMI) along with serum levels of hemoglobin, iron, ferritin, zinc, copper, magnesium, albumin, globulin, thyroid stimulating hormone (TSH), thyroxine (free T4), and triiodothyronine (T3). Evaluations were conducted at the first appointment, before treatment, and at the end of the first, second, fourth, and sixth month of PCM treatment. The control group was only evaluated once. We observed that before treatment, patients with PCM, had higher levels of copper and lower level of iron than those of the control group. After one month of treatment, the iron levels increased, whereas the levels of copper after six months of treatment. Reduction in inflammatory activity, indicated by the normalization of C-reactive protein, ferritin, albumin, and globulin levels, was observed during treatment. However, no correlation was observed between the serum levels of minerals and inflammatory activity or thyroid function in this study. In conclusion, our results showed higher serum copper levels in control group compared to those in pretreatment patients; the clinical importance of this observation should be investigated in further studies. After treatment, serum copper levels showed a tendency to decrease. In addition, serum iron levels were decreased at the stage of active disease, and were increased after treatment. Thus, serum iron levels can be used as a better biomarker for treatment control.
Collapse
Affiliation(s)
| | - Iasmim Mayumi Enokida
- Scientific initiation CNPq, Faculty of Medicine - FAMED, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Daniel Araujo Gonçalves
- Department of Chemistry, Minas Gerais State University - UEMG, Ituiutaba, Minas Gerais, Brazil
| | - Sandra Maria do Valle Leone de Oliveira
- Faculty of Medicine- FAMED, Center for Biological and Health Sciences- CCBS, Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Campo Grande, Brazil
| | - James Venturini
- Faculty of Medicine- FAMED, Center for Biological and Health Sciences- CCBS, Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Campo Grande, Brazil
| | - Lidia Raquel Carvalho
- Department of Biostatistics, Institute of Biosciences, State University Paulista "Júlio de Mesquita Filho" -UNESP, Botucatu, São Paulo Brazil
| | - Rinaldo Poncio Mendes
- Department of Tropical Diseases, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Anamaria Mello Miranda Paniago
- Faculty of Medicine- FAMED, Center for Biological and Health Sciences- CCBS, Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Campo Grande, Brazil
| |
Collapse
|
25
|
Veasey JV, Pessotti NS, Lellis RF. Paracoccidioidomycosis in a child: exuberant presentation due to the inadvertent use of systemic corticosteroids. An Bras Dermatol 2019; 94:470-472. [PMID: 31644624 PMCID: PMC7007017 DOI: 10.1590/abd1806-4841.20198355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/07/2018] [Accepted: 09/22/2018] [Indexed: 08/16/2023] Open
Abstract
Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.
Collapse
|
26
|
Giusiano G, Aguirre C, Vratnica C, Rojas F, Corallo T, Cattana ME, Fernández M, Mussin J, de Los Angeles Sosa M. Emergence of acute/subacute infant-juvenile paracoccidioidomycosis in Northeast Argentina: Effect of climatic and anthropogenic changes? Med Mycol 2019; 57:30-37. [PMID: 29346653 DOI: 10.1093/mmy/myx153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/31/2017] [Accepted: 11/23/2017] [Indexed: 11/14/2022] Open
Abstract
Argentina has two endemic areas of paracoccidioidomycosis (PCM). Bordering Paraguay and Brazil, Northeast Argentina (NEA) comprises the area with the highest incidence where the chronic adult clinical form has historically been reported. Juvenile form in children and adolescents is rare in this area since only one case was reported in the last 10 years. Despite this, between 2010 and 2012, several cases of acute/subacute clinical forms in children aged 10 to 16 (median 12) were detected. In the last decade, the NEA region has been exposed to ecological variations as consequences of certain climatic and anthropogenic changes, including El Niño-Southern Oscillation phenomenon during 2009, and deforestation. The region has also suffered from the significant ecological effects of the construction of one of the biggest hydroelectric dams of South America. This study aims to describe clinical and epidemiological aspects of acute/subacute PCM cases detected in children from NEA and to discuss climatic and anthropogenic changes as possible contributing factors in the emergence of this disease in children. This acute/subacute PCM cluster was characterized by severe disseminated and aggressive presentations to localized form, with a high spectrum of clinical manifestations uncommonly observed. Due to the lack of experience in acute/subacute PCM in children in the studied area and the atypical clinical manifestations observed, the diagnosis was delayed. In order to avoid misdiagnosis, a higher level of suspicion is now required in NEA and countries bordering the southern part of the endemic area, which are affected by the changes discussed in this article.
