1
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Franco PDA, Araújo Neto CAD, da Silva SRL, Coelho Filho JC, Brites C, Pereira-Silva JL. Autochtonal case of chronic, unifocal, pulmonary paracoccidioidomycosis with methotrexate use, in Salvador ‒ Brazil. Braz J Infect Dis 2024; 28:103768. [PMID: 38851212 PMCID: PMC11224999 DOI: 10.1016/j.bjid.2024.103768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/15/2024] [Accepted: 05/19/2024] [Indexed: 06/10/2024] Open
Abstract
We report an autochthonous case of mild unifocal chronic pulmonary paracoccidioidomycosis in a 48-year-old previously healthy woman with no history of possible environmental exposures in endemic rural areas, supposedly resulting from reactivation of a latent pulmonary focus secondary to the use of methotrexate for the control of Chikungunya arthropathy. Laboratory investigation ruled out other immunosuppression. Her only symptoms were a dry cough and chest pain. Diagnosis confirmed by needle lung biopsy. There were no abnormalities on physical examination nor evidence of central nervous system involvement. MRI of the total abdomen showed no involvement of other organs. Computed chest tomography showed a favorable evolution under the use of itraconazole (200 mg/day). Different tomographic presentations findings are highlighted when performed before and after treatment. CONCLUSIONS: PCM should be considered even in a woman without a history of consistent environmental exposure and in a non-endemic geographic area.
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Affiliation(s)
| | | | | | | | - Carlos Brites
- Universidade Federal da Bahia, Departamento de Medicina, Salvador, BA, Brazil.
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2
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Laux K, Teixeira MDM, Barker B. Love in the time of climate change: A review of sexual reproduction in the order Onygenales. Fungal Genet Biol 2023; 167:103797. [PMID: 37100376 DOI: 10.1016/j.fgb.2023.103797] [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: 09/10/2022] [Revised: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
Life-threatening infections caused by fungi in the order Onygenales have been rising over the last few decades. Increasing global temperature due to anthropogenic climate change is one potential abiotic selection pressure that may explain the increase in infections. The generation of genetically novel offspring with novel phenotypes through the process of sexual recombination could allow fungi to adapt to changing climate conditions. The basic structures associated with sexual reproduction have been identified in Histoplasma, Blastomyces, Malbranchea, and Brunneospora. However, for Coccidioides and Paracoccidioides, the actual structural identification of these processes has yet to be identified despite having genetic evidence that suggests sexual recombination is occurring in these organisms. This review highlights the importance of assessing sexual recombination in the order Onygenales as a means of understanding the mechanisms these organisms might employ to enhance fitness in the face of a changing climate and provides details regarding the known reproductive mechanisms in the Onygenales.
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Affiliation(s)
- Klaire Laux
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr., Bldg 56 Ste 210, Flagstaff, AZ 86011, USA.
| | - Marcus de Melo Teixeira
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr., Bldg 56 Ste 210, Flagstaff, AZ 86011, USA; Nùcleo de Medicina Tropical, University of Brasilia, Universitário Darcy Ribeiro, s/n -Asa Norte, Brasília, DF 70910-900, Brazil
| | - Bridget Barker
- The Pathogen and Microbiome Institute, Northern Arizona University, 1395 S Knoles Dr., Bldg 56 Ste 210, Flagstaff, AZ 86011, USA.
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3
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Peçanha-Pietrobom PM, Tirado-Sánchez A, Gonçalves SS, Bonifaz A, Colombo AL. Diagnosis and Treatment of Pulmonary Coccidioidomycosis and Paracoccidioidomycosis. J Fungi (Basel) 2023; 9:218. [PMID: 36836333 PMCID: PMC9959547 DOI: 10.3390/jof9020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Coccidioidomycosis (CM) and paracoccidioidomycosis (PCM) are systemic mycoses that are highly endemic in Latin America and have recently been included on the World Health Organization (WHO) Fungal Priority Pathogens List. Coccidioides immitis and Coccidioides posadasii are recognized as etiological agents of CM, with peculiarities in their geographic distribution. The genus Paracoccidioides now includes Paracoccidioides lutzii and the Paracoccidioides brasiliensis complex, which encompasses four phylogenetic species. In both diseases, pulmonary signs and symptoms are the main reasons for patients to seek medical assistance, and they are frequently misdiagnosed as tuberculosis. In this paper, we present a critical view of the strategies for diagnosis and clinical management of CM and PCM. Over the past few decades, there has been an increase in the number of reports of endemic fungal infections in areas previously thought to be "non-endemic" due to climate change and increased travel, among other factors. Learning to recognize their main epidemiological aspects and clinical manifestations is crucial so that clinicians can include them in the differential diagnosis of lung disease and avoid late diagnosis.
