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dos Santos APFB, Russo TVC, Pascuotte B, Visconde LFS, Luetz ACN, Sarris AB, Rocha MDG, Puga FG, Gaspar GG, Bollela VR, Martinez R. Chylothorax and chylous ascites due to juvenile paracoccidioidomycosis: a case report. Rev Soc Bras Med Trop 2023; 56:e06052022. [PMID: 37222352 PMCID: PMC10204149 DOI: 10.1590/0037-8682-0605-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/24/2023] [Indexed: 05/25/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides species. Chylothorax is a rare complication of PCM. A 16-year-old adolescent presented daily fever, lymphadenomegaly, sweating, weight loss, ventilatory-dependent pain, and dysphagia, which confirmed PCM. During treatment, the patient developed chylothorax and chylous ascites. Chronic inflammatory and fibrotic lymphadenopathy may obstruct lymphatic vessels, resulting in the extravasation of lymph into the abdomen or pleural cavities. Chylothorax is one of several complications of PCM and can lead to respiratory insufficiency, even in patients undergoing antifungal therapy.
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Affiliation(s)
- Ana Paula Freitas Bahia dos Santos
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Tomás Varella Costa Russo
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Beatriz Pascuotte
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Luis Felipe Silva Visconde
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Adryelle Carolynne Nogueira Luetz
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Andrey Biff Sarris
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Matheus Dias Girão Rocha
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Fernanda Guioti Puga
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Gilberto Gambero Gaspar
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Valdes Roberto Bollela
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
| | - Roberto Martinez
- Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Clínica Médica, Infectologia, Ribeirão Preto, SP, Brasil
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Severe paracoccidioidomycosis, with a fatal outcome and incidence related to an environmental event. An Bras Dermatol 2023; 98:133-137. [PMID: 36253243 PMCID: PMC9837630 DOI: 10.1016/j.abd.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/19/2021] [Accepted: 12/03/2021] [Indexed: 01/21/2023] Open
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Updates in Paracoccidioides Biology and Genetic Advances in Fungus Manipulation. J Fungi (Basel) 2021; 7:jof7020116. [PMID: 33557381 PMCID: PMC7915485 DOI: 10.3390/jof7020116] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/28/2022] Open
Abstract
The dimorphic fungi of the Paracoccidioides genus are the causative agents of paracoccidioidomycosis (PCM). This disease is endemic in Latin America and primarily affects workers in rural areas. PCM is considered a neglected disease, despite being a disabling disease that has a notable impact on the public health system. Paracoccidioides spp. are thermally dimorphic fungi that present infective mycelia at 25 °C and differentiate into pathogenic yeast forms at 37 °C. This transition involves a series of morphological, structural, and metabolic changes which are essential for their survival inside hosts. As a pathogen, the fungus is subjected to several varieties of stress conditions, including the host immune response, which involves the production of reactive nitrogen and oxygen species, thermal stress due to temperature changes during the transition, pH alterations within phagolysosomes, and hypoxia inside granulomas. Over the years, studies focusing on understanding the establishment and development of PCM have been conducted with several limitations due to the low effectiveness of strategies for the genetic manipulation of Paracoccidioides spp. This review describes the most relevant biological features of Paracoccidioides spp., including aspects of the phylogeny, ecology, stress response, infection, and evasion mechanisms of the fungus. We also discuss the genetic aspects and difficulties of fungal manipulation, and, finally, describe the advances in molecular biology that may be employed in molecular research on this fungus in the future.
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Clinical features and genetic background of the sympatric species Paracoccidioides brasiliensis and Paracoccidioides americana. PLoS Negl Trop Dis 2019; 13:e0007309. [PMID: 30986220 PMCID: PMC6483274 DOI: 10.1371/journal.pntd.0007309] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/25/2019] [Accepted: 03/15/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction The agents of paracoccidioidomycosis, historically identified as Paracoccidioides brasiliensis, are in fact different phylogenetic species. This study aims to evaluate associations between Paracoccidioides phylogenetic species and corresponding clinical data. Methods Paracoccidioides strains from INI/Fiocruz patients (1998–2016) were recovered. Socio-demographic, epidemiological, clinical, serological, therapeutic and prognostic data of the patients were collected to evaluate possible associations of these variables with the fungal species identified through partial sequencing of the ADP-ribosylation factor (arf) and the 43-kDa-glycoprotein (gp43) genes. Results Fifty-four fungal strains were recovered from 47 patients, most (72.3%) infected in Rio de Janeiro state, Brazil. Forty-one cases were caused by Paracoccidioides brasiliensis and six by Paracoccidioides americana (former PS2). P. brasiliensis was responsible for severe lymph abdominal forms, whereas patients infected with P. americana presented a high rate of adrenal involvement. However, no statistically significant associations were found for all variables studied. P. americana presented 100% reactivity to immunodiffusion, even when tested against antigens from other species, while negative results were observed in 9 (20%) cases caused by P. brasiliensis, despite being tested against a homologous antigen. Conclusions P. brasiliensis and P. americana are sympatric and share similar clinical features and habitat, where they may compete for similar hosts. Paracoccidioidomycosis (PCM) is a severe systemic mycosis caused by different phylogenetic species. According to previous studies, these species could have an impact in PCM clinical features. This study aims to investigate possible associations between Paracoccidioides species and corresponding clinical data. The fungal strains from the patients were recovered, whereas their clinical data were collected to evaluate possible associations of these variables with the fungal species identified through DNA sequencing. Fifty-four fungal strains were recovered from 47 patients, most infected in Rio de Janeiro state, Brazil. Forty-one cases were caused by Paracoccidioides brasiliensis and six by Paracoccidioides americana. P. brasiliensis was responsible for severe clinical forms, and patients infected with P. americana presented a high rate of adrenal involvement. However, no statistically significant associations were found for all variables studied. P. brasiliensis and P. americana share similar clinical features.
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Promising New Antifungal Treatment Targeting Chorismate Synthase from Paracoccidioides brasiliensis. Antimicrob Agents Chemother 2018; 63:AAC.01097-18. [PMID: 30348661 DOI: 10.1128/aac.01097-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/13/2018] [Indexed: 12/24/2022] Open
Abstract
Paracoccidioidomycosis (PCM), caused by Paracoccidioides, is a systemic mycosis with granulomatous character and a restricted therapeutic arsenal. The aim of this work was to search for new alternatives to treat largely neglected tropical mycosis, such as PCM. In this context, the enzymes of the shikimate pathway constitute excellent drug targets for conferring selective toxicity because this pathway is absent in humans but essential for the fungus. In this work, we have used a homology model of the chorismate synthase (EC 4.2.3.5) from Paracoccidioides brasiliensis (PbCS) and performed a combination of virtual screening and molecular dynamics testing to identify new potential inhibitors. The best hit, CP1, successfully adhered to pharmacological criteria (adsorption, distribution, metabolism, excretion, and toxicity) and was therefore used in in vitro experiments. Here we demonstrate that CP1 binds with a dissociation constant of 64 ± 1 μM to recombinant chorismate synthase from P. brasiliensis and inhibits enzymatic activity, with a 50% inhibitory concentration (IC50) of 47 ± 5 μM. As expected, CP1 showed no toxicity in three cell lines. On the other hand, CP1 reduced the fungal burden in lungs from treated mice, similar to itraconazole. In addition, histopathological analysis showed that animals treated with CP1 displayed less lung tissue infiltration, fewer yeast cells, and large areas with preserved architecture. Therefore, CP1 was able to control PCM in mice with a lower inflammatory response and is thus a promising candidate and lead structure for the development of drugs useful in PCM treatment.
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Macedo PMD, Almeida-Paes R, Almeida MDA, Coelho RA, Andrade HB, Ferreira ABTBC, Zancopé-Oliveira RM, Valle ACFD. Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 plus HIV co-infection. Mem Inst Oswaldo Cruz 2018; 113:167-172. [PMID: 29412355 PMCID: PMC5804308 DOI: 10.1590/0074-02760170310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/11/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is one of the most important systemic mycoses in
Latin America and the leading fungal cause of mortality in non-immunosuppressed
individuals in Brazil. However, HIV/PCM co-infection can increase the clinical
severity in these co-infected patients. This co-infection is rarely reported in
the literature mainly because of the different epidemiological profiles of these
infections. Furthermore, PCM is a neglected and non-notifiable disease, which may
underestimate the real importance of this disease. The advent of molecular studies
on the species of the genus Paracoccidioides has expanded the
knowledge regarding the severity and the clinical spectrum in PCM. In this
context, the development of studies to describe the association of the
Paracoccidioides phylogenetic cryptic species in vulnerable
populations, such as HIV-infected patients, appears relevant. OBJECTIVE To describe the clinical, epidemiological, therapeutic and prognostic aspects in
HIV/PCM co-infected patients, along with the molecular identification of the
Paracoccidioides species involved in these cases. METHODS The investigators performed a molecular and clinical retrospective study involving
HIV/PCM co-infected patients, from a reference centre for PCM care in the endemic
area of Rio de Janeiro, Brazil, from 1998 to 2015. Molecular identification of the
fungal strains was done by amplification of partial sequences of
arf and gp43 genes. FINDINGS Of 89 patients diagnosed with PCM by fungal isolation in the culture, a viable
isolate was recovered for molecular analysis from 44 patients. Of these 44
patients, 28 (63.6%) had their serum samples submitted for enzyme immunoassay
tests for screening of HIV antibodies, and 5 (17.9%) had a positive result. All
cases were considered severe, with a variable clinical presentation, including
mixed, acute/subacute clinical forms and a high rate of complications, requiring
combination therapy. Paracoccidioides brasiliensis S1 was the
species identified in all cases. CONCLUSIONS HIV/PCM co-infection can change the natural history of this fungal disease. The
authors reinforce the need to include HIV screening diagnostic tests routinely for
patients with PCM.
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Affiliation(s)
- Priscila Marques de Macedo
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Almeida-Paes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Marcos de Abreu Almeida
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Rowena Alves Coelho
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Hugo Boechat Andrade
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Departamento de Assistência a Pacientes Internados, Fiocruz, Rio de Janeiro, RJ, Brasil
| | | | - Rosely Maria Zancopé-Oliveira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Antonio Carlos Francesconi do Valle
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
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