Collapse
Affiliation(s)
- Gustavo Giusiano
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - Clarisa Aguirre
- Hospital Pediátrico Dr. Avelino Castelán, Resistencia, Argentina
| | | | - Florencia Rojas
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - Teresa Corallo
- Hospital Pediátrico Dr. Avelino Castelán, Resistencia, Argentina
| | - María Emilia Cattana
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - Mariana Fernández
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - Javier Mussin
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - María de Los Angeles Sosa
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
- Laboratorio Central de Salud Pública, Corrientes, Argentina
| |
Collapse
|
27
|
Affiliation(s)
| | - Arnaldo Lopes Colombo
- Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil
| | - David W. Denning
- The University of Manchester, Manchester, United Kingdom
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Global Action Fund for Fungal Infections, Geneva, Switzerland
- * E-mail: ,
| |
Collapse
|
28
|
Marques SA, Jorge MFS, Hrycyk MF, Bosco SDMG. Paracoccidioidomycosis manifested by sarcoidosis-like cutaneous lesions and caused by Paracoccidioides brasiliensis sensu stricto (S1a). An Bras Dermatol 2019; 93:902-904. [PMID: 30484542 PMCID: PMC6256202 DOI: 10.1590/abd1806-4841.20188293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/14/2018] [Accepted: 04/06/2018] [Indexed: 11/22/2022] Open
Abstract
Molecular studies have shown more than one species of the genus Paracoccidioides to be the causal agent of paracoccidioidomycosis. Efforts have been made to correlate the identified species with epidemiological and clinical data of patients, aiming to determine the real meaning and impact of new species. Bearing this objective in mind, the authors report a clinical case of paracoccidioidomycosis, from São Paulo state, Brazil, that manifested as uncommon sarcoid-like cutaneous lesions and was caused by Paracoccidioides brasiliensis sensu stricto (S1a). The patient was treated with itraconazole 200mg/day for 12 months, with complete clinical remission.
Collapse
Affiliation(s)
- Sílvio Alencar Marques
- Department of Dermatology and Radiotherapy, Faculdade de Medicina de
Botucatu, Universidade Estadual Paulista, Botucatu (SP), Brazil
| | - Marilia Formentini Scotton Jorge
- Dermatology Service, Hospital das Clínicas, Faculdade de
Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP), Brazil
| | - Marluce Francisca Hrycyk
- Laboratory of Microbiology and Immunology, Faculdade de
Ciências Biológicas e Agrárias, Universidade do Estado de Mato
Grosso, Alta Floresta (MT), Brazil
| | - Sandra de Moraes Gimenes Bosco
- Laboratory of Medical Mycology, Departamento de Microbiologia e
Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual
Paulista, Botucatu (SP), Brazil
| |
Collapse
|
29
|
Abstract
Paracoccidioidomycosis is a systemic granulomatous disease caused by the dimorphic fungus Paracoccidioides brasiliensis and is restricted to Latin America. It normally affects lungs, skin and lymph nodes. Abdominal organs are usually not involved. In rare cases paracoccidioidomycosis may simulate neoplasm. Herein we describe our experience with four cases of paracoccidioidomycosis mimicking cholangiocarcinoma. To the best of our knowledge, this is the largest case series on this subject produced in English. Paracoccidioidomycosis must be considered as a differential diagnosis of cholangiocarcinoma, especially in individuals who come from endemic areas.
Collapse
Affiliation(s)
- Klaus Steinbrück
- Hepatobiliary Surgery, Bonsucesso Federal Hospital, Health Ministry, Rio de Janeiro, Brazil.
| | - Reinaldo Fernandes
- Hepatobiliary Surgery, Bonsucesso Federal Hospital, Health Ministry, Rio de Janeiro, Brazil
| |
Collapse
|
30
|
Gomes Carvalho Neto E, Coletto A, Biazus PG, Pereira Dos Santos I, Rieder CRM, de Castro Ribeiro M. Neuroparacoccidioidomycosis. Neurol Neuroimmunol Neuroinflamm 2019; 6:e519. [PMID: 30568997 PMCID: PMC6278888 DOI: 10.1212/nxi.0000000000000519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Euripedes Gomes Carvalho Neto
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Aline Coletto
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Paula Ghidini Biazus
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Iuri Pereira Dos Santos
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Carlos R M Rieder
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Marlise de Castro Ribeiro
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| |
Collapse
|
31
|
Vicente CR, Falqueto A. Differentiation of mucosal lesions in mucocutaneous leishmaniasis and paracoccidioidomycosis. PLoS One 2018; 13:e0208208. [PMID: 30475920 PMCID: PMC6258372 DOI: 10.1371/journal.pone.0208208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022] Open
Abstract
Mucocutaneous leishmaniasis and paracoccidioidomycosis are infectious diseases with similar epidemiological and clinical aspects. Cases of both diseases may manifest similar lesions in the mucosa. Therefore, the determination of distinguishing characteristics for the purpose of differential diagnosis is critical for better management of the diseases. The present study evaluated factors that assist in the differentiation of mucosal lesions between these diseases. This cross-sectional study included data from medical records of 122 cases of mucocutaneous leishmaniasis and 83 cases of paracoccidioidomycosis attended at the university hospital Cassiano Antonio Moraes, located in Vitória, Espírito Santo State, Brazil. Comparison between the diseases included the following variables: sex, age, time of disease evolution, location of the lesion and symptoms. Adults and males were affected by both diseases at higher rates. Lesions in the nasal region (95.1%; p-value = 0.000) and the pharynx (20.5%; p-value = 0.009) and nasal obstruction (34.4%; p-value = 0.000) were associated with leishmaniasis. Paracoccidioidomycosis was associated with lesions in the oral region (90.4%; p-value = 0.000), oral pain (16.9%; p-value = 0.000), and hoarseness (14.5%; p-value = 0.008). In leishmaniasis, lesions in oral regions were not associated with oral pain and were frequently located close to the nasal area. The manifestations cited above could improve the differential diagnosis of leishmaniasis and paracoccidioidomycosis, and thereby potentially aid in the choice of appropriate confirmatory diagnostic testing.
Collapse
Affiliation(s)
- Creuza Rachel Vicente
- Department of Social Medicine, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
- * E-mail:
| | - Aloisio Falqueto
- Department of Social Medicine, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
| |
Collapse
|
32
|
Tracogna MF, Fernández Lugo S, Gariboglio Vázquez ML, Fernández MS, Andriani ME, Presti SE, Arce V, López R, Iliovich E, Marques IA, Cattana ME. [Clinical and epidemiological characteristics of patients with paracoccidioidomycosis diagnosed in a hospital of Resistencia, Chaco]. Rev Argent Microbiol 2018; 51:144-147. [PMID: 30243524 DOI: 10.1016/j.ram.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/25/2018] [Accepted: 06/13/2018] [Indexed: 11/18/2022] Open
Abstract
In order to describe the clinical and epidemiological characteristics of paracoccidioidomycosis, a descriptive study of all the cases diagnosed by the Clinical Microbiology Service at Dr. Julio C. Perrando hospital in the city of Resistencia (Chaco Province, Argentina) was conducted. Between 2011 and 2014, 46 cases were detected. In the period 2013-2014, an almost 4-fold increase in the incidence rate was detected. The chronic form of the disease was predominant with an average age of 53 years. Serological tests in 39 out of 46 patients were performed. In 15 of 39 patients, serological tests were the only diagnostic tool while in 4 patients with a microbiological diagnosis serological tests were non-reactive. In patients from endemic areas with non-specific infectious syndrome it is important to include paracoccidioidomycosis in the differential diagnosis and to apply all available diagnostic tools to reach a timely diagnosis and to reduce the long-term sequelae and their socio-economic impact.
Collapse
Affiliation(s)
| | | | | | | | | | - Sara E Presti
- Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina
| | - Verónica Arce
- Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina
| | - Rosana López
- Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina
| | | | | | - María E Cattana
- Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina
| |
Collapse
|
33
|
Sylvestre TF, Cavalcante RDS, da Silva JDF, Paniago AMM, Weber SS, Pauletti BA, de Carvalho LR, dos Santos LD, Mendes RP. Serological proteomic biomarkers to identify Paracoccidioides species and risk of relapse. PLoS One 2018; 13:e0202804. [PMID: 30157221 PMCID: PMC6114792 DOI: 10.1371/journal.pone.0202804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/09/2018] [Indexed: 12/20/2022] Open
Abstract
The sensitivity of the double agar gel immunodiffusion test is about 90% in patients with untreated paracoccidioidomycosis (PCM), but it is much lower in cases of relapse. In addition, serum from patients with PCM caused by Paracoccidioides lutzii, frequent in the Midwest region of Brazil, do not react with the classical antigen obtained from Pb B-339. These findings showed the need for alternative diagnostic methods, such as biological markers through proteomics. The aim of this study was to identify biomarkers for the safe identification of PCM relapse and specific proteins that could distinguish infections caused by Paracoccidioides brasiliensis from those produced by Paracoccidioides lutzii. Proteomic analysis was performed in serum from 9 patients with PCM caused by P. brasiliensis, with and without relapse, from 4 patients with PCM produced by P. lutzii, and from 3 healthy controls. The comparative evaluation of the 29 identified plasma proteins suggested that the presence of the immunoglobulin (Ig) alpha-2 chain C region and the absence of Ig heavy chain V-III TIL indicate infection by P. lutzii. In addition, the absence of complement factor B protein might be a predictor of relapse. The evaluation of these proteins in a higher number of patients should be carried out in order to validate these findings.
Collapse
Affiliation(s)
| | | | | | | | - Simone Schneider Weber
- Universidade Federal de Mato Grosso do Sul (UFMS), Faculdade de Medicina, Campo Grande, Brazil
- Instituto de Ciências Exatas e Tecnologia (ICET), Universidade Federal do Amazonas (UFAM), Itacoatiara, Brazil
| | | | - Lídia Raquel de Carvalho
- Universidade Estadual Paulista (UNESP), Instituto de Biociência de Botucatu, Botucatu, São Paulo, Brazil
| | | | - Rinaldo Poncio Mendes
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Botucatu, São Paulo, Brazil
| |
Collapse
|
34
|
Bernardes Filho F, Queiroz RM, Towersey L, Hay R, Valentin MVN. Chronic Multifocal Paracoccidioidomycosis: Pulmonary and Cutaneous Involvement. J Emerg Med 2018; 55:e57-e60. [PMID: 29793811 DOI: 10.1016/j.jemermed.2018.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Fred Bernardes Filho
- Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rodolfo Mendes Queiroz
- Centro Avançado de Diagnóstico por Imagem, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil
| | - Loan Towersey
- AIDS Division, Carlos Tortelly Municipal Hospital, Ministry of Health, Niterói, Rio de Janeiro, Brazil
| | - Roderick Hay
- International Foundation for Dermatology, London, United Kingdom
| | | |
Collapse
|
35
|
Salzer HJF, Stoney RJ, Angelo KM, Rolling T, Grobusch MP, Libman M, López-Vélez R, Duvignaud A, Ásgeirsson H, Crespillo-Andújar C, Schwartz E, Gautret P, Bottieau E, Jordan S, Lange C, Hamer DH. Epidemiological aspects of travel-related systemic endemic mycoses: a GeoSentinel analysis, 1997-2017. J Travel Med 2018; 25:5067362. [PMID: 30085265 PMCID: PMC6628256 DOI: 10.1093/jtm/tay055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/15/2018] [Indexed: 11/13/2022]
Abstract
Background International travel has increased in the past few decades, placing more travellers at risk of acquiring systemic endemic mycoses. There are limited published data on systemic endemic mycoses among international travellers. We report epidemiological characteristics of non-migrant, international travellers who acquired systemic endemic mycoses during travel. Methods We analysed records of non-migrant international travellers with a confirmed diagnosis of histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis or talaromycosis reported from 1997 through 2017 to GeoSentinel, a global surveillance network now consisting of 70 travel or tropical medicine centres in 31 countries. Results Sixty-nine records met the inclusion criteria. Histoplasmosis was most frequently reported; the 51 travellers with histoplasmosis had the lowest median age (30 years; range: 8-85) and shortest median duration of travel (12 days; range: 5-154). Coccidioidomycosis was reported in 14 travellers; travellers with coccidioidomycosis were older (median 62 years; range: 22-78) and had the longest median number of days between return from travel and presentation to a GeoSentinel site (55 days; range: 17-273). Almost all travellers with coccidioidomycosis were exposed in the USA. Other systemic endemic mycoses were less frequently reported, including blastomycosis (three travellers) and talaromycosis (one traveller). Conclusions Although relatively rare, systemic endemic mycoses should be considered as potential travel-related infections in non-migrant international travellers. Epidemiological exposures should be used to guide diagnostic evaluations and treatment.
Collapse
Affiliation(s)
- Helmut J. F. Salzer
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Rhett J. Stoney
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Kristina M. Angelo
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Thierry Rolling
- Section of Infectious Diseases and Tropical Medicine, 1st Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michael Libman
- J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Hilmir Ásgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Clara Crespillo-Andújar
- National Referral Unit for Tropical and Travel Medicine, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Eli Schwartz
- The Center for Geographic Medicine and Internal Medicine ‘C’ Chaim Sheba Medical Center, Tel HaShomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philippe Gautret
- Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sabine Jordan
- Section of Infectious Diseases and Tropical Medicine, 1st Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | | |
Collapse
|
36
|
Parente DB, Louza GF, Carneiro LH, Zanetti G, Marchiori E. Scrotal swelling in a farmworker with paracoccidioidomycosis. Braz J Infect Dis 2018; 22:155-156. [PMID: 29551333 PMCID: PMC9428204 DOI: 10.1016/j.bjid.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/24/2018] [Accepted: 02/25/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Daniella Braz Parente
- Departamento de Radiologia. Universidade Federal do Rio de Janeiro, Rua Prof. Rodolfo Paulo Rocco, n° 255 - Cidade Universitária - Ilha do Fundão - CEP: 219.419-13. Rio de Janeiro, RJ Brazil
| | - Guilherme Felix Louza
- Departamento de Radiologia. Universidade Federal do Rio de Janeiro, Rua Prof. Rodolfo Paulo Rocco, n° 255 - Cidade Universitária - Ilha do Fundão - CEP: 219.419-13. Rio de Janeiro, RJ Brazil
| | - Leonardo Hoehl Carneiro
- Departamento de Radiologia. Universidade Federal do Rio de Janeiro, Rua Prof. Rodolfo Paulo Rocco, n° 255 - Cidade Universitária - Ilha do Fundão - CEP: 219.419-13. Rio de Janeiro, RJ Brazil
| | - Gláucia Zanetti
- Departamento de Radiologia. Universidade Federal do Rio de Janeiro, Rua Prof. Rodolfo Paulo Rocco, n° 255 - Cidade Universitária - Ilha do Fundão - CEP: 219.419-13. Rio de Janeiro, RJ Brazil
| | - Edson Marchiori
- Departamento de Radiologia. Universidade Federal do Rio de Janeiro, Rua Prof. Rodolfo Paulo Rocco, n° 255 - Cidade Universitária - Ilha do Fundão - CEP: 219.419-13. Rio de Janeiro, RJ Brazil.
| |
Collapse
|
37
|
Teive HA, Arruda WO, Ramina R, Meneses MS, Bleggi-Torres LF, Telles-Filho FQ. Paracoccidioidomycosis Granuloma Simulating Posterior Fossa Tumour. J R Soc Med 2018; 84:562-3. [PMID: 1941863 PMCID: PMC1293425 DOI: 10.1177/014107689108400922] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- H A Teive
- Department of Neurology and Neurosurgery, Hospital Das Naçŏes, Curitiba-Pr, Brazil
| | | | | | | | | | | |
Collapse
|
38
|
Vázquez C, Orlova M, Zarba M, Catanzariti MJ, Christiansen SB, Dalurzo MCL, Freixas AA, Vallone MG. [Timely diagnosis of disseminated paracoccidioidomycosis in an immunocompetent adult]. Medicina (B Aires) 2018; 78:199-202. [PMID: 29940548] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Paracoccidioidomycosis is endemic in subtropical rainforests of Latin America. Acute/subacute presentations involve an aggressive dissemination throughout the lymphatic system, while chronic forms (more frequent) arise as differential diagnosis for other conditions involving lung, oropharynx, skin, and eventually the brain. We present the case of a man referred for evaluation and treatment of a possible lung tumor with brain metastasis. The finding of multibudded yeasts and the microbiological isolation of a dimorphic fungus identified as Paracoccidioides sp. from a brain biopsy prompted a cardinal change in prognosis and treatment. This case alerts on the importance of considering systemic fungal diseases as differential diagnosis of compatible clinical presentations in patients who had lived in, or visited, endemic areas.
Collapse
Affiliation(s)
- Carolina Vázquez
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. E-mail:
| | - María Orlova
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martín Zarba
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - María J Catanzariti
- Micología, Laboratorio Central, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Antonio A Freixas
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo G Vallone
- Clínica Médica, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
39
|
Canteros CE. [Paracoccidioidomycosis: chronicle of a neglected disease]. Medicina (B Aires) 2018; 78:180-184. [PMID: 29940544] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is among the systemic mycoses which are endemic only in Latin America. In Argentina, the vast majority of the cases are reported at north of latitude 34.5° S. The disease is produced by thermodimorphic fungi of the genus Paracoccidoides: P. brasiliensis (S1), P. americana (PS2), P. restrepiensis (PS3), P. venezuelensis (PS4) y P. lutzii. The natural habitat of members of this genus is the soil, where they produce infectious conidia. Little is known, however, about their specific ecologic niche(s), and this knowledge gap hampers the design of measures to control the infection. Rural male workers are the group most at risk of developing PCM. Infection occurs by inhalation of aerosolized conidia and may either be asymptomatic or cause mild respiratory symptoms. In turn, this primary infection may be self-limited or progress to severe pulmonary or disseminated disease. The disease has two clinical presentations: (i) acute or subacute (juvenile), frequent in children, adolescents and people with immunodeficiencies; and (ii) chronic progressive, in adults. Active lesions often resolve into fibrotic scars which can cause dysphagia, dysphonia, adrenal insufficiency, and intestinal obstruction. Although efficient tools are available for diagnosis and treatment, the nonspecific nature of PCM clinical manifestations frequently delay the diagnosis. In addition, the poor adherence to long antifungal treatments allows the advance of the disease and the development of extensive fibrosis compromising severely and permanently respiratory and adrenal functions, thus altering the patient"s quality of life and even causing his/her death.
Collapse
Affiliation(s)
- Cristina E Canteros
- Servicio Micosis Profundas, Departamento Micología, INEI-ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina. E-mail
| |
Collapse
|
40
|
Tavares Dos Santos H, Augusto Benevenuto de Andrade B, Fernandes D, Caxias Travassos D, Bufalino A. Chronic paracoccidioidmycosis in a woman with Crohn Disease. Dermatol Online J 2017; 23:13030/qt1gp8z9gx. [PMID: 28541872] [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] [Received: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023] Open
Abstract
We report a rare case of chronic paracoccidioidomycosis(PCM) in a woman with Crohn disease in the setting of treatment with azathioprine and mesalazine. Serum tests for antigens to Paracoccidioides brasiliensis, Histoplasma capsulatum, and Aspergillus fumigatus were negative. An incisional biopsy of an oral lesion with periodic acid-schiff and Grocott-methenamine silver stains revealed chronic granulomatous inflammation with multinucleated giant cells with Paracoccidioides brasiliensis within the cytoplasm, confirming the diagnosis of PCM.
Collapse
Affiliation(s)
| | | | - Darcy Fernandes
- Department of Diagnosis and Surgery, Araraquara Dental School, UNESP - Univ Estadual Paulista, Araraquara, São Paulo, Brazil.
| | | | | |
Collapse
|
41
|
de Macedo PM, Almeida-Paes R, Freitas DFS, Varon AG, Paixão AG, Romão AR, Coutinho ZF, Pizzini CV, Zancopé-Oliveira RM, Francesconi do Valle AC. Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro, Brazil. PLoS Negl Trop Dis 2017; 11:e0005500. [PMID: 28355221 PMCID: PMC5386294 DOI: 10.1371/journal.pntd.0005500] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/10/2017] [Accepted: 03/17/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is a systemic mycosis caused by pathogenic dimorphic fungi of the genus Paracoccidioides. It is the most important systemic mycosis in Latin America and the leading cause of hospitalizations and death among them in Brazil. Acute PCM is less frequent but relevant because vulnerable young patients are affected and the severity is usually higher than that of the chronic type. METHODS The authors performed a retrospective cohort study from 2001 to 2009 including acute juvenile PCM patients from a reference center in Rio de Janeiro, Brazil. Clinical, epidemiological, diagnostic, therapeutic, and prognostic data were reported. RESULTS Twenty-nine patients were included. The average age was 23 years old and the male to female ratio was 1:1.07. All cases were referred from 3 of 9 existing health areas in the state of Rio de Janeiro, predominantly from urban areas (96.5%). Lymph nodes were the most affected organs (100%), followed by the skin and the spleen (31% each). Twenty-eight patients completed treatment (median 25 months) and progressed to clinical and serological cure; 1 death occurred. Twenty-four patients completed 48-month median follow-up. Four patients abandoned follow-up after the end of treatment. The most frequent sequela was low adrenal reserve. Paracoccidioides brasiliensis S1 was identified by partial sequencing of the arf and gp43 genes from 4 patients who presented a viable fungal culture. CONCLUSION Acute juvenile PCM is a severe disease with a high rate of complications. There are few cohort clinical studies of acute PCM in the literature. More studies should be developed to promote improvement in patients' healthcare.
Collapse
Affiliation(s)
- Priscila Marques de Macedo
- Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Dayvison Francis Saraiva Freitas
- Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Andréa Gina Varon
- Department of Inpatient Health Care, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Ariane Gomes Paixão
- Department of Inpatient Health Care, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Anselmo Rocha Romão
- Geoprocessing Laboratory, Institute of Scientific and Technological Communication and Information in Health, Fiocruz, Rio de Janeiro, Brazil
| | | | - Claudia Vera Pizzini
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | | - Antonio Carlos Francesconi do Valle
- Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| |
Collapse
|
42
|
Alcántara Figueroa C, Verástegui R, Aphang Lam M, Cáceres Alpaca D. [Colon Paracoccidioidomycosis in a hospital from Lima - Peru: report of 4 cases]. Rev Gastroenterol Peru 2017; 37:77-81. [PMID: 28489841] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Paracoccidioidomycosis is the most prevalent mycosis in South America. Mucocutaneous and lymph node involvement is the most frequent affectation of this disease in our country, with the intestinal commitment rarely reported. We report 4 cases of colonic manifestation with abdominal pain, chronic diarrhea, and weight loss. The diagnosis was made with biopsy and Gomori stain. The average age was 29 years old. The colonoscopy showed many ulcers in the ileum distal and colon. We found VIH as comorbidity in one patient.
Collapse
Affiliation(s)
| | - Rosa Verástegui
- Servicio de Medicina Interna, Hospital Nacional Arzobispo Loayza. Lima, Perú
| | - Meylin Aphang Lam
- Servicio de Medicina Interna, Hospital Nacional Arzobispo Loayza. Lima, Perú
| | | |
Collapse
|
43
|
Marques de Macedo P, de Oliveira LC, Freitas DFS, da Rocha JA, Freitas AD, Nucci M, Zancopé-Oliveira RM, Almeida-Paes R, do Valle ACF. Acute Paracoccidioidomycosis Due to Paracoccidioides brasiliensis S1 Mimicking Hypereosinophilic Syndrome with Massive Splenomegaly: Diagnostic Challenge. PLoS Negl Trop Dis 2016; 10:e0004487. [PMID: 27054891 PMCID: PMC4824360 DOI: 10.1371/journal.pntd.0004487] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Priscila Marques de Macedo
- Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Luã Cardoso de Oliveira
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Dayvison Francis Saraiva Freitas
- Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Jaqueline Abel da Rocha
- Nosocomial Infection Surveillance and Control Program, Central Hospital of Military Police (HCPM), Rio de Janeiro, Brazil
| | - Andrea D’Ávila Freitas
- Department of Inpatient Health Care, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro (HUCFF, UFRJ), Rio de Janeiro, Brazil
| | | | - Rodrigo Almeida-Paes
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Antonio Carlos Francesconi do Valle
- Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| |
Collapse
|
44
|
Frangella J, Pizzarro D, Giurbino A, Lescano S, Frank L. [Disseminated paracoccidioidomycosis. Presentation as pseudotumoral cerebral injury]. Medicina (B Aires) 2016; 76:103. [PMID: 27135847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Julia Frangella
- Servicio de Radiodiagnóstico, Hospital J. A. Fernández, Argentina. E-mail:
| | | | | | | | | |
Collapse
|
45
|
Affiliation(s)
- Juan Carlos Cataño
- *Address correspondence to Juan Carlos Cataño, Calle 15 Sur # 48–130, Medellín, Colombia. E-mail:
| | | |
Collapse
|
46
|
Gaviria M, Rivera V, Muñoz-Cadavid C, Cano LE, Naranjo TW. Validation and clinical application of a nested PCR for paracoccidioidomycosis diagnosis in clinical samples from Colombian patients. Braz J Infect Dis 2015; 19:376-83. [PMID: 26100437 PMCID: PMC9427526 DOI: 10.1016/j.bjid.2015.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/30/2015] [Revised: 04/08/2015] [Accepted: 04/22/2015] [Indexed: 11/30/2022] Open
Abstract
Paracoccidioidomycosis is a systemic and endemic mycosis, restricted to tropical and subtropical areas of Latin America. The infection is caused by the thermal dimorphic fungus Paracoccidioides brasiliensis and Paracoccidioides lutzii. The diagnosis of paracoccidioidomycosis is usually performed by microscopic examination, culture and immunodiagnostic tests to respiratory specimens, body fluids and/or biopsies; however these methods require laboratory personnel with experience and several days to produce a result. In the present study, we have validated and evaluated a nested PCR assay targeting the gene encoding the Paracoccidioides gp43 membrane protein in 191 clinical samples: 115 samples from patients with proven infections other than paracoccidioidomycosis, 51 samples as negative controls, and 25 samples from patients diagnosed with paracoccidioidomycosis. Additionally, the specificity of the nested PCR assay was also evaluated using purified DNA isolated from cultures of different microorganisms (n=35) previously identified by culture and/or sequencing. The results showed that in our hands, this nested PCR assay for gp43 protein showed specificity and sensitivity rates of 100%. The optimized nested PCR conditions in our laboratory allowed detection down to 1fg of P. brasiliensis DNA.
Collapse
Affiliation(s)
- Marcela Gaviria
- Corporación para Investigaciones Biológicas, Medellín, Colombia
| | - Vanessa Rivera
- Corporación para Investigaciones Biológicas, Medellín, Colombia
| | | | - Luz Elena Cano
- Corporación para Investigaciones Biológicas, Medellín, Colombia; Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Tonny Williams Naranjo
- Corporación para Investigaciones Biológicas, Medellín, Colombia; Escuela de Ciencias de la Salud, Universidad Pontifica Bolivariana, Medellín, Colombia.
| |
Collapse
|
47
|
Di Martino Ortiz B, Moreno T, Galeano G, Rodríguez M. Acute Disseminated Paracoccidioidomycosis with Molluscoid Lesions in a Young Woman. Actas Dermosifiliogr 2015; 106:597-9. [PMID: 25665493 DOI: 10.1016/j.ad.2014.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/14/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- B Di Martino Ortiz
- Cátedra de Dermatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay.
| | - T Moreno
- Cátedra de Dermatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - G Galeano
- Cátedra de Dermatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - M Rodríguez
- Cátedra de Dermatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| |
Collapse
|
48
|
dos Santos PO, Rodrigues AM, Fernandes GF, da Silva SHM, Burger E, de Camargo ZP. Immunodiagnosis of paracoccidioidomycosis due to Paracoccidioides brasiliensis using a latex test: detection of specific antibody anti-gp43 and specific antigen gp43. PLoS Negl Trop Dis 2015; 9:e0003516. [PMID: 25679976 PMCID: PMC4334539 DOI: 10.1371/journal.pntd.0003516] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is a life-threatening systemic disease and is a neglected public health problem in many endemic regions of Latin America. Though several diagnostic methods are available, almost all of them present with some limitations. METHOD/PRINCIPLE FINDINGS A latex immunoassay using sensitized latex particles (SLPs) with gp43 antigen, the immunodominant antigen of Paracoccidioides brasiliensis, or the monoclonal antibody mAb17c (anti-gp43) was evaluated for antibody or antigen detection in sera, cerebrospinal fluid (CSF), and bronchoalveolar lavage (BAL) from patients with PCM due to P. brasiliensis. The gp43-SLPs performed optimally to detect specific antibodies with high levels of sensitivity (98.46%, 95% CI 91.7-100.0), specificity (93.94%, 95% CI 87.3-97.7), and positive (91.4%) and negative (98.9%) predictive values. In addition, we propose the use of mAb17c-SLPs to detect circulating gp43, which would be particularly important in patients with immune deficiencies who fail to produce normal levels of immunoglobulins, achieving good levels of sensitivity (96.92%, 95% CI 89.3-99.6), specificity (88.89%, 95% CI 81.0-94.3), and positive (85.1%) and negative (97.8%) predictive values. Very good agreement between latex tests and double immune diffusion was observed for gp43-SLPs (k = 0.924) and mAb17c-SLPs (k = 0.850), which reinforces the usefulness of our tests for the rapid diagnosis of PCM in less than 10 minutes. Minor cross-reactivity occurred with sera from patients with other fungal infections. We successfully detected antigens and antibodies from CSF and BAL samples. In addition, the latex test was useful for monitoring PCM patients receiving therapy. CONCLUSIONS/SIGNIFICANCE The high diagnostic accuracy, low cost, reduced assay time, and simplicity of this new latex test offer the potential to be commercialized and makes it an attractive diagnostic assay for use not only in clinics and medical mycology laboratories, but mainly in remote locations with limited laboratory infrastructure and/or minimally trained community health workers.
Collapse
Affiliation(s)
- Priscila Oliveira dos Santos
- Federal University of São Paulo, Department of Microbiology, Immunology and Parasitology, Cell Biology Division, São Paulo, Brazil
| | - Anderson Messias Rodrigues
- Federal University of São Paulo, Department of Microbiology, Immunology and Parasitology, Cell Biology Division, São Paulo, Brazil
| | - Geisa Ferreira Fernandes
- Federal University of São Paulo, Department of Microbiology, Immunology and Parasitology, Cell Biology Division, São Paulo, Brazil
| | | | - Eva Burger
- Federal University of Alfenas, Institute of Biomedical Sciences, Alfenas, Minas Gerais, Brazil
| | - Zoilo Pires de Camargo
- Federal University of São Paulo, Department of Microbiology, Immunology and Parasitology, Cell Biology Division, São Paulo, Brazil
| |
Collapse
|
49
|
Rojas-Jaimes J, Castillo Cordova R, Tárraga Gonzales D. [Paracoccidiomicosis in the central nervous system: a case report]. Rev Peru Med Exp Salud Publica 2015; 32:183-186. [PMID: 26102123] [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] [Received: 06/29/2014] [Accepted: 12/10/2015] [Indexed: 06/04/2023] Open
Abstract
Paracoccidioidomycosis is a fungal disease which can compromise the central nervous system (CNS).We present a case of an immunocompetent 45 year old man from Satipo, Peru who developed paracoccidioidomycosis in the CNS without any apparent point of entry or infection. The patient was diagnosed by imaging with a cerebellar granuloma, followed by a craniotomy where tissue and secretion of the granuloma abscess was obtained. Histological and microbiological diagnoses were performed on the tissue and secretion, respectively. Yeasts were observed in the histological section and growth of the fungus in the culture. The patient initially received antifungals, then acquired an intrahospital infection, received colistin and subsequently died. The case report emphasizes the importance of early and correct diagnosis for good outcomes of paracoccidioidomycosis cases.
Collapse
Affiliation(s)
- Jesús Rojas-Jaimes
- Laboratorio de Microbiología, Hospital Guillermo Almenara Irigoyen, Lima, Perú
| | | | | |
Collapse
|
50
|
Sylvestre TF, Silva LRF, Cavalcante RDS, Moris DV, Venturini J, Vicentini AP, de Carvalho LR, Mendes RP. Prevalence and serological diagnosis of relapse in paracoccidioidomycosis patients. PLoS Negl Trop Dis 2014; 8:e2834. [PMID: 24787147 PMCID: PMC4006716 DOI: 10.1371/journal.pntd.0002834] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/16/2014] [Indexed: 11/30/2022] Open
Abstract
A review of 400 clinical records of paracoccidioidomycosis (PCM) patients, 93 with the acute/subacute (AF) and 307 with the chronic form (CF), attended from 1977 to 2011, selected as to the schedule of release for study by the Office of Medical Records at the University Hospital of the Faculdade de Medicina de Botucatu-São Paulo State University--UNESP, was performed to detect cases in relapse. The control of cure was performed by clinical and serological evaluation using the double agar gel immunodiffusion test (DID). In the diagnosis of relapse, DID, enzyme-linked immunosorbent assay (ELISA) and immunoblotting assay (IBgp70 and IBgp43) were evaluated. Out of 400 patients, 21 (5.2%) went through relapse, 18 of them were male and 3 were female, 6∶1 male/female ratio. Out of the 21 patients in relapse, 15 (4.8%) showed the CF, and 6 (6.4%) the AF (p>0.05). The sensitivity of DID and ELISA before treatment was the same (76.1%). DID presented higher sensitivity in pre-treatment (80%) than at relapse (45%; p = 0.017), while ELISA showed the same sensitivity (80% vs 65%; p = 0.125). The serological methods for identifying PCM patients in relapse showed low rates of sensitivity, from 12.5% in IBgp70 to 65.0% in IBgp43 identification and 68.8% in ELISA. The sensitivity of ELISA in diagnosing PCM relapse showed a strong tendency to be higher than DID (p = 0.06) and is equal to IBgp43 (p = 0.11). In sum, prevalence of relapse was not high in PCM patients whose treatment duration was based on immunological parameters. However, the used methods for serological diagnosis present low sensitivity. While more accurate serological methods are not available, we pay special attention to the mycological and histopathological diagnosis of PCM relapse. Hence, direct mycological, cytopathological, and histopathological examinations and isolation in culture for P. brasiliensis must be appropriately and routinely performed when the hypothesis of relapse is considered.
Collapse
Affiliation(s)
- Tatiane Fernanda Sylvestre
- Tropical Diseases Department - Faculdade de Medicina de Botucatu – Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | | | - Ricardo de Souza Cavalcante
- Tropical Diseases Department - Faculdade de Medicina de Botucatu – Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | | | - James Venturini
- Laboratory of Experimental Immunology, Department of Biological Science, Faculty of Science, São Paulo State University – UNESP, São Paulo, Brazil
| | | | | | - Rinaldo Poncio Mendes
- Tropical Diseases Department - Faculdade de Medicina de Botucatu – Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| |
Collapse
|