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Affiliation(s)
| | - Andrés Tirado-Sánchez
- Dermatology Service & Mycology Department, Hospital General de México, “Dr. Eduardo Liceaga”, Mexico City 06726, Mexico
- Internal Medicine Department, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Mexico City 07950, Mexico
| | - Sarah Santos Gonçalves
- Department of Pathology, Infectious Diseases Postgraduate Program, Federal University of Espírito Santo (UFES), Vitoria 29043900, Brazil
| | - Alexandro Bonifaz
- Internal Medicine Department, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Mexico City 07950, Mexico
| | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo 04039032, Brazil
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4
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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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5
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Sousa C, Marchiori E, Youssef A, Mohammed TL, Patel P, Irion K, Pasini R, Mançano A, Souza A, Pasqualotto AC, Hochhegger B. Chest Imaging in Systemic Endemic Mycoses. J Fungi (Basel) 2022; 8:1132. [PMID: 36354899 PMCID: PMC9692403 DOI: 10.3390/jof8111132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 09/20/2023] Open
Abstract
Endemic fungal infections are responsible for high rates of morbidity and mortality in certain regions of the world. The diagnosis and management remain a challenge, and the reason could be explained by the lack of disease awareness, variability of symptoms, and insidious and often overlooked clinical presentation. Imaging findings are nonspecific and frequently misinterpreted as other more common infectious or malignant diseases. Patient demographics and clinical and travel history are important clues that may lead to a proper diagnosis. The purpose of this paper is to review the presentation and differential diagnosis of endemic mycoses based on the most common chest imaging findings.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Edson Marchiori
- Radiology Department, Universidade Federal de Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Ali Youssef
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Tan-Lucien Mohammed
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Pratik Patel
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Klaus Irion
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Romulo Pasini
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Alexandre Mançano
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Arthur Souza
- Radiology Department, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090-000, Brazil
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
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6
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Paracoccidioidomycosis: What We Know and What Is New in Epidemiology, Diagnosis, and Treatment. J Fungi (Basel) 2022; 8:jof8101098. [PMID: 36294662 PMCID: PMC9605487 DOI: 10.3390/jof8101098] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America caused by thermodimorphic fungi of the genus Paracoccidioides. In the last two decades, enhanced understanding of the phylogenetic species concept and molecular variations has led to changes in this genus’ taxonomic classification. Although the impact of the new species on clinical presentation and treatment remains unclear, they can influence diagnosis when serological methods are employed. Further, although the infection is usually acquired in rural areas, the symptoms may manifest years or decades later when the patient might be living in the city or even in another country outside the endemic region. Brazil accounts for 80% of PCM cases worldwide, and its incidence is rising in the northern part of the country (Amazon region), owing to new settlements and deforestation, whereas it is decreasing in the south, owing to agriculture mechanization and urbanization. Clusters of the acute/subacute form are also emerging in areas with major human intervention and climate change. Advances in diagnostic methods (molecular and immunological techniques and biomarkers) remain scarce, and even the reference center’s diagnostics are based mainly on direct microscopic examination. Classical imaging findings in the lungs include interstitial bilateral infiltrates, and eventually, enlargement or calcification of adrenals and intraparenchymal central nervous system lesions are also present. Besides itraconazole, cotrimoxazole, and amphotericin B, new azoles may be an alternative when the previous ones are not tolerated, although few studies have investigated their use in treating PCM.
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7
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Ribeiro SM, Nunes TF, Cavalcante RDS, Paniago AMM, Pereira BAS, Mendes RP. A scoping study of pulmonary paracoccidioidomycosis: severity classification based on radiographic and tomographic evaluation. J Venom Anim Toxins Incl Trop Dis 2022; 28:e20220053. [DOI: 10.1590/1678-9199-jvatitd-2022-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022] Open
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8
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Proteomic analysis of serum samples of paracoccidioidomycosis patients with severe pulmonary sequel. PLoS Negl Trop Dis 2021; 15:e0009714. [PMID: 34424905 PMCID: PMC8425554 DOI: 10.1371/journal.pntd.0009714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/08/2021] [Accepted: 08/06/2021] [Indexed: 12/26/2022] Open
Abstract
Background Pulmonary sequelae (PS) in patients with chronic paracoccidioidomycosis (PCM) typically include pulmonary fibrosis and emphysema. Knowledge of the molecular pathways involved in PS of PCM is required for treatment and biomarker identification. Methodology/Principal findings This non-concurrent cohort study included 29 patients with pulmonary PCM that were followed before and after treatment. From this group, 17 patients evolved to mild/ moderate PS and 12 evolved severe PS. Sera from patients were evaluated before treatment and at clinical cure, serological cure, and apparent cure. A nanoACQUITY UPLC-Xevo QT MS system and PLGS software were used to identify serum differentially expressed proteins, data are available via ProteomeXchange with identifier PXD026906. Serum differentially expressed proteins were then categorized using Cytoscape software and the Reactome pathway database. Seventy-two differentially expressed serum proteins were identified in patients with severe PS compared with patients with mild/moderate PS. Most proteins altered in severe PS were involved in wound healing, inflammatory response, and oxygen transport pathways. Before treatment and at clinical cure, signaling proteins participating in wound healing, complement cascade, cholesterol transport and retinoid metabolism pathways were downregulated in patients with severe PS, whereas signaling proteins in gluconeogenesis and gas exchange pathways were upregulated. At serological cure, the pattern of protein expression reversed. At apparent cure pathways related with tissue repair (fibrosis) became downregulated, and pathway related oxygen transport became upregulated. Additionally, we identified 15 proteins as candidate biomarkers for severe PS. Conclusions/Significance Development of severe PS is related to increased expression of proteins involved in glycolytic pathway and oxygen exchange), indicative of the greater cellular activity and replication associated with early dysregulation of wound healing and aberrant tissue repair. Our findings provide new targets to study mechanisms of PS in PCM, as well as potential biomarkers. Pulmonary fibrosis is the main sequel of paracoccidioidomycosis (PCM), a fungal disease that affects mainly men, rural workers. The development of pulmonary fibrosis is complex and involves several mechanisms that culminate in aberrant collagen production and deposition in the lungs making it became stiff and blocking the air passages. These changes lead to difficulty in breathing and in PCM patients dyspnea in response to high or low levels of exertion is common. Therefore, these patients show incapacity to work and the decreased quality of life. With the possibility of identifying some marker, for example, it could help the indication of respiratory physiotherapy, professional rehabilitation, or therapeutic intervention. This is the first study to examine the pulmonary sequelae (PS) in patients with paracoccidioidomycosis using an approach combining proteomics with bioinformatics. Here, we identify the specific proteome pattern found in PCM patients with severe sequelae that distinguishes these patients from that with mild/moderate sequelae. Our results showed that time points immediately before treatment and at clinical cure are key moments at which PS can progress to severe PS due a dysregulation in wound healing with consequent delayed in the healing processes resulting in an aberrant scar. As such, we suggest that the prognoses for severe PS should be considered as soon as possible and as early as diagnosis of PCM. Furthermore, we used proteomics to identify possible serum biomarkers with which to predict the likely development of severe PS, to be validated in future studies.
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9
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de Araújo MV, Santos Júnior SRD, Nosanchuk JD, Taborda CP. Therapeutic Vaccination with Cationic Liposomes Formulated with Dioctadecyldimethylammonium and Trehalose Dibehenate (CAF01) and Peptide P10 Is Protective in Mice Infected with Paracoccidioides brasiliensis. J Fungi (Basel) 2020; 6:jof6040347. [PMID: 33302372 PMCID: PMC7762540 DOI: 10.3390/jof6040347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023] Open
Abstract
The peptide P10 is a vaccine candidate for Paracoccidioidomycosis, a systemic mycosis caused by fungal species of the genus Paracoccidioides spp. We have previously shown that peptide P10 vaccination, in the presence of several different adjuvants, induced a protective cellular immune response mediated by CD4+ Th1 lymphocytes that was associated with the increased production of IFN-γ in mice challenged with a virulent isolate of Paracoccidoides brasiliensis. Cationic liposomes formulated with dioctadecyldimethylammonium and trehalose dibehenate (DDA/TDB, termed also CAF01–cationic adjuvant formulation) have been developed for safe administration in humans and CAF01 liposomes are utilized as an adjuvant for modulating a robust Th1/Th17 cellular response. We evaluated the efficacy of the adsorption of peptide P10 to CAF01 cationic liposomes and used the generated liposomes to vaccinate C57Bl/6 mice infected with P. brasiliensis. Our results showed that P10 was efficiently adsorbed onto CAF01 liposomes. The vaccination of infected mice with cationic liposomes formulated with DDA/TDB 250/50 µg/mL and 20 µg of P10 induced an effective cellular immune response with increased levels of Th17 cytokines, which correlated with significant decreases in the fungal burdens in lungs and protective granulomatous tissue responses. Hence, cationic liposomes of DDA/TDB 250/50 µg/mL with 20 µg of P10 are a promising therapeutic for safely and effectively improving the treatment of paracoccidioidomycosis.
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Affiliation(s)
- Marcelo Valdemir de Araújo
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo 05508-000, Brazil; (M.V.d.A.); (S.R.D.S.J.)
| | - Samuel Rodrigues Dos Santos Júnior
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo 05508-000, Brazil; (M.V.d.A.); (S.R.D.S.J.)
| | - Joshua D. Nosanchuk
- Departments of Medicine (Division of Infectious Disease), Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA;
| | - Carlos Pelleschi Taborda
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo 05508-000, Brazil; (M.V.d.A.); (S.R.D.S.J.)
- Departamento de Dermatologia, Instituto de Medicina Tropical de São Paulo—LIM53, Faculdade de Medicina, Universidade de São Paulo, São Paulo 4023-062, Brazil
- Correspondence: ; Tel.: +55-11-3091-7351
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10
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Almeida Donanzam DDF, Donato TAG, Dos Reis KH, da Silva AP, Finato AC, Dos Santos AR, Cavalcante RS, Mendes RP, Venturini J. Exoantigens of Paracoccidioides spp. Promote Proliferation and Modulation of Human and Mouse Pulmonary Fibroblasts. Front Cell Infect Microbiol 2020; 10:590025. [PMID: 33194837 PMCID: PMC7662685 DOI: 10.3389/fcimb.2020.590025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic granulomatous fungal infection caused by thermally dimorphic fungi of the genus Paracoccidioides. Endemic in Latin America, PCM presents with high incidence in Brazil, Colombia, and Venezuela, especially among rural workers. The main clinical types are acute/subacute (AF) form and chronic form (CF). Even after effective antifungal treatment, patients with CF usually present sequelae, such as pulmonary fibrosis. In general, pulmonary fibrosis is associated with dysregulation wound healing and abnormal fibroblast activation. Although fibrogenesis is recognized as an early process in PCM, its mechanisms remain unknown. In the current study, we addressed the role of Paracoccidioides spp. exoantigens in pulmonary fibroblast proliferation and responsiveness. Human pulmonary fibroblasts (MRC-5) and pulmonary fibroblasts isolated from BALB/c mice were cultivated with 2.5, 5, 10, 100, and 250 µg/ml of exoantigens produced from P. brasiliensis (Pb18 and Pb326) and P. lutzii (Pb01, Pb8334, and Pb66) isolates. Purified gp43, the immunodominant protein of P. brasiliensis exoantigens, was also evaluated at concentrations of 5 and 10 µg/ml. After 24 h, proliferation and production of cytokines and growth factors by pulmonary fibroblasts were evaluated. Each exoantigen concentration promoted a different level of interference of the pulmonary fibroblasts. In general, exoantigens induced significant proliferation of both murine and human pulmonary fibroblasts (p < 0.05). All concentrations of exoantigens promoted decreased levels of IL-6 (p < 0.05) and VEGF (p < 0.05) in murine fibroblasts. Interestingly, decreased levels of bFGF (p < 0.05) and increased levels of TGF-β1 (p < 0.05) and pro-collagen I (p < 0.05) were observed in human fibroblasts. The gp43 protein induced increased TGF-β1 production by human cells (p = 0.02). In conclusion, our findings showed for the first time that components of P. brasiliensis and P. lutzii interfered in fibrogenesis by directly acting on the biology of pulmonary fibroblasts.
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Affiliation(s)
- Débora de Fátima Almeida Donanzam
- Faculdade de Medicina, Universidade Federal do Mato Grosso do Sul, Campo Grande, Brazil.,Faculdade de Medicina, Departamento de Doenças Tropicais e Diagnóstico por Imagem, UNESP, Botucatu, Brazil
| | | | - Karoline Haghata Dos Reis
- Faculdade de Medicina, Departamento de Doenças Tropicais e Diagnóstico por Imagem, UNESP, Botucatu, Brazil
| | - Adriely Primo da Silva
- Faculdade de Medicina, Departamento de Doenças Tropicais e Diagnóstico por Imagem, UNESP, Botucatu, Brazil
| | - Angela Carolina Finato
- Faculdade de Medicina, Departamento de Doenças Tropicais e Diagnóstico por Imagem, UNESP, Botucatu, Brazil
| | - Amanda Ribeiro Dos Santos
- Faculdade de Medicina, Universidade Federal do Mato Grosso do Sul, Campo Grande, Brazil.,Faculdade de Medicina, Departamento de Doenças Tropicais e Diagnóstico por Imagem, UNESP, Botucatu, Brazil
| | - Ricardo Souza Cavalcante
- Faculdade de Medicina, Departamento de Doenças Tropicais e Diagnóstico por Imagem, UNESP, Botucatu, Brazil
| | - Rinaldo Poncio Mendes
- Faculdade de Medicina, Universidade Federal do Mato Grosso do Sul, Campo Grande, Brazil.,Faculdade de Medicina, Departamento de Doenças Tropicais e Diagnóstico por Imagem, UNESP, Botucatu, Brazil
| | - James Venturini
- Faculdade de Medicina, Universidade Federal do Mato Grosso do Sul, Campo Grande, Brazil.,Faculdade de Medicina, Departamento de Doenças Tropicais e Diagnóstico por Imagem, UNESP, Botucatu, Brazil
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11
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The Therapy of Pulmonary Fibrosis in Paracoccidioidomycosis: What Are the New Experimental Approaches? J Fungi (Basel) 2020; 6:jof6040217. [PMID: 33050568 PMCID: PMC7712212 DOI: 10.3390/jof6040217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Pulmonary fibrosis (PF) is considered the most important sequela developed in patients suffering from the chronic form of paracoccidioidomycosis (PCM), which leads to the loss of respiratory function in 50% of cases; this residual pulmonary abnormality is present even after antifungal treatment. To date, there is no effective treatment for PF. However, the use of antifungal drugs in combination with other antibiotics or immunomodulatory compounds, as well as biological therapies that include a monoclonal antibody specific to neutrophils, or prophylactic vaccination employing a recombinant antigen of Paracoccidioides brasiliensis that successfully attenuated PF, has been reported. Additionally, mesenchymal stem cell transplantation in combination with antifungal therapy slightly reduced the inflammatory response and profibrotic molecules induced by P. brasiliensis infection. In this review, I report experimental findings from several studies aiming to identify promising therapeutic strategies for treating PF developed in PCM.
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12
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Finato AC, Almeida DF, Dos Santos AR, Nascimento DC, Cavalcante RS, Mendes RP, Soares CT, Paniago AMM, Venturini J. Evaluation of antifibrotic and antifungal combined therapies in experimental pulmonary paracoccidioidomycosis. Med Mycol 2020; 58:667-678. [PMID: 31578565 DOI: 10.1093/mmy/myz100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/27/2019] [Accepted: 09/11/2019] [Indexed: 01/04/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the Paracoccidioides genus. Most of the patients with chronic form present sequelae, like pulmonary fibrosis, with no effective treatment, leading to impaired lung functions. In the present study, we aimed to investigate the antifibrotic activity of three compounds: pentoxifylline (PTX), azithromycin (AZT), and thalidomide (Thal) in a murine model of pulmonary PCM treated with itraconazole (ITC) or cotrimoxazole (CMX). BALB/c mice were inoculated with P. brasiliensis (Pb) by the intratracheal route and after 8 weeks, they were submitted to one of the following six treatments: PTX/ITC, PTX/CMX, AZT/ITC, AZT/CMX, Thal/ITC, and Thal/CMX. After 8 weeks of treatment, the lungs were collected for determination of fungal burden, production of OH-proline, deposition of reticulin fibers, and pulmonary concentrations of cytokines and growth factors. Pb-infected mice treated with PTX/ITC presented a reduction in the pulmonary concentrations of OH-proline, associated with lower concentrations of interleukin (IL)-6, IL-17, and transforming growth factor (TGF)-β1 and higher concentrations of IL-10 compared to the controls. The Pb-infected mice treated with AZT/CMX exhibited decreased pulmonary concentrations of OH-proline associated with lower levels of TGF-β1, and higher levels of IL-10 compared controls. The mice treated with ITC/Thal and CMX/Thal showed intense weight loss, increased deposition of reticulin fibers, high pulmonary concentrations of CCL3, IFN-γ and VEGF, and decreased concentrations of IL-6, IL-1β, IL-17, and TGF-β1. In conclusion, our findings reinforce the antifibrotic role of PTX only when associated with ITC, and AZT only when associated with CMX, but Thal did not show any action upon addition.
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Affiliation(s)
- Angela C Finato
- Faculdade de Ciências. Universidade Estadual Paulista (UNESP), 17033-360 Bauru, SP, Brazil
| | - Débora F Almeida
- Faculdade de Ciências. Universidade Estadual Paulista (UNESP), 17033-360 Bauru, SP, Brazil.,Faculdade de Medicina (FAMED). Universidade Federal do Mato Grosso do Sul (UFMS). 79070-900 Campo Grande, MS, Brazil
| | - Amanda R Dos Santos
- Faculdade de Ciências. Universidade Estadual Paulista (UNESP), 17033-360 Bauru, SP, Brazil.,Faculdade de Medicina (FAMED). Universidade Federal do Mato Grosso do Sul (UFMS). 79070-900 Campo Grande, MS, Brazil
| | | | - Ricardo S Cavalcante
- Faculdade de Medicina de Botucatu. Universidade Estadual Paulista (UNESP), 18618-687 Botucatu, SP, Brazil
| | - Rinaldo P Mendes
- Faculdade de Medicina (FAMED). Universidade Federal do Mato Grosso do Sul (UFMS). 79070-900 Campo Grande, MS, Brazil.,Faculdade de Medicina de Botucatu. Universidade Estadual Paulista (UNESP), 18618-687 Botucatu, SP, Brazil
| | | | - Anamaria M M Paniago
- Faculdade de Medicina (FAMED). Universidade Federal do Mato Grosso do Sul (UFMS). 79070-900 Campo Grande, MS, Brazil
| | - James Venturini
- Faculdade de Medicina (FAMED). Universidade Federal do Mato Grosso do Sul (UFMS). 79070-900 Campo Grande, MS, Brazil
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13
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Kayser M, Rickerts V, Drick N, Gerkrath J, Kreipe H, Soudah B, Welte T, Suhling H. Chronic progressive pulmonary paracoccidioidomycosis in a female immigrant from Venezuela. Ther Adv Respir Dis 2020; 13:1753466619894913. [PMID: 31840561 PMCID: PMC6918496 DOI: 10.1177/1753466619894913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a fungal infection caused by Paracoccidioides brasiliensis and P. lutzii. It is endemic to South and Central America. While PCM frequently remains latent, the disease can reactivate years after the initial infection. As the disease is rare outside the endemic area, and symptoms can mimic other pulmonary diseases, correct diagnosis can be challenging for clinicians in developed countries. In this report, we present the case of a 57-year-old female Venezuelan immigrant with PCM. She was initially misdiagnosed with sarcoidosis and treated with corticosteroids, leading to an exacerbation of the infection requiring intensive care. Because cultivation of Paracoccidioides sp. is slow and unsensitive, we opted for microscopic observation of fungal elements and molecular testing on a tissue biopsy and bronchoalveolar lavage (BAL) together with antibody detection. This allowed the diagnosis of PCM, enabling specific management. PCM and other imported mycoses should be considered as a differential diagnosis in patients originating from South and Central America displaying symptoms suggestive of sarcoidosis. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Moritz Kayser
- Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | | | - Nora Drick
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | | | - Hans Kreipe
- Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Bisharah Soudah
- Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Hendrik Suhling
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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14
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Arias Ramos D, Alzate JA, Giraldo Montoya ÁM, Trujillo YA, Arias Ramos LY. Thinking in paracoccidioidomycosis: a delayed diagnosis of a neglected tropical disease, case report and review of clinical reports and eco-epidemiologic data from Colombia since the 2000. BMC Infect Dis 2020; 20:119. [PMID: 32041552 PMCID: PMC7011283 DOI: 10.1186/s12879-020-4864-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis is a neglected tropical disease, endemic in several countries of South America including Colombia. We report a case of a patient with Chronic Multifocal Paracoccidioidomycosis with long-standing symptoms and a delayed diagnosis caused by several barriers to achieve it. We did a review of the papers published in Colombia about this disease, focusing in clinical data and eco-epidemiology with the finding of a lack of new information on this topic since the 2000 in our region. CASE PRESENTATION We present a 54-year-old man, farmer in his youth, with a chronic ulcerated lesion in the lower lip similar to a lip carcinoma, a deforming lesion in the nose, and respiratory symptoms with emphysematous lung. Lip biopsy with silver methenamine stain revealed small and large budding yeasts that resembles a "mariner's wheel" confirming Chronic Multifocal Paracoccidioidomycosis. He was treated successfully but subsequently lost to follow up. CONCLUSIONS It is very important to focus attention, reinforce the search and create networks for the study of neglected tropical diseases. The presented case illustrates a usual clinical presentation, but with a delayed diagnosis due to the difficulties that still occur in some regions like ours for the early recognition of a case of chronic multifocal paracoccidioidomycosis.
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Affiliation(s)
- Deving Arias Ramos
- Universidad Tecnológica de Pereira, Pereira, Colombia. .,Grupo de Investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia.
| | - John Alexander Alzate
- Grupo de Investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia.,Hospital Universitario San Jorge, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Ángela María Giraldo Montoya
- Universidad Tecnológica de Pereira, Pereira, Colombia.,Grupo de Investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia.,Hospital Universitario San Jorge, Pereira, Colombia
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15
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Rodrigues-Vendramini FAV, Faria DR, Arita GS, Capoci IRG, Sakita KM, Caparroz-Assef SM, Becker TCA, de Souza Bonfim-Mendonça P, Felipe MS, Svidzinski TIE, Maigret B, Kioshima ÉS. Antifungal activity of two oxadiazole compounds for the paracoccidioidomycosis treatment. PLoS Negl Trop Dis 2019; 13:e0007441. [PMID: 31163021 PMCID: PMC6548352 DOI: 10.1371/journal.pntd.0007441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/06/2019] [Indexed: 01/04/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a neglected disease present in Latin America with difficulty in treatment and occurrence of serious sequelae. Thus, the development of alternative therapies is imperative. In the current work, two oxadiazole compounds (LMM5 and LMM11) presented fungicidal activity against Paracoccidioides spp. The minimum inhibitory and fungicidal concentration values ranged from 1 to 32 μg/mL, and a synergic effect was observed for both compounds when combined with Amphotericin B. LMM5 and LMM11 were able to reduce CFU counts (≥2 log10) on the 5th and 7th days of time-kill curve, respectively. The fungicide effect was confirmed by fluorescence microscopy (FUN-1/FUN-2). The hippocratic screening and biochemical analysis were performed in Balb/c male mice that received a high dose of each compound, and the compounds showed no in vivo toxicity. The treatment of experimental PCM with the new oxadiazoles led to significant reduction in CFU (≥1 log10). Histopathological analysis of the groups treated exhibited control of inflammation, as well as preserved lung areas. These findings suggest that LMM5 and LMM11 are promising hits structures, opening the door for implementing new PCM therapies.
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Affiliation(s)
| | - Daniella Renata Faria
- Department of Clinical and Biomedical Analysis, State University of Maringá, Maringá, Brazil
| | - Glaucia Sayuri Arita
- Department of Clinical and Biomedical Analysis, State University of Maringá, Maringá, Brazil
| | | | - Karina Mayumi Sakita
- Department of Clinical and Biomedical Analysis, State University of Maringá, Maringá, Brazil
| | | | | | | | - Maria Sueli Felipe
- Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brazil
| | | | | | - Érika Seki Kioshima
- Department of Clinical and Biomedical Analysis, State University of Maringá, Maringá, Brazil
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16
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Abstract
Lung cavitation may be due to infectious or noninfectious pathologic processes. The latter category includes nonmalignant conditions, such as granulomatosis with polyangiitis, and malignant conditions, such as squamous cell carcinoma of the lung. Infectious etiologies that produce lung cavitation usually cause chronic illness, although some, particularly pyogenic bacteria, may produce acute cavitary disease. Tuberculosis is the most common cause of chronic pulmonary infection with cavitation. The goal of this review was to highlight a selection of the better-known infectious agents, other than tuberculosis, that can cause chronic lung disease with cavitation. Emphasis is placed on the following organisms: nontuberculous mycobacteria, Histoplasma, Blastomyces, Coccidioides, Paracoccidioides, Aspergillus, Burkholderia pseudomallei, Paragonimus westermani, and Rhodococcus equi. These organisms generally produce clinical features and radiologic findings that overlap or mimic those of tuberculosis. In a companion article, we have further emphasized aspects of the same conditions that are more pertinent to radiologists.
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17
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Promising New Antifungal Treatment Targeting Chorismate Synthase from Paracoccidioides brasiliensis. Antimicrob Agents Chemother 2018; 63:AAC.01097-18. [PMID: 30348661 DOI: 10.1128/aac.01097-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/13/2018] [Indexed: 12/24/2022] Open
Abstract
Paracoccidioidomycosis (PCM), caused by Paracoccidioides, is a systemic mycosis with granulomatous character and a restricted therapeutic arsenal. The aim of this work was to search for new alternatives to treat largely neglected tropical mycosis, such as PCM. In this context, the enzymes of the shikimate pathway constitute excellent drug targets for conferring selective toxicity because this pathway is absent in humans but essential for the fungus. In this work, we have used a homology model of the chorismate synthase (EC 4.2.3.5) from Paracoccidioides brasiliensis (PbCS) and performed a combination of virtual screening and molecular dynamics testing to identify new potential inhibitors. The best hit, CP1, successfully adhered to pharmacological criteria (adsorption, distribution, metabolism, excretion, and toxicity) and was therefore used in in vitro experiments. Here we demonstrate that CP1 binds with a dissociation constant of 64 ± 1 μM to recombinant chorismate synthase from P. brasiliensis and inhibits enzymatic activity, with a 50% inhibitory concentration (IC50) of 47 ± 5 μM. As expected, CP1 showed no toxicity in three cell lines. On the other hand, CP1 reduced the fungal burden in lungs from treated mice, similar to itraconazole. In addition, histopathological analysis showed that animals treated with CP1 displayed less lung tissue infiltration, fewer yeast cells, and large areas with preserved architecture. Therefore, CP1 was able to control PCM in mice with a lower inflammatory response and is thus a promising candidate and lead structure for the development of drugs useful in PCM treatment.
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18
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Puerta-Arias JD, Pino-Tamayo PA, Arango JC, Salazar-Peláez LM, González A. Itraconazole in combination with neutrophil depletion reduces the expression of genes related to pulmonary fibrosis in an experimental model of paracoccidioidomycosis. Med Mycol 2018; 56:579-590. [PMID: 29420794 DOI: 10.1093/mmy/myx087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/24/2017] [Indexed: 12/21/2022] Open
Abstract
Itraconazole (ITC) is the drug of choice for treating paracoccidioidomycosis (PCM); nonetheless, patients with the chronic form of this mycosis develop fibrosis, a residual pulmonary abnormality, even after treatment. Recently, we observed that the depletion of neutrophils with a specific monoclonal antibody (mAb-anti-Ly6G) during the chronic stages of PCM was associated with a decrease in the fungal burden, the inflammatory response and a reduction of fibrosis. Herein, we aimed to evaluate the effect of ITC in combination with the mAb-anti-Ly6G in an experimental model of pulmonary PCM. BALB/c male mice were challenged with Paracoccidioides brasiliensis yeasts and treated with the mAb-anti-Ly6G and/or ITC at 4th week post-infection (p.i.) and then sacrificed at 12th week p.i. to assess neutrophil subpopulations, fungal load, collagen, expression of fibrosis- and pro-inflammatory-related genes and histopathology. We observed that combination of ITC/mAb-anti-Ly6G favored the control of infection and diminished the inflammatory response. Of note, such therapeutic strategy reduced the expression of IL-1β, IL-6, IL-17, IL-10, TNF-α, TGF-β1, TGF-β3, GATA-3, RORc, Ahr, MMP-1α, MMP-8 MMP-15, TIMP-1, and TIMP-2 genes in an additive manner compared to those mice treated with the mAb or ITC alone. Interestingly, ITC induced an increase of type-II neutrophils even in those mice treated with the mAb-anti-Ly6G. These results indicate that combination ITC/mAb-anti-Ly6G reduced the infection and pulmonary fibrosis through down-regulation of inflammatory and pro-fibrotic genes. Additionally, we confirmed the immunomodulatory properties of this antifungal in vivo. This work emphasizes the importance of exploring new potential combination treatments to treat fungal infections.
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Affiliation(s)
- Juan David Puerta-Arias
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | | | - Julián Camilo Arango
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia.,School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | | | - Angel González
- School of Microbiology, Universidad de Antioquia, Medellín, Colombia.,Basic and Applied Microbiology Research Group (MICROBRA), Universidad de Antioquia, Medellín, Colombia
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19
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Rosa Júnior M, Baldon IV, Amorim AFC, Fonseca APA, Volpato R, Lourenço RB, Baptista RM, de Mello RAF, Peçanha P, Falqueto A. Imaging paracoccidioidomycosis: A pictorial review from head to toe. Eur J Radiol 2018; 103:147-162. [PMID: 29685479 DOI: 10.1016/j.ejrad.2018.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/17/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
Paracoccidioidomycosis is an infectious disease characterized primarily by pulmonary involvement and potential dissemination to other organs, mainly mucosa and skin; however, it can affect any organ in the body. Although difficult to diagnose purely based on imaging, imaging is important for diagnosis, follow-up, and assessment of disease-related complications. We provide a comprehensive review of the most notable imaging findings of paracoccidioidomycosis.
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Affiliation(s)
- Marcos Rosa Júnior
- Department of Neuroradiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Isabella Vargas Baldon
- Department of Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - André Felipe Candeas Amorim
- Department of Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Ana Paula Alves Fonseca
- Department of Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Richard Volpato
- Department of Abdominal Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Rafael B Lourenço
- Department of Musculoskeletal Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Rodrigo Melo Baptista
- Department of Thoracic Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Ricardo Andrade Fernandes de Mello
- Department of Musculoskeletal Radiology, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Paulo Peçanha
- Department of Infectious Diseases, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
| | - Aloísio Falqueto
- Department of Infectious Diseases, Hospital Universitário Cassiano Antônio de Moraes da Universidade Federal do Espírito Santo - HUCAM/UFES/EBSERH, Vitória ES, Brazil.
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20
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67Ga Scintigraphy for Assessment of Disease Severity and Treatment Response in Patients With Paracoccidioidomycosis. Clin Nucl Med 2018. [PMID: 29517539 DOI: 10.1097/rlu.0000000000002017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The evaluation of therapy response of patients with deep mycosis is a major challenge. The aim of this study was to assess the severity of disease at admission and evaluate treatment response of patients with paracoccidioidomycosis using Ga scintigraphy. SUBJECTS AND METHODS Seventy-three patients with fully active disease were enrolled. A scoring system based on clinicoradiological and serological evaluation and Ga scan was devised. Pretherapy Ga score of 73 patients was compared with clinicoradiological and serological scores. A subgroup of 23 patients was followed up during treatment, and the rates of improvement of their clinicoradiological, serological, and Ga scores during treatment were compared at 3 time points (fully active phase, after clinical improvement, and clinically inactive disease). RESULTS The correlations between scores before therapy were statistically significant. Ga score correlated with clinical score (r = 0.47, P < 0.001). Serological score correlated with both Ga and clinical scores (r = 0.32, P = 0.006, and r = 0.25, P = 0.034, respectively). Concerning evaluation of therapy response, clinicoradiological, serological, and Ga scores decreased significantly after therapy (P < 0.001). Notably, Ga score was the single one to become negative in most patients at the end of treatment (20 of 23 patients compared with 7 on clinicoradiological evaluation and 10 on serology, P = 0.003). CONCLUSIONS In patients with paracoccidioidomycosis, pretherapy Ga scintigraphy correlates with disease severity. Serial Ga scans seem to be helpful in evaluating the response to therapy.
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21
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Paracoccidioides brasiliensis Infection Mimicking Recurrent Hodgkin Lymphoma: A Case Report and Review of the Literature. Mycopathologia 2018; 183:973-977. [PMID: 29476307 DOI: 10.1007/s11046-018-0252-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
Abstract
Paracoccidioides infection is a rare entity in the USA. This dimorphic fungus is found in Central and South America and is thought to be acquired by inhalation through the soil. We report a case of Paracoccidioides brasiliensis infection presenting as a clavicular bone lesion, peripancreatic mass, and various skin lesions. A 35-year-old man with a history significant for Hodgkin lymphoma presented with a left clavicular mass that was suspected clinically and radiologically as recurrent Hodgkin lymphoma. He was not experiencing any associated symptoms and was undergoing chemotherapy treatment for his known Hodgkin disease. On CT imaging, the mass was seen as a lytic bone lesion with an overlying soft tissue mass. This was biopsied and histologically diagnosed as a Paracoccidioides brasiliensis infection with associated necrotizing granulomatous inflammation. Also found on the CT scan was an enlarging peripancreatic mass which on endoscopic biopsy had similar histologic findings. In conclusion, this report presents a rare case of Paracoccidioides brasiliensis infection mimicking recurrent Hodgkin lymphoma.
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22
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Arango JC, Puerta-Arias JD, Pino-Tamayo PA, Salazar-Peláez LM, Rojas M, González Á. Impaired anti-fibrotic effect of bone marrow-derived mesenchymal stem cell in a mouse model of pulmonary paracoccidioidomycosis. PLoS Negl Trop Dis 2017; 11:e0006006. [PMID: 29040281 PMCID: PMC5659794 DOI: 10.1371/journal.pntd.0006006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/27/2017] [Accepted: 10/02/2017] [Indexed: 02/06/2023] Open
Abstract
Bone marrow-derived mesenchymal stem cells (BMMSCs) have been consider as a promising therapy in fibrotic diseases. Experimental models suggest that BMMSCs may be used as an alternative therapy to treat chemical- or physical-induced pulmonary fibrosis. We investigated the anti-fibrotic potential of BMMSCs in an experimental model of lung fibrosis by infection with Paracoccidioides brasiliensis. BMMSCs were isolated and purified from BALB/c mice using standardized methods. BALB/c male mice were inoculated by intranasal infection of 1.5x106P. brasiliensis yeasts. Then, 1x106 BMMSCs were administered intra venous at 8th week post-infection (p.i.). An additional group of mice was treated with itraconazole (ITC) two weeks before BMMSCs administration. Animals were sacrificed at 12th week p.i. Histopathological examination, fibrocytes counts, soluble collagen and fibrosis-related genes expression in lungs were evaluated. Additionally, human fibroblasts were treated with homogenized lung supernatants (HLS) to determine induction of collagen expression. Histological analysis showed an increase of granulomatous inflammatory areas in BMMSCs-treated mice. A significant increase of fibrocytes count, soluble collagen and collagen-3α1, TGF-β3, MMP-8 and MMP-15 genes expression were also observed in those mice. Interestingly, when combined therapy BMMSCs/ITC was used there is a decrease of TIMP-1 and MMP-13 gene expression in infected mice. Finally, human fibroblasts stimulated with HLS from infected and BMMSCs-transplanted mice showed a higher expression of collagen I. In conclusion, our findings indicate that late infusion of BMMSCs into mice infected with P. brasiliensis does not have any anti-fibrotic effect; possibly because their interaction with the fungus promotes collagen expression and tissue remodeling. This is the first study that evaluates the effect of BMMSCs therapy for lung fibrosis induced by the fungal pathogen Paracoccