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Pereira BAS, Cavalcante RDS, Pereira-Chioccola VL, Melhem MDSC, de Carvalho LR, Mendes RP. Standardization of Semi-Quantitative Dot Blotting Assay-Application in the Diagnosis, Follow-Up, and Relapse of Paracoccidioidomycosis. Microorganisms 2024; 12:351. [PMID: 38399756 PMCID: PMC10892552 DOI: 10.3390/microorganisms12020351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION This study standardized a semi-quantitative dot blotting assay (DB) and a quantitative real-time polymerase chain reaction (qPCR) to detect specific antibodies for Paracoccidioides brasiliensis and its DNA in PCM patients. METHODOLOGY We evaluated 42 confirmed PCM patients upon admission using a serological double agar gel immunodiffusion test (DID), DB, and molecular tests (qPCR in total blood). The control groups included 42 healthy individuals and 37 patients with other infectious diseases. The serological progress during treatment was evaluated in eight patients, and there was a relapse diagnosis in ten patients using the Pb B.339 strain antigen. The cut-off points for the serological tests were determined by a receiver operator characteristic curve. RESULTS The DB and DID tests showed similar accuracy, but the DB identified lower antibody concentrations. Cross-reactions were absent in the DB assay. In the relapse diagnoses, DB exhibited much higher sensitivity (90%) than DID (30%). CONCLUSIONS A DB assay is easier and faster than a DID test to be performed; DB and DID tests show the same accuracy, while blood qPCR is not recommended in the diagnosis at the time of admission; cross-reactions were not observed with other systemic diseases; DB and DID tests are useful for treatment monitoring PCM patients; and a DB assay is the choice for diagnosing relapse. These findings support the introduction of semi-quantitative DB assays in clinical laboratories.
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Affiliation(s)
- Beatriz Aparecida Soares Pereira
- UNESP Botucatu, School of Medicine—Discipline of Infectology, São Paulo State University, Botucatu 18618-689, São Paulo State, Brazil; (R.d.S.C.); (M.d.S.C.M.); (R.P.M.)
| | - Ricardo de Souza Cavalcante
- UNESP Botucatu, School of Medicine—Discipline of Infectology, São Paulo State University, Botucatu 18618-689, São Paulo State, Brazil; (R.d.S.C.); (M.d.S.C.M.); (R.P.M.)
| | | | - Marcia de Souza Carvalho Melhem
- UNESP Botucatu, School of Medicine—Discipline of Infectology, São Paulo State University, Botucatu 18618-689, São Paulo State, Brazil; (R.d.S.C.); (M.d.S.C.M.); (R.P.M.)
- FUMS Campo Grande, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande 79070-900, Mato Grosso do Sul, Brazil
| | - Lídia Raquel de Carvalho
- Institute of Biosciences—Department of Biodiversity and Biostatistics, UNESP Botucatu, São Paulo State University, Botucatu 18618-689, São Paulo State, Brazil;
| | - Rinaldo Poncio Mendes
- UNESP Botucatu, School of Medicine—Discipline of Infectology, São Paulo State University, Botucatu 18618-689, São Paulo State, Brazil; (R.d.S.C.); (M.d.S.C.M.); (R.P.M.)
- FUMS Campo Grande, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande 79070-900, Mato Grosso do Sul, Brazil
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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] [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.
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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
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Falcão EMM, Freitas DFS, Coutinho ZF, Quintella LP, Muniz MDM, Almeida-Paes R, Zancopé-Oliveira RM, de Macedo PM, do Valle ACF. Trends in the Epidemiological and Clinical Profile of Paracoccidioidomycosis in the Endemic Area of Rio de Janeiro, Brazil. J Fungi (Basel) 2023; 9:946. [PMID: 37755054 PMCID: PMC10532664 DOI: 10.3390/jof9090946] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a neglected endemic mycosis in Latin America. Most cases occur in Brazil. It is classified as PCM infection and PCM disease and is subdivided into chronic (adult type) or acute (juvenile type) disease, with the latter being less frequent and more severe. In 2016, we reported an increase in the numbers of patients diagnosed with acute PCM after a highway's construction. We conducted a study at INI-Fiocruz, a reference center for infectious diseases, including endemic mycoses, in Rio de Janeiro, Brazil, aiming to deepen the analysis of this new clinical and epidemiological profile of PCM. The authors developed a retrospective study including 170 patients diagnosed with PCM between 2010 and 2019. There was an increase in the number of atypical and severe forms, starting in 2014. In subsequent years, we detected a higher incidence of adverse outcomes with patients requiring more hospitalizations and an increased mortality rate. We estimate that PCM has become more severe throughout the Rio de Janeiro state, affecting a greater number of young individuals and leading to a greater number of and longer hospitalizations. Surveillance measures and close monitoring of future notification data in the state, with emphasis on children, adolescents, and young adults are necessary for a better understanding of the perpetuation of this public health challenge.
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Affiliation(s)
- Eduardo Mastrangelo Marinho Falcão
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (D.F.S.F.); (P.M.d.M.); (A.C.F.d.V.)
| | - Dayvison Francis Saraiva Freitas
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (D.F.S.F.); (P.M.d.M.); (A.C.F.d.V.)
| | - Ziadir Francisco Coutinho
- Germano Sinval Faria School Health Center, Sergio Arouca National School of Public Health, Fiocruz, Rio de Janeiro 21040-900, Brazil;
| | - Leonardo Pereira Quintella
- Anatomical Pathology Service, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil;
| | - Mauro de Medeiros Muniz
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.d.M.M.); (R.A.-P.); (R.M.Z.-O.)
| | - Rodrigo Almeida-Paes
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.d.M.M.); (R.A.-P.); (R.M.Z.-O.)
| | - Rosely Maria Zancopé-Oliveira
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.d.M.M.); (R.A.-P.); (R.M.Z.-O.)
| | - Priscila Marques de Macedo
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (D.F.S.F.); (P.M.d.M.); (A.C.F.d.V.)
| | - Antonio Carlos Francesconi do Valle
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (D.F.S.F.); (P.M.d.M.); (A.C.F.d.V.)
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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5
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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: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [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.
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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
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de Almeida SM, Kulik A, Malaquias MAS, Nagashima S, de Paula CBV, Muro MD, de Noronha L. The Impact of Paracoccidioides spp Infection on Central Nervous System Cell Junctional Complexes. Mycopathologia 2022; 187:567-577. [PMID: 35922705 DOI: 10.1007/s11046-022-00653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022]
Abstract
Paracoccidioidomycosis (PCM), a systemic mycosis caused by the fungus Paracoccidioides spp. is the most prevalent fungal infection among immunocompetent patients in Latin America. The estimated frequency of central nervous system (CNS) involvement among the human immunodeficiency virus (HIV)/PCM-positive population is 2.5%. We aimed to address the impact of neuroparacoccidioidomycosis (NPCM) and HIV/NPCM co-infection on the tight junctions (TJ) and adherens junction (AJ) proteins of the CNS. Four CNS formalin-fixed paraffin-embedded (FFPE) tissue specimens were studied: NPCM, NPCM/HIV co-infection, HIV-positive without opportunistic CNS infection, and normal brain autopsy (negative control). Immunohistochemistry was used to analyze the endothelial cells and astrocytes expressions of TJ markers: claudins (CLDN)-1, -3, -5 and occludin; AJ markers: β-catenin and E-cadherin; and pericyte marker: alpha-smooth muscle actin. FFPE CNS tissue specimens were analyzed using the immunoperoxidase assay. CLDN-5 expression in the capillaries of the HIV/NPCM coinfected tissues (mixed clinical form of PCM) was lower than that in the capillaries of the HIV or NPCM monoinfected (chronic clinical form of PCM) tissues. A marked decrease in CLDN-5 expression and a compensatory increase in CLDN-1 expression in the NPCM/HIV co-infection tissue samples was observed. The authors suggest that Paracoccidioides spp. crosses the blood-brain barrier through paracellular pathway, owing to the alteration in the CLDN expression, or inside the macrophages (Trojan horse).
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Affiliation(s)
- Sérgio Monteiro de Almeida
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil. .,Neuroinfection Outclinic, Hospital de Clinicas, Universidade Federal do Paraná, Rua Padre Camargo 280, Curitiba, Paraná, 80060-240, Brazil.
| | - Amanda Kulik
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | - Seigo Nagashima
- Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Caroline Busatta Vaz de Paula
- Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Marisol Dominguez Muro
- Micology Laboratory, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Lucia de Noronha
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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Paracoccidioidomycosis in people living with HIV/AIDS: A historical retrospective cohort study in a national reference center for infectious diseases, Rio de Janeiro, Brazil. PLoS Negl Trop Dis 2022; 16:e0010529. [PMID: 35704666 PMCID: PMC9239448 DOI: 10.1371/journal.pntd.0010529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/28/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is one of the main endemic systemic mycoses in Latin America, usually occurring in rural areas. When PCM occurs simultaneously with underlying immunosuppressive conditions, it can present as an opportunistic disease. Between 2000 and 2017, literature reported around 200 PCM cases in people living with HIV/AIDS (PLWHA). To address research gaps on this co-infection and to study its possible temporal changes in the last decade, we performed an active co-infection case search on the HIV/AIDS and PCM cohorts from a Brazilian reference center database from 1989 to 2019. We found 20 PLWHA among 684 PCM patients (2.92%), predominantly male (70.0%) and urban workers (80.0%). The median age of patients was higher in the 2010–2019 decade (p = 0.006). The occurrence of PCM in PLWHA was lower when compared with other fungal diseases. Although 50.0% of the patients had already been diagnosed with HIV infection and presented CD4+ T cell counts greater than 200/mm3 at the time of PCM diagnosis, the suspicion of immunosuppression in the context of atypical and more severe clinical forms of PCM revealed the diagnosis of HIV infection in 35.0% of the patients. Two (10.0%) patients had an evolution compatible with immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral therapy (ART).We highlight the importance of considering a PCM diagnosis in PLWHA to prevent a late-onset treatment and progression to severe manifestations and unfavorable outcomes. In addition, HIV investigation is recommended in PCM patients, especially those with atypical and more severe clinical presentations. Paracoccidioidomycosis (PCM) is a severe systemic mycosis caused by inhalation of fungi belonging to the genus Paracoccidioides present in the soil of endemic areas in Latin America. However, it is still a neglected disease, affecting vulnerable populations such as rural workers. In the last decade, there was an increase of acute PCM cases in young people living in urban areas of the endemic area of Rio de Janeiro, Brazil. This could increase the occurrence of PCM in people living HIV/AIDS (PLWHA) because they are more concentrated in these regions. When PCM and immunosuppression due to AIDS occur simultaneously, PCM can present as an opportunistic disease, with more severe, invasive, and atypical presentations. In these cases, late diagnosis and treatment can lead to higher risk of complications, sequelae, and deaths. PCM occurrence in PLWHA is scarcely reported in the literature. This study aims to describe the clinical profile of patients diagnosed with PCM and HIV co-infection from a 30-year historical cohort followed at a Brazilian reference center for infectious diseases. Our results revealed that the suspicion of this co-infection in patients with more severe clinical forms of PCM as well as routine HIV testing in PCM patients could help to prevent late-onset treatment and progression to unfavorable outcomes.
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Andrade-Silva J, Andrade-Silva LE, Paes HC, Alves L, Rosa A, Tenório BG, Ferreira MS, Felipe MSS, Teixeira MDM, Silva-Vergara ML. Molecular epidemiology of Paracoccidiodes spp. recovered from patients with paracoccidioidomycosis in a teaching hospital from Minas Gerais State of Brazil. PLoS Negl Trop Dis 2021; 15:e0009956. [PMID: 34843484 PMCID: PMC8659327 DOI: 10.1371/journal.pntd.0009956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/09/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Paracoccidioidomycosis (PCM) is caused by several species of the Paracoccidioides genus which can be differentiated by interspecific genetic variations, morphology and geographic distribution. Intraspecific variability correlation with clinical and epidemiological aspects of these species still remains unclear. This study aimed to sequence the loci GP43, exon 2 and ARF of 23 clinical isolates of Paracoccidioides spp. from patients in the Southeast Region of Brazil. Methodology and main findings GenBank was used to compare the present (23) with previous described sequences (151) that included ARF and GP43. It was identified a high polymorphism rate among the 23 isolates in comparison to the other 151. Among the isolates, 22 (95.66%) were S1/P. brasiliensis and 1 (4.34%) was identified as PS2/P. americana. A total of 45 haplotypes were found as follows: 19 from S1/P. brasiliensis (13 from the present study), 15 from P. lutzii, 6 from PS2/P. americana (1 from the present study), 3 from PS3/P. restrepiensis and 2 from PS4/P. venezuelensis. Moreover, exclusive haplotypes according to clinical origin and geographical area were found. S1/P. brasiliensis (HD = 0.655 and K = 4.613) and P. lutzii (HD = 0.649 and K = 2.906) presented the highest rate of polymorphism among all species, from which 12 isolates of the present study were clustered within S1b/P. brasiliensis. The GP43 locus showed a higher variability and was found to be the main reason for the species differentiation. Conclusions The results herein decribed show a high intraspecific genetic variability among S1/P. brasiliensis isolates and confirm the predominance of this species in the Southeast region of Brazil. The finding of exclusive haplotypes according to clinical origin and geographical area would suggest correlation between the molecular profile with the clinical form and geographic origin of patients with PCM. Paracoccidioidomycosis (PCM) is one of the most important systemic mycosis of Latin America. This disease can be caused by Paracoccidioides lutzii and four different phylogenetic species: S1/Paracoccidioides brasiliensis sensu stricto that harboring S1a and S1b, PS2/Paracoccidioides americana, PS3/Paracoccidioides restrepiensis and PS4/Paracoccidioides venezuelensis. Some of these species show differences in their main geographic region of predominance such as PS2/P. americana that can be found in Venezuela and Southern Brazil; PS3/P. restrepiensis and PS4/P. venezuelensis which are distributed in Colombia and Venezuela. However, and due to their wide geographical distribution, the species S1/P. brasiliensis and P. lutzii overlapping ecological niches and can be found in different regions of Brazil and other Latin American countries. Regarding eco-epidemiological aspects, the habitat is believed to be the soil due to the predominance of the disease among rural workers who become infected by inhaling infectious propagules during their farm activities. According to other authors, these species could have relation with the different PCM clinical presentation. This study aimed to describe the molecular epidemiology associated with clinical and epidemiological data of Paracoccidiodes spp. in the Minas Gerais State, located in the Southeast region, Brazil. Among the 23 isolates herein evaluated, 22 were S1/P. brasiliensis and 1 was identified as PS2/P. americana. A total of 45 haplotypes were found when these isolates were compared with other 151 deposited in the Genbank. The preliminar finding of exclusive haplotypes according to clinical origin and geographical area would suggest correlation between the molecular profile with the clinical form and geographic origin of patients with PCM. The GP43 locus showed a higher variability and was found to be the main promotor of species differentiation. The results herein described pointed out a high intraspecific genetic variability among S1/P. brasiliensis isolates and confirm the predominance of this species in the Southeast region of Brazil.
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Affiliation(s)
- Juliana Andrade-Silva
- Infectious Diseases Unit, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, Brazil
| | | | - Hugo Costa Paes
- Faculty of Medicina, University of Brasília, Brasília, Brazil
| | - Lucas Alves
- Faculty of Medicina, University of Brasília, Brasília, Brazil
| | - Adair Rosa
- Faculty of Medicina, University of Brasília, Brasília, Brazil
| | | | - Marcelo Simão Ferreira
- Infectious diseases Unit, Internal Medicine Department Federal University of Uberlândia, Uberlândia, Brazil
| | | | | | - Mario León Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, Brazil
- * E-mail:
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9
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Nery AF, de Camargo ZP, Rodrigues AM, Portela TF, Hoffmann-Santos HD, Dambros PVK, de Souza JFR, Garcia AC, Santos CAD, Hagen F, Hahn RC. Paracoccidioidomycosis due to P lutzii: The importance of neutrophil/lymphocyte ratio in the symptomatic and asymptomatic phases in severe cases. Mycoses 2021; 64:874-881. [PMID: 33829534 DOI: 10.1111/myc.13282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND PCM is a neglected systemic mycosis endemic in Brazil. The middle-west region of Brazil has shown the highest number of PCM by Paracoccidioides lutzii (P lutzii) cases. Differentiating cases of severe PCM from non-severe ones should be a concern at the bedside. Diagnosis of severe PCM by P lutzii is based on the subjectivity of clinical manifestations, which can result in a delay in starting its treatment and, consequently evolution to severe sequelae. There is not laboratory biomarker available to support the early diagnosis of severe PCM that is feasible for all the realities that coexist in Brazil. OBJECTIVES The aim of this study was to investigate the usefulness of laboratory biomarkers as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the diagnosis of severe PCM. PATIENTS/METHODS ESR, CRP and NLR were analysed for 44 patients with PCM by P lutzii and a Receiver Operation Characteristic (ROC) curve were generated to identify the NLR cut-off point and point out the presence of severe PCM. RESULTS Sixteen (36.4%) had severe PCM and 28 (63.6%) had non-severe PCM. The mean NLR was higher and statistically significant among patients with severe PCM than among those with non-severe PCM. The area under the ROC curve was 0.859 for the diagnosis of severe PCM. The cut-off point for NLR for the diagnosis of severe PCM was 3.318 (sensitivity of 100%, specificity of 77%). CONCLUSIONS According to results, it is plausible to conclude that NLR represents a potential biomarker for the diagnosis of severe PCM.
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Affiliation(s)
- Andreia Ferreira Nery
- Internal Medicine Department, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, MT, Brazil.,Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, MT, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, SP, Brazil.,Discipline of Infectious Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, SP, Brazil.,Discipline of Infectious Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.,Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Rosane Christine Hahn
- Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, MT, Brazil.,Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, MT, Brazil
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10
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Vasconcelos DDM, Bertolini DL, Ferreira MD. Chronic mucocutaneous candidiasis associated with paracoccidioidomycosis in a patient with mannose receptor deficiency: First case reported in the literature. Rev Soc Bras Med Trop 2021; 54:e0008-2021. [PMID: 33759911 PMCID: PMC8008892 DOI: 10.1590/0037-8682-0008-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 11/22/2022] Open
Abstract
We describe the first report of a patient with chronic mucocutaneous candidiasis associated with disseminated and recurrent paracoccidioidomycosis. The investigation demonstrated that the patient had a mannose receptor deficiency, which would explain the patient’s susceptibility to chronic infection by Candida spp. and systemic infection by paracoccidioidomycosis. Mannose receptors are responsible for an important link between macrophages and fungal cells during phagocytosis. Deficiency of this receptor could explain the susceptibility to both fungal species, suggesting the impediment of the phagocytosis of these fungi in our patient.
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Affiliation(s)
- Dewton de Moraes Vasconcelos
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas, Departamento de Dermatologia, Ambulatório das Manifestações Cutâneas das Imunodeficiências Primárias, São Paulo, SP, Brasil
| | - Dalton Luís Bertolini
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas, Departamento de Dermatologia, Ambulatório das Manifestações Cutâneas das Imunodeficiências Primárias, São Paulo, SP, Brasil
| | - Maurício Domingues Ferreira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas, Departamento de Dermatologia, Ambulatório das Manifestações Cutâneas das Imunodeficiências Primárias, São Paulo, SP, Brasil
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11
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Peçanha PM, Bahiense IC, Kruschewsky WLL, Biasutti C, Júnior CUGF, Pinheiro BG, Maifrede SB, Camargo ZPD, Rodrigues AM, Grão-Velloso TR, Falqueto A, Gonçalves SS. Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 associated with acquired immunodeficiency syndrome: A case report. Rev Iberoam Micol 2020; 38:5-8. [PMID: 33317932 DOI: 10.1016/j.riam.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is an endemic disease in Latin America. In immunocompetent hosts, PCM occurs in two main clinical forms: acute and chronic. However, in HIV-infected patients PCM may show up simultaneous manifestations of acute and chronic forms. CASE REPORT We present the case of a patient diagnosed with HIV who had disseminated skin lesions and generalized lymphadenopathy, as well as respiratory and central nervous system involvement. The PCM diagnosis was confirmed by direct KOH examination, double immunodiffusion and the isolation of the fungus in samples of an abscess in the subcostal region. The isolate was identified as Paracoccidioides brasiliensis S1 by species-specific PCR using primers for protein-coding gene GP43 (exon 2) followed by PCR-RFLP of the alpha-tubulin gene. CONCLUSIONS There are few data in literature reporting species-specific molecular identification of Paracoccidioides in HIV/PCM patients. Therefore, this case report may contribute to improve the knowledge about this severe disease, its causative cryptic species, and its consequences to patients.
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12
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Messina F, Romero M, Benchetrit A, Marin E, Arechavala A, Depardo R, Negroni R, Santiso G. Clinical and microbiological characteristics of paracoccidioidomycosis in patients with AIDS in Buenos Aires, Argentina. Med Mycol 2020; 58:22-29. [PMID: 30874811 DOI: 10.1093/mmy/myz021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022] Open
Abstract
Paracoccidioidomycosis (Pm) is a systemic disease, endemic in the American continent. There are two different clinical forms, the infant-juvenile or subacute form (PmS) and the chronic adult form (PmC). The human immunodeficiency virus (HIV) associated paracoccidioidomycosis (PmHIV) shares characteristics with both of the previously mentioned forms. The objective of this work was to describe the epidemiological, clinical and laboratory features of the PmHIV and to compare them with the ones of PmS and the PmC. A retrospective analysis of 119 patients with paracoccidioidomycosis was performed. Ninety four suffered the chronic form, 11 the subacute one and 14 were coinfected with HIV. Patients with PmHIV presented a CD4+ T lymphocytes median of 70.5 cells/μl, 71.4% had fever, 64.3% had a miliary pattern on the chest radiography, 64.3% had hepatosplenomegaly, 64.3% had mucosal lesions and 50% had skin lesions. One patient died during his hospitalization. The clinical presentation of Pm in patients with HIV resembled the subacute form with fever, hepatomegaly and skin lesions. However, they also tended to present mucosal lesions, positive serology for Pm and pulmonary parenchyma lesions as usually seen in PmC (9/14 PmHIV patients had overlapping features, while 4/14 PmHIV patients clinically resembled PmS and 1/14 PmC). The incidence of Pm has not changed with the burden of AIDS as it has happened with other fungal infections but it appears clinically different from the classic clinical forms of the disease.
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Affiliation(s)
- F Messina
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - M Romero
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - A Benchetrit
- Ward 21. Infectious Diseases Hospital F.J. Muñiz, Buenos Aires, Argentina
| | - E Marin
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - A Arechavala
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - R Depardo
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - R Negroni
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - G Santiso
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
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13
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Queiroz-Telles F, Buccheri R, Benard G. Sporotrichosis In Immunocompromised Hosts. J Fungi (Basel) 2019; 5:jof5010008. [PMID: 30641918 PMCID: PMC6463096 DOI: 10.3390/jof5010008] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 02/06/2023] Open
Abstract
Sporotrichosis is a global implantation or subcutaneous mycosis caused by several members of the genus Sporothrix, a thermo-dimorphic fungus. This disease may also depict an endemic profile, especially in tropical to subtropical zones around the world. Interestingly, sporotrichosis is an anthropozoonotic disease that may be transmitted to humans by plants or by animals, especially cats. It may be associated with rather isolated or clustered cases but also with outbreaks in different periods and geographic regions. Usually, sporotrichosis affects immunocompetent hosts, presenting a chronic to subacute evolution course. Less frequently, sporotrichosis may be acquired by inhalation, leading to disseminated clinical forms. Both modes of infection may occur in immunocompromised patients, especially associated with human immunodeficiency virus (HIV) infection, but also diabetes mellitus, chronic alcoholism, steroids, anti-TNF treatment, hematologic cancer and transplanted patients. Similar to other endemic mycoses caused by dimorphic fungi, sporotrichosis in immunocompromised hosts may be associated with rather more severe clinical courses, larger fungal burden and longer periods of systemic antifungal therapy. A prolonged outbreak of cat-transmitted sporotrichosis is in progress in Brazil and potentially crossing the border to neighboring countries. This huge outbreak involves thousands of human and cats, including immunocompromised subjects affected by HIV and FIV (feline immunodeficiency virus), respectively. We reviewed the main epidemiologic, clinical, diagnostic and therapeutic aspects of sporotrichosis in immunocompromised hosts.
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Affiliation(s)
- Flavio Queiroz-Telles
- Department of Public Health, Federal University of Paraná, Curitiba 80060-000, Brazil.
| | - Renata Buccheri
- Emilio Ribas Institute of Infectious Diseases, São Paulo 05411-000, Brazil.
| | - Gil Benard
- Laboratory of Medical Mycology, Department of Dermatology, and Tropical Medicine Institute, University of São Paulo, Sao Paulo 05403-000, Brazil.
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14
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de Almeida JN, Peçanha-Pietrobom PM, Colombo AL. Paracoccidioidomycosis in Immunocompromised Patients: A Literature Review. J Fungi (Basel) 2018; 5:E2. [PMID: 30587784 PMCID: PMC6463037 DOI: 10.3390/jof5010002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/09/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is an endemic mycosis found in Latin America that causes systemic disease mostly in immunocompetent hosts. A small percentage of PCM occurs in immunocompromised patients where low clinical suspicion of the infection, late diagnosis, and uncertainties about its management are factors that negatively impact their outcomes. We conducted a literature review searching reports on PCM associated to HIV, cancer, maligned hemopathies, solid organ transplantation, and immunotherapies, in order to check for peculiarities in terms of natural history and challenges in the clinical management of PCM in this population. HIV patients with PCM usually had low T CD4⁺ cell counts, pulmonary and lymph nodes involvement, and a poorer prognosis (≈50% mortality). Most of the patients with PCM and cancer had carcinoma of the respiratory tract. Among maligned hemopathies, PCM was more often related to lymphoma. In general, PCM prognosis in patients with malignant diseases was related to the cancer stage. PCM in transplant recipients was mostly associated with the late phase of kidney transplantation, with a high mortality rate (44%). Despite being uncommon, reactivation of latent PCM may take place in the setting of immunocompromised patients exhibiting clinical particularities and it carries higher mortality rates than normal hosts.
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Affiliation(s)
- João N de Almeida
- Central Laboratory Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, CEP 05403-000 São Paulo, Brazil.
| | - Paula M Peçanha-Pietrobom
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, CEP 04039-032 São Paulo, Brazil.
| | - Arnaldo L Colombo
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, CEP 04039-032 São Paulo, Brazil.
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15
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de Almeida SM, Salvador GLO, Roza TH, Izycki LF, Dos Santos I, Aragão A, Kulik A, Muro M, Torres LFB, de Noronha L. Geographical evaluation of Neuroparacoccidioidomycosis and Paracoccidioidomycosis in Southern Brazil. Mycoses 2018; 61:587-593. [PMID: 29663530 DOI: 10.1111/myc.12782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 11/30/2022]
Abstract
Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis among immunocompetent patients in Latin America. This study aimed to describe the expansion over time and the geographical distribution of confirmed Neuroparacoccidioidomycosis (NPCM) and PCM cases, and relate it to environmental characteristics such as climate, soil types and coffee crops. This was a retrospective study of autopsy and biopsy reports between 1951 and 2014 from the Medical Pathology Section of the Hospital de Clinicas, Universidade Federal do Paraná (UFPR), Curitiba, Southern Brazil. PCM was predominant in male agricultural workers. PCM cases predominated in areas with subtropical climate with hot summers in North West Parana state. NPCM cases were distributed statewide more frequent in rural than metropolitan area. There was no association with climate, soil type, or coffee crop culture. Most of the PCM cases were in the metropolitan area of the capital, chiefly due to migration fluxes. Even though the history is predominantly agricultural, PCM cases were distributed mainly in the metropolitan area of the state capital, there was no association with climate and soil. NPCM cases were numerically more frequent in rural than metropolitan area.
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Affiliation(s)
- Sergio Monteiro de Almeida
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Virology Laboratory, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Gabriel L O Salvador
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Thiago Henrique Roza
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Luís Felipe Izycki
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Isaias Dos Santos
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Afonso Aragão
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Amanda Kulik
- Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Marisol Muro
- Mycology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Luis Fernando Bleggi Torres
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Lucia de Noronha
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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16
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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: 9] [Impact Index Per Article: 1.5] [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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17
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de Almeida SM, Roza TH, Salvador GLO, Izycki LF, Locatelli G, Santos ID, Aragão A, Torres LFB, de Noronha LH. Autopsy and biopsy study of paracoccidioidomycosis and neuroparacoccidioidomycosis with and without HIV co-infection. Mycoses 2018; 61:237-244. [PMID: 29274088 DOI: 10.1111/myc.12737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/13/2017] [Accepted: 12/16/2017] [Indexed: 11/29/2022]
Abstract
Paracoccidioidomycosis (PCM) is a systemic mycosis prevalent among immunocompetent patients in Latin America. This study aimed to describe the frequency, demographics and clinical characteristics of central nervous system PCM (NPCM) and PCM in an endemic region, and the impact of human immunosuppression virus (HIV) co-infection. This was a retrospective study of autopsy and biopsy reports from the Medical Pathology Section of the Hospital de Clinicas, UFPR, Curitiba, Southern Brazil, between 1951 and 2014. PCM was present in 0.1% of 378,323 cases examined, with 5.7% being NPCM. Infection was prevalent in working-age men, agricultural workers and rural residents. Numbers of HIV autopsy cases increased over time, while those of PCM cases decreased. Prevalence of co-infection of HIV/PCM and HIV/NPCM was 1.6%, and 0.4%, respectively. Adrenals were affected more frequently in the NPCM group compared with the PCM group. Mortality was higher on NPCM group. The clinical course of PCM in HIV patients resembles an acute/sub-acute infection. Association of NPCM and HIV is rare, while diagnosis of NPCM is difficult, it should be considered a differential diagnosis in HIV patients who live in, or have visited, endemic areas and present with neurological symptoms.
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Affiliation(s)
- Sergio Monteiro de Almeida
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil.,Virology Laboratory, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Thiago Henrique Roza
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Gabriel L O Salvador
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Luís Felipe Izycki
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Giuliana Locatelli
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Isaias Dos Santos
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Afonso Aragão
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Luis Fernando Bleggi Torres
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Lucia Helena de Noronha
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil.,Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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18
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Mendes RP, Cavalcante RDS, Marques SA, Marques MEA, Venturini J, Sylvestre TF, Paniago AMM, Pereira AC, da Silva JDF, Fabro AT, Bosco SDMG, Bagagli E, Hahn RC, Levorato AD. Paracoccidioidomycosis: Current Perspectives from Brazil. Open Microbiol J 2017; 11:224-282. [PMID: 29204222 PMCID: PMC5695158 DOI: 10.2174/1874285801711010224] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This review article summarizes and updates the knowledge on paracoccidioidomycosis. P lutzii and the cryptic species of P. brasiliensis and their geographical distribution in Latin America, explaining the difficulties observed in the serological diagnosis. OBJECTIVES Emphasis has been placed on some genetic factors as predisposing condition for paracoccidioidomycosis. Veterinary aspects were focused, showing the wide distribution of infection among animals. The cell-mediated immunity was better characterized, incorporating the recent findings. METHODS Serological methods for diagnosis were also compared for their parameters of accuracy, including the analysis of relapse. RESULTS Clinical forms have been better classified in order to include the pictures less frequently observesiod. CONCLUSION Itraconazole and the trimethoprim-sulfamethoxazole combination was compared regarding efficacy, effectiveness and safety, demonstrating that azole should be the first choice in the treatment of paracoccidioidomycosis.
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Affiliation(s)
- Rinaldo Poncio Mendes
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Ricardo de Souza Cavalcante
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Sílvio Alencar Marques
- Department of Dermatology, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | | | - James Venturini
- Laboratory of Experimental Immunology, Department of Biological Science, Faculty of Science, São Paulo State University – UNESP, São Paulo, Brazil
| | - Tatiane Fernanda Sylvestre
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Anamaria Mello Miranda Paniago
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina – Federal University of Mato Grosso do Sul – UFMS, Brazil
| | | | - Julhiany de Fátima da Silva
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Alexandre Todorovic Fabro
- Unit of Experimental Research, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Sandra de Moraes Gimenes Bosco
- Department of Microbiology and Immunology – Instituto de Biociências de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Eduardo Bagagli
- Department of Microbiology and Immunology – Instituto de Biociências de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Rosane Christine Hahn
- Laboratory of Investigation and Mycology, Federal University of Mato Grosso, Faculty of Medicine Cuiabá, Mato Grosso, Brazil
| | - Adriele Dandara Levorato
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
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19
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de Almeida SM, Roza TH, Salvador GLO, França JCB, Vidal LRR, Nogueira MB, Oliva LV, Torres LFB, de Noronha LH. Neurological and multiple organ involvement due to Paracoccidioides brasiliensis and HIV co-infection diagnosed at autopsy. J Neurovirol 2017; 23:913-918. [PMID: 28895099 DOI: 10.1007/s13365-017-0577-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/04/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Abstract
Paracoccidioidomycosis (PCM), caused by Paracoccidioides brasiliensis, is the most prevalent systemic mycosis among immunocompetent patients in Latin America; it is rare in immunocompromised patients. The estimated frequency of central nervous system (CNS) involvement in the HIV/PCM population was 2.5%. We report a case of HIV/P. brasiliensis co-infection, with neurological (NPCM) and multiple organ involvement, indicating a diagnosis of AIDS. PCM diagnosis was established during the autopsy. This is the first described case of HIV/P. brasiliensis co-infection with CNS involvement diagnosed at autopsy. In conclusion, the diagnosis of NPCM is challenging, and it must be considered in the differential diagnosis in HIV-positive patients who reside in or have visited areas in which the condition is endemic and who present with neurological symptoms.
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Affiliation(s)
- Sergio Monteiro de Almeida
- Medical Pathology Department, Medicine School, Universidade Federal do Paraná, Curitiba, Paraná, Brazil. .,Virology Laboratory, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil. .,Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil. .,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil. .,Hospital de Clínicas-UFPR, Seção de Virologia, Setor Análises Clínicas, Rua Padre Camargo, 280, Curitiba, PR, Brazil.
| | - Thiago H Roza
- Medical Pathology Department, Medicine School, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Gabriel L O Salvador
- Medical Pathology Department, Medicine School, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - João C B França
- Infectious Diseases Unit, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | - Meri Bordignon Nogueira
- Virology Laboratory, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Lubomira Veronica Oliva
- Medical Pathology Department, Medicine School, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | - Lucia Helena de Noronha
- Medical Pathology Department, Medicine School, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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20
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Peçanha PM, Batista Ferreira ME, Massaroni Peçanha MA, Schmidt EB, Lamas de Araújo M, Zanotti RL, Potratz FF, Delboni Nunes NE, Gonçalves Ferreira CU, Delmaestro D, Falqueto A. Paracoccidioidomycosis: Epidemiological and Clinical Aspects in 546 Cases Studied in the State of Espírito Santo, Brazil. Am J Trop Med Hyg 2017; 97:836-844. [PMID: 28749757 PMCID: PMC5590575 DOI: 10.4269/ajtmh.16-0790] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 05/22/2016] [Indexed: 11/07/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is an endemic disease in the southeast region of Brazil, which includes the state of Espírito Santo (ES). This historic case series analyses 546 patients treated in this state from 1978 to 2012. Patients aged from 7 to 83 years, 509 males and 37 females, yielding a ratio of 13.7:1. Most of the patients (81.4%) originated from rural areas in ES, 71.0% being farmers. A higher concentration of cases was observed in municipalities located along the western range of the state. Sixty patients (11.0%) had an acute/subacute form of the disease, 485 (88.9%) had a chronic form, and one had a subclinical form. The most affected organs included the lungs, oropharyngeal mucosa, lymph nodes, skin, and larynx. The diagnosis was confirmed by histopathology in 252 (46.2%) cases, direct examination in 168 (30.7%), both exams in 111 (20.3%) and serology in 15 (2.8%). Tuberculosis, acquired immune deficiency syndrome, leishmaniasis, and intestinal parasites were the most frequently associated infectious diseases. From 328 patients followed up, total regression of the lesions was observed in 17.4%, partial regression in 77.4%, and no regression in 17 (5.2%) cases. Regarding the number of cases in this series, ES emerges as an important endemic area for PCM in Brazil.
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Affiliation(s)
- Paulo Mendes Peçanha
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Mayara Elisa Batista Ferreira
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Maria Angélica Massaroni Peçanha
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Edilaine Brandão Schmidt
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Mariceli Lamas de Araújo
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Raphael Lubiana Zanotti
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Felipe Fonseca Potratz
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Nilo Eduardo Delboni Nunes
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Carlos Urbano Gonçalves Ferreira
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Délio Delmaestro
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Aloísio Falqueto
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
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21
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Nery AF, Crepaldi NP, Rossi SBRS, Tadano T, Leal-Santos FA, Hahn RC, Menezes VM, Fontes CJF. Therapeutic Response in Adult Patients with Nonsevere Chronic Paracoccidioidomycosis Treated with Sulfamethoxazole-Trimethoprim: A Retrospective Study. Am J Trop Med Hyg 2017; 97:556-562. [PMID: 28722596 DOI: 10.4269/ajtmh.16-0255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
According to the Brazilian Consensus on Paracoccidioidomycosis (PCM), itraconazole is the drug of choice for treatment. However, the combination of sulfamethoxazole and trimethoprim (SMX-TMP) is most commonly used in clinical practice because of its higher availability in the public health services. The aims of this study were to evaluate the therapeutic response of patients with nonsevere chronic PCM to SMX-TMP and highlight the factors related to treatment failure. An adequate therapeutic response was defined as completely improved disease signs and symptoms after medication use for a minimum of 6 months, followed by normalized hematological and biochemical changes, radiological improvements, and negative mycological examination findings. Medical records were analyzed for 244 patients with nonsevere chronic PCM who were treated between 1998 and 2014. In total, 41.9% of the patients had PCM for ≥ 8 months. Seven (2.9%) patients were coinfected with human immunodeficiency virus (HIV). The median (25%, 75% percentiles) treatment duration was 21 (10, 25) months. Adequate treatment adherence was reported by 68.3% of patients. In addition, 73.6% of patients exhibited an adequate therapeutic response. The majority (82.6%) of patients who were treated with SMX-TMP for > 24 months displayed an adequate therapeutic response, and the frequency of adequate therapeutic response gradually decreased as the duration of treatment decreased. Treatment nonadherence (P < 0.001) and PCM-HIV coinfection (P = 0.019) were factors associated with therapeutic failure. The study results support the good efficacy of SMX-TMP. Attention should be given to PCM-HIV coinfection, emphasizing the concern of a higher risk of PCM therapeutic failure in these patients.
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Affiliation(s)
- Andreia F Nery
- Julio Müller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil
| | - Natasha P Crepaldi
- Julio Müller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil
| | | | - Tomoko Tadano
- Julio Müller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil
| | | | - Rosane Christine Hahn
- Research Laboratory, Faculty of Medicine, Federal University of Mato Grosso, Cuiaba, Brazil
| | - Valfredo M Menezes
- Julio Müller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil
| | - Cor Jesus F Fontes
- Julio Müller University Hospital, Federal University of Mato Grosso, Cuiaba, Brazil
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22
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Shikanai-Yasuda MA, Mendes RP, Colombo AL, Queiroz-Telles FD, Kono ASG, Paniago AMM, Nathan A, Valle ACFD, Bagagli E, Benard G, Ferreira MS, Teixeira MDM, Silva-Vergara ML, Pereira RM, Cavalcante RDS, Hahn R, Durlacher RR, Khoury Z, Camargo ZPD, Moretti ML, Martinez R. Brazilian guidelines for the clinical management of paracoccidioidomycosis. Rev Soc Bras Med Trop 2017; 50:715-740. [PMID: 28746570 DOI: 10.1590/0037-8682-0230-2017] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/30/2017] [Indexed: 01/30/2023] Open
Abstract
Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis ( P. brasiliensis ) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii ( P. lutzii ), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients' sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.
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Affiliation(s)
- Maria Aparecida Shikanai-Yasuda
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Rinaldo Pôncio Mendes
- Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Arnaldo Lopes Colombo
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP Brasil
| | | | - Adriana Satie Gonçalves Kono
- Divisão de Moléstias Infecciosas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Anamaria M M Paniago
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
| | - André Nathan
- Divisão de Pneumologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Eduardo Bagagli
- Departamento de Microbiologia e Imunologia, Instituto de Biociências, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Gil Benard
- Departamento de Dermatologia, Faculdade de Medicina,Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Simão Ferreira
- Serviço de Infectologia, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | | | - Mario León Silva-Vergara
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Triângulo Mineiro, Uberaba, MG. Brasil
| | - Ricardo Mendes Pereira
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Ricardo de Souza Cavalcante
- Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Rosane Hahn
- Núcleo de Doenças Infecciosas e Tropicais, Faculdade de Ciências Médicas, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil
| | | | - Zarifa Khoury
- Instituto de Infectologia Emílio Ribas, Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brasil
| | - Zoilo Pires de Camargo
- Departamento de Microbiologia e Imunologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Maria Luiza Moretti
- Departamento de Clínica Médica, Faculdade Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Roberto Martinez
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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23
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Radisic MV, Linares L, Afeltra J, Pujato N, Vitale RG, Bravo M, Dotta AC, Casadei DH. Acute pulmonary involvement by paracoccidiodomycosis disease immediately after kidney transplantation: Case report and literature review. Transpl Infect Dis 2017; 19. [PMID: 28039947 DOI: 10.1111/tid.12655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 09/18/2016] [Indexed: 11/26/2022]
Abstract
Paracoccidioides brasiliensis is the cause of paracoccidioidomycosis, one of the most important systemic mycoses in Latin America. Human disease has been observed in a limited geographic and ecological niche, and it is attributed to exposure to the fungus in soil. Most primary infections are subclinical, as the infection is contained by the host mainly through cell-mediated immune response. However, as the fungus has the ability to survive in a dormant state for long periods, an impairment of the immune response may lead to reactivation and clinical disease. Surprisingly, paracoccidioidomycosis has rarely been reported in transplanted patients. The aim of this communication is to report a case occurring in a kidney recipient in an acute clinical form immediately after transplantation, and to review the available information on previously reported cases.
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Affiliation(s)
- Marcelo V Radisic
- Infectious Diseases Department, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Laura Linares
- Infectious Diseases Department, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Javier Afeltra
- Parasitology Unit, Mycology (Unidad de Parasitologia Micología) Hospital JM Ramos Mejía, Buenos Aires, Argentina.,Microbiology Department (Departamento de Microbiología), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Natalia Pujato
- Infectious Diseases Department, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Roxana G Vitale
- Parasitology Unit, Mycology (Unidad de Parasitologia Micología) Hospital JM Ramos Mejía, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Martin Bravo
- Infectious Diseases Department, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Ana C Dotta
- Kidney Transplant Unit, Department of Transplantation, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Domingo H Casadei
- Kidney Transplant Unit, Department of Transplantation, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
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24
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Almeida OP, Jacks J, Scully C. Erratum: Paracoccidioidomycosis of the Mouth: an Emerging Deep Mycosis. ACTA ACUST UNITED AC 2016; 14:377-83. [PMID: 14530306 DOI: 10.1177/154411130301400508] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oral fungal infections (mycoses) have come into particular prominence since the advent of infection with Human Immunodeficiency Virus (HIV), and recognition of the Acquired Immune Deficiency Syndrome (AIDS), as well as the phenomenal increase in world travel with increased exposure to infections endemic in the tropics. Paracoccidioidomycosis is a rare mycosis worldwide but common in Brazil and some other areas in Latin America. It can be life-threatening and can manifest with a spectrum of clinical presentations, including frequent oral lesions. This paper reviews the more recent information on Paracoccidioidomycosis, emphasizing those areas most relevant in dental science.
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Affiliation(s)
- Oslei Paes Almeida
- Department of Oral Pathology, Dental School of Piracicaba-UNICAMP, Av. Limeira 901, CEP 13.414.903-CP 52, Piracicaba, SP, Brazil.
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25
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Almeida FAD, Neves FF, Mora DJ, Reis TAD, Sotini DM, Ribeiro BDM, Andrade-Silva LE, Nascentes GN, Ferreira-Paim K, Silva-Vergara ML. Paracoccidioidomycosis in Brazilian Patients With and Without Human Immunodeficiency Virus Infection. Am J Trop Med Hyg 2016; 96:368-372. [PMID: 27895278 DOI: 10.4269/ajtmh.16-0254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is endemic to Latin America, where 10 million people may be infected with Paracoccidioides brasiliensis/Paracoccidioides lutzii and 1,600,000 individuals live with human immunodeficiency virus (HIV) infection. An epidemiological overlapping of these infections occurred early in acquired immunodeficiency syndrome era with nearly 180 published cases. This study presents epidemiological, clinical, and outcome profiles for 31 PCM patients with HIV infection diagnosed in a teaching hospital in Brazil, and includes an update of previously reported cases. Medical records were reviewed and data compared with 64 PCM patients without HIV infection. Of the 31 PCM patients with HIV infection, 23 (74.1%) were male, with a median age of 36.7 years, whereas of the 64 PCM, 45 (70.3%) were male, with a median age of 35.1 years. Both groups presented similar proportions for smoking and alcoholism. PCM patients with HIV infection presented more fever, weight loss, and the acute clinical form than the PCM patients who had more mucosal and respiratory involvement characterizing the chronic form. Most PCM patients with HIV infection exhibited overlapping symptoms from both clinical forms with median symptom duration of 4.5 months compared with 8.3 months for the PCM control. Patients received sulfonamides and/or itraconazole for a median of 15.7 and 16.7 months for PCM/HIV-infected and PCM, respectively. Relapses occurred more in PCM (12 [30%]) than PCM/HIV-infected (4 [14.8%]) patients, whose mortality rate was higher (10 [32.8%]) than PCM patients (8 [20%]). The cases of PCM/HIV infection confirm that HIV can interact with some endemic diseases without increasing their frequency, while changing their natural history, clinical presentation, and outcome. The data presented here are in agreement with those observed in other studies.
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Affiliation(s)
- Fabrício Arantes de Almeida
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Fernando Freitas Neves
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Delio Jose Mora
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Tarcisio Albertin Dos Reis
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Diego Moelas Sotini
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Barbara De Melo Ribeiro
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | | | | | - Kennio Ferreira-Paim
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Mario León Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.
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Safe IP, Valle FFD, Maia DCC, Agonio B, Monte RL, Araújo JDR, Cordeiro-Santos M. Extra-pulmonary manifestations of paracoccidioidomycosis associated with acquired immunodeficiency syndrome: a case report. An Bras Dermatol 2014; 89:150-3. [PMID: 24626662 PMCID: PMC3938368 DOI: 10.1590/abd1806-4841.20142768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/24/2013] [Indexed: 11/22/2022] Open
Abstract
We present a patient with Paracoccidioidomycosis/HIV coinfection which has been
investigated because of chronic monoarthritis and mucocutaneous lesions. A biopsy of
the synovial membrane and skin revealed structures consistent with Paracoccidioides
brasiliensis. At diagnosis, the count of CD4 + T cells was 44 cells/mm3.
We emphasize the importance of clinical suspicion of Paracoccidioidomycosis in
patients with HIV/AIDS who live in or are from risk areas.
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Affiliation(s)
- Izabella Picinin Safe
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil, MD, Resident in Infectious Diseases at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Fabio Francesconi do Valle
- Universidade Federal do Amazonas, Manaus, Brazil, MD, Dermatologist. Assistant Professor at Universidade Federal do Amazonas. Supervisor of medical residency in Dermatology at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Daniela Cristina Caetano Maia
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil, MD, Resident in Dermatology at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Bárbara Agonio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil, MD, Resident in Dermatology at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Rossicléia Lins Monte
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil, Bacteriology Management at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - José de Ribamar Araújo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil, MD, Pathologist. Pathological Anatomy Management at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Marcelo Cordeiro-Santos
- Universidade do Estado do Amazonas, Manaus, Brazil, MD, PhD Infectious Diseases specialist. Adjunct Professor at Universidade do Estado do Amazonas. Supervisor of medical residency in Infectious Diseases at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, (FMT-HVD), Manaus, Brazil
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de Oliveira RB, Atobe JH, Souza SA, de Castro Lima Santos DW. Epidemiology of Invasive Fungal Infections in Patients with Acquired Immunodeficiency Syndrome at a Reference Hospital for Infectious Diseases in Brazil. Mycopathologia 2014; 178:71-8. [DOI: 10.1007/s11046-014-9755-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
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Moreno L, Figueredo M, Sadigursky M, Badaro R. A Man With Newly Diagnosed HIV/AIDS With Unusual Severe Opportunistic Infection and No AIDS-Defining Disease. Clin Infect Dis 2014. [DOI: 10.1093/cid/ciu147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fabris LR, Andrade ÚV, Ferreira Dos Santos A, Marques APDC, Oliveira SMDVLD, Mendes RP, Paniago AMM. Decreasing prevalence of the acute/subacute clinical form of paracoccidioidomycosis in Mato Grosso do Sul State, Brazil. Rev Inst Med Trop Sao Paulo 2014; 56:121-5. [PMID: 24626413 PMCID: PMC4085850 DOI: 10.1590/s0036-46652014000200006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 08/05/2013] [Indexed: 05/28/2023] Open
Abstract
With the objective to evaluate the behavior of paracoccidioidomycosis
in the last three decades, clinical and epidemiological data of 595 patients
admitted to clinical services of the Federal University of Mato Grosso do Sul
from 1980 to 2009 were investigated. Gender, age distribution, clinical form,
comorbidity with tuberculosis or AIDS, and mortality were compared by decades of
clinical admission. It was shown that during the three decades there was a
decrease in women percentage, and the same manner occurred a reduction in
participants in the age group of 20 to 39 years. Moreover, the acute/subacute
forms have been diminished in the period. These fluctuations are closely related
and can be simultaneously analyzed. Increased AIDS co-infection prevalence from
the first to the second decade was also revealed, coinciding with the appearance
of the retroviral epidemic and stabilizing during the third decade. No change in
the tuberculosis co-infection rate was observed (overall = 6.9%). It
reinforces the importance of this co-morbidity. The overall mortality rate
remained steady at 6.7%, not varying significantly from one decade to another.
The persistent mortality rate calls attention to the importance of this
neglected disease.
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Affiliation(s)
- Larissa Rodrigues Fabris
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo GrandeMS, Brazil, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. E-mails: , , , ,
| | - Úrsulla Vilella Andrade
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo GrandeMS, Brazil, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. E-mails: , , , ,
| | - Aline Ferreira Dos Santos
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo GrandeMS, Brazil, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. E-mails: , , , ,
| | - Ana Paula da Costa Marques
- Centro de Ciências Biológicas e da Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande (UFMS)MS, Brazil, Centro de Ciências Biológicas e da Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande (UFMS), MS, Brazil. E-mail:
| | - Sandra Maria do Valle Leone de Oliveira
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo GrandeMS, Brazil, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. E-mails: , , , ,
| | - Rinaldo Pôncio Mendes
- Faculdade de Medicina, Universidade Estadual Paulista (UNESP), BotucatuSP, Brazil, Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil. E-mail:
| | - Anamaria Mello Miranda Paniago
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo GrandeMS, Brazil, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil. E-mails: , , , ,
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Alencar Marques S, Petrechen L, Kakuda AC, V Chiossi MP, EA Marques M. Paracoccidioidomycosis and HIV coinfection presenting severe disease even with CD4+ cells in the normal range. Rev Iberoam Micol 2014; 31:154-5. [DOI: 10.1016/j.riam.2012.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/12/2012] [Accepted: 12/05/2012] [Indexed: 11/28/2022] Open
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Epidemiology, Clinical, and Therapeutic Aspects of Paracoccidioidomycosis. CURRENT TROPICAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40475-014-0013-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Central nervous system paracoccidioidomycosis in an AIDS patient: case report. Mycopathologia 2014; 177:137-41. [PMID: 24464241 DOI: 10.1007/s11046-014-9729-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/13/2014] [Indexed: 01/06/2023]
Abstract
Up to now, over 200 patients with paracoccidioidomycosis (PCM) associated to HIV infection have already been reported; however, the central nervous system involvement in this coinfection was rarely reported. This paper presents a 35-year-old Brazilian male AIDS patient who developed pulmonary PCM successfully treated with itraconazole. At the antiretroviral therapy starting, he had 32 CD4(+) T cells baseline count and high viral load levels. After 9 months, he presented severe fungal meningoencephalitis diagnosed by sublenticular enhanced nodular lesion at computerized tomography and magnetic resonance brain imaging and a positive Paracoccidiodes brasiliensis smear and culture from cerebrospinal fluid. At the time, a sixfold increase in CD4(+) T cell count and undetectable viral load level were evidenced. The patient received amphotericin B during 1 year presenting slow but progressive clinical improvement, and he is currently asymptomatic and without neurological disabilities. To our knowledge, this is the second case report of a patient with neuroparacoccidioidomycosis associated to HIV infection.
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Denis B, Lortholary O. [Pulmonary fungal infection in patients with AIDS]. Rev Mal Respir 2013; 30:682-95. [PMID: 24182654 DOI: 10.1016/j.rmr.2013.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 02/07/2013] [Indexed: 01/15/2023]
Abstract
Fungal infections are the most common opportunistic infections (OI) occurring during the course of HIV infection, though their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy (cART). Most cases occur in untreated patients, noncompliant patients or patients whose multiple antiretroviral regimens have failed and they are a good marker of the severity of cellular immunodepression. Pneumocystis jiroveci pneumonia is the second most frequent OI in France and cryptococcosis remains a major problem in the Southern Hemisphere. With the increase in travel, imported endemic fungal infection can occur and may mimic other infections, notably tuberculosis. Fungal infections often have a pulmonary presentation but an exhaustive search for dissemination should be made in patients infected with HIV, at least those at an advanced stage of immune deficiency. Introduction of cART in combination with anti-fungal treatment depends on the risk of AIDS progression and on the risk of cumulative toxicity and the immune reconstitution inflammatory syndrome (IRIS) if introduced too early. Fungal infections in HIV infected patients remain a problem in the cART era. IRIS can complicate the management and requires an optimised treatment regime.
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Affiliation(s)
- B Denis
- Service des maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur, université Paris Descartes, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
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Abstract
Infectious and noninfectious skin diseases are observed in about 90% of HIV patients, and their incidence increases and is more severe as the immune system weakens. Cutaneous manifestations are considered good clinical predictors for the immunological condition of the patient with AIDS and the introduction of highly effective antiretroviral therapy totally changed the prognosis of the mycoses, among other diseases associated with AIDS, permitting longer survival and acceptable level of quality of life for these patients. This contribution describes the systemic mycoses that are more frequent in the seropositive population, that is, patients with HIV/AIDS, which are cryptococcosis, histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, sporotrichosis, penicilliosis, and aspergillosis. Their causative agents, mode of transmission, clinics, laboratorial diagnosis and therapy, in the aspects related to immunodepressed patients, are reviewed.
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Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL, Souza AS, Rodrigues RS. Thoracic paracoccidioidomycosis: radiographic and CT findings. Radiographics 2012; 32:71-84. [PMID: 22236894 DOI: 10.1148/rg.321115052] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Paracoccidioidomycosis (PCM) is the most common systemic mycosis in Latin America. Although most cases occur in developing countries, recent immigration patterns and an increase in travel have led to a growing number of PCM cases in the United States and Europe. PCM is caused by the dimorphic fungus Paracoccidioides brasiliensis, and the chronic form may progress to severe pulmonary involvement. Several radiologic patterns have been described for pulmonary PCM, including linear and reticular opacities, variable-sized nodules, patchy ill-defined opacities, airspace consolidation, and cavitary lesions. Fibrosis and paracicatricial emphysema are common associated findings. Chest computed tomography (CT) is the method of choice for evaluating pulmonary PCM, with the most common CT findings being ground-glass attenuation, consolidation, small or large nodules, masses, cavitations, interlobular septal thickening, emphysema, and fibrotic lesions. PCM is also an important cause of the "reversed halo" sign at high-resolution CT and should be considered in the differential diagnosis. Awareness of the multiple radiologic manifestations of PCM as well as its epidemiologic and clinical characteristics may permit early diagnosis and initiation of specific treatment, thereby reducing associated morbidity and mortality.
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Affiliation(s)
- Miriam M Barreto
- Department of Radiology, Federal University of Rio de Janeiro, Rúa Thomaz Cameron 438, Valparaiso CEP 25685.120, Petrópolis, Rio de Janeiro, Brazil
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36
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Co-infection of HIV and tropical infectious agents that affect the nervous system. Rev Neurol (Paris) 2012; 168:270-82. [PMID: 22405463 DOI: 10.1016/j.neurol.2012.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/03/2012] [Indexed: 11/22/2022]
Abstract
Tropical infections refer to a group of diseases usually located in regions with a warm climate, particularly affecting developing countries, partly because of the conditions that allow them to thrive. However, due to the increased international travel, infectious agents that were previously limited to tropical regions pose an increasing threat to populations at risk for opportunistic infection (OI), especially those infected with the HIV. Tropical infections can facilitate HIV transmission and accelerate the progression of asymptomatic HIV infection to AIDS. Some have the potential to alter the epidemiology, natural history, and/or response to treatment of the other. The introduction of highly active antiretroviral therapy has provided a huge benefit for the vast majority of patients infected with the HIV, by allowing the immune system to recover, improving the clinical and radiological results and reducing the number of OI. On the other hand, some patients have developed various disorders of immune reconstitution, resulting in either hyper-immune inflammatory response to an exogenous antigen or autoimmunity. A significant proportion of these cases have been reported in immigrants from tropical countries to high-income countries, therefore awareness of these phenomena is needed since clinical presentations are often atypical and pose diagnostic challenges. This article reviews some of the key diagnostic aspects of tropical infections associated with HIV infection.
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37
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Nogueira LMC, Santos M, Ferreira LCDL, Talhari C, Rodrigues RR, Talhari S. AIDS-associated paracoccidioidomycosis in a patient with a CD4+ T-cell count of 4 cells/mm³. An Bras Dermatol 2012; 86:S129-32. [PMID: 22068792 DOI: 10.1590/s0365-05962011000700034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 12/14/2010] [Indexed: 11/21/2022] Open
Abstract
We describe a case of a patient presenting with HIV and paracoccidioidomycosis co-infection. At the time of diagnosis total CD4+ T-cell count was 4 cells/mm3. Histopathology revealed tuberculoid granulomas, scarce CD4+ T cells, a moderate number of CD8+ cells and the absence of Foxp3+ cells. Most of the cutaneous lesions healed after two weeks of treatment with amphotericin B. After 14 months the patient is still under antiretroviral therapy and no clinical evidence of recurrence of the mycosis has been observed.
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Expanding the clinical and genetic spectrum of human CD40L deficiency: the occurrence of paracoccidioidomycosis and other unusual infections in Brazilian patients. J Clin Immunol 2011; 32:212-20. [PMID: 22193914 DOI: 10.1007/s10875-011-9623-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
CD40 ligand (CD40L) deficiency or X-linked hyper-IgM syndrome (X-HIGM) is a well-described primary immunodeficiency in which Pneumocystis jiroveci pneumonia is a common clinical feature. We have identified an unusual high incidence of fungal infections and other not yet described infections in a cohort of 11 X-HIGM patients from nine unrelated Brazilian families. Among these, we describe the first case of paracoccidioidomycosis (PCM) in X-HIGM. The molecular genetic analysis of CD40L was performed by gene sequencing and evaluation of CD40L protein expression. Nine of these 11 patients (82%) had fungal infections. These included fungal species common to CD40L deficiency (P. jiroveci and Candida albicans) as well as Paracoccidioides brasiliensis. One patient presented with PCM at age 11 years and is now doing well at 18 years of age. Additionally, one patient presented with a simultaneous infection with Klebsiella and Acinetobacter, and one with condyloma caused by human papilloma virus. Molecular analysis revealed four previously described CD40L mutations, two novel missense mutations (c.433 T > G and c.476 G > C) resulting in the absence of CD40L protein expression by activated CD4(+) cells and one novel insertion (c.484_485insAA) within the TNFH domain leading to a frame shift and premature stop codon. These observations demonstrated that the susceptibility to fungal infections in X-HIGM extends beyond those typically associated with X-HIGM (P. jiroveci and C. albicans) and that these patients need to be monitored for those pathogens.
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Benard G, Patzina RL, Schwab JB, Gabriel TC, Ho YL. Fatal septic shock due to a disseminated chronic form of paracoccidioidomycosis in an aged woman. Med Mycol 2011; 50:407-11. [PMID: 22103342 DOI: 10.3109/13693786.2011.630685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Once rare, septic shock (SS) due to disseminated fungal infections has been increasingly reported due to a growing number of immunocompromised patients, but remains rare in non-immune-compromised individuals. In paracoccidioidomycosis, it has been described in only three patients with the severe, acute form of the disease. We describe the development of a refractory, fatal septic shock due to a severe disseminated chronic form of paracoccidioidomycosis in an older woman without any other microbial insults. A striking event in the evolution of her case was the severe depletion of lymphocytes from the peripheral blood and lymphoid organs. Lymphocyte depletion due to apoptosis is described in the late phase of sepsis and can contribute both to immunosuppression and the progression of SS. The possible mechanisms involved in the induction of SS in the chronic form of paracoccidioidomycosis are discussed.
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Affiliation(s)
- Gil Benard
- Laboratory of Dermatology and immunodeficiencies (LIM-56), Dermatology Division of the Hospital das Clínicas, Medical School and Laboratory of Medical Mycology (LIM-53), Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil.
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Sarti ECFB, de Oliveira SMDVL, dos Santos LF, de Camargo ZP, Paniago AMM. Paracoccidioidal Infection in HIV Patients at an Endemic Area of Paracoccidioidomycosis in Brazil. Mycopathologia 2011; 173:145-9. [DOI: 10.1007/s11046-011-9495-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 10/21/2011] [Indexed: 11/30/2022]
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Teles F, Martins M. Laboratorial diagnosis of paracoccidioidomycosis and new insights for the future of fungal diagnosis. Talanta 2011; 85:2254-64. [DOI: 10.1016/j.talanta.2011.07.099] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/21/2011] [Accepted: 07/29/2011] [Indexed: 11/30/2022]
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Bellissimo-Rodrigues F, Vitali LH, Martinez R. Serological diagnosis of paracoccidioidomycosis in HIV-coinfected patients. Mem Inst Oswaldo Cruz 2011; 105:904-7. [PMID: 21120361 DOI: 10.1590/s0074-02762010000700011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 07/27/2010] [Indexed: 11/22/2022] Open
Abstract
Paracoccidioidomycosis should be differentiated from other opportunistic diseases in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients who live in Latin America. Laboratory investigation can begin with serological tests, which are rapid and efficient. In the present study, double immunodiffusion (DID), counterimmunoelectrophoresis (CIEP) and an enzyme linked immunosorbent assay (ELISA) tests were assessed for the detection of anti-Paracoccidioides brasiliensis antibodies in 40 patients coinfected with HIV. The results were compared to those obtained for 75 non-HIV-infected patients with endemic paracoccidioidomycosis. Anti-P. brasiliensis antibodies were detected in 65% (DID), 79% (CIEP) and 95% (ELISA) of the patients with HIV/AIDS, significantly lower rates than those detected in cases of endemic paracoccidioidomycosis, which were 89%, 99% and 100%, respectively. The reactive sera of HIV-infected patients also showed lower anti-P. brasiliensis antibody titres than those of non-HIV-infected patients. Despite the lower intensity of the specific humoral response, serological tests are useful for the diagnosis of opportunistic paracoccidioidomycosis in the HIV/AIDS population. We suggest optimization of the laboratory diagnosis by combining the ELISA test with CIEP or DID.
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Affiliation(s)
- Fernando Bellissimo-Rodrigues
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Karp CL, Mahanty S. Approach to the Patient with HIV and Coinfecting Tropical Infectious Diseases. TROPICAL INFECTIOUS DISEASES: PRINCIPLES, PATHOGENS AND PRACTICE 2011. [PMCID: PMC7150329 DOI: 10.1016/b978-0-7020-3935-5.00139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marques SA, Camargo RMP, Abbade LPF, Fortaleza CMCB, Marques MEA. Paracoccidioidomycosis: an unusual presentation in a young girl disclosing an unnoted HIV-infection. Med Mycol 2010; 48:182-7. [PMID: 19384752 DOI: 10.3109/13693780902893405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The association of paracoccidioidomycosis with AIDS is apparently less frequent than expected. The authors present an unusual case of paracoccidioidomycosis in a 13-year-old female student which was later found to be the first opportunistic infection in the course of the patient's HIV-infection. The clinical presentation followed an accidental incised wound on the palmar region initially described as a 'sporotrichotic-chancre'. After good response under sulfamethoxazole-trimethoprin, the patient relapsed and presented an associated oral candidiasis. HIV-infection was documented and additional investigation showed CD4(+) T-cells=22/mm(3), CD8(+)=280 cell/mm(3) and viral load=4,043 log. This case report presents an uncommon dermatological-clinical picture in the youngest patient in which such association has been reported to date.
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Affiliation(s)
- Silvio Alencar Marques
- Departamento de Dermatologia e Radioterapia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, Brazil.
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de Freitas RS, Dantas KC, Garcia RSP, Magri MMC, de Andrade HF. Paracoccidioides brasiliensis causing a rib lesion in an adult AIDS patient. Hum Pathol 2010; 41:1350-4. [DOI: 10.1016/j.humpath.2010.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 01/26/2010] [Accepted: 03/10/2010] [Indexed: 11/26/2022]
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Brunaldi MO, Rezende REF, Zucoloto S, Garcia SB, Módena JLP, Machado AA. Co-infection with paracoccidioidomycosis and human immunodeficiency virus: report of a case with esophageal involvement. Am J Trop Med Hyg 2010; 82:1099-101. [PMID: 20519606 DOI: 10.4269/ajtmh.2010.09-0751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Paracoccidioiodomycosis (PCM) is a systemic and deep mycosis endemic in Latin America, especially in Brazil. In patients infected with human immunodeficiency virus (HIV), PCM can manifest with prominent involvement of the reticuloendothelial system. There are no reports in the literature of esophageal involvement by PCM in that population. We report a case of PCM with pulmonary and esophageal involvement without radiologic evidence of an esophageal-bronchial fistula in an HIV-infected patient.
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Affiliation(s)
- Mariângela O Brunaldi
- Department of Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
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Alves CC, Azevedo AL, Rodrigues MF, Machado RP, Souza MA, Machado MA, Teixeira HC, Ferreira AP. Cellular and humoral immune responses during intrathoracic paracoccidioidomycosis in BALB/c mice. Comp Immunol Microbiol Infect Dis 2009; 32:513-25. [DOI: 10.1016/j.cimid.2008.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2008] [Indexed: 10/21/2022]
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Abstract
Paracoccidioidomycosis is the most prevalent systemic mycosis in Latin America. It is becoming globally relevant, as increasing numbers of cases have been detected in returning travellers and immigrants from endemic regions. It is characterized by pulmonary involvement, lymphadenopathy, and chronic progression of mucocutaneous lesions. Untreated, systemic disease can be severe and fatal. Skin features are common and characteristic, enabling the dermatologist to diagnose infection early and prevent the development of serious sequelae. This review outlines the clinical features and management of paracoccidioidomycosis and discusses notable recent developments in molecular diagnosis, prognostics and therapies.
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Affiliation(s)
- M Ameen
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Trust, London SE1 7EH, UK.
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Transplantation and tropical infectious diseases. Int J Infect Dis 2009; 14:e189-96. [PMID: 19647464 DOI: 10.1016/j.ijid.2009.04.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 04/03/2009] [Accepted: 04/14/2009] [Indexed: 02/08/2023] Open
Abstract
The number of transplant recipients with tropical infectious diseases is growing due to increasing international travel and the rising number of transplants taking place in the tropics and subtropics. With increases in population migration, the prevalence of individuals infected with geographically restricted organisms also rises. There are three potential categories of tropical infections in transplant patients: (1) donor-related infections transmitted by the graft or through transfusion of blood products; (2) reactivation or recrudescence of latent infections in the donor recipient; and (3) de novo acquisition of infection in the post-transplant period through the traditional route of infection. We present an overall discussion of the association of parasitic (protozoa and helminths) and non-parasitic (viral, bacterial, and fungal) tropical infectious diseases and solid-organ and hematopoietic transplantation. We also suggest potential screening guidelines for some of these tropical infections.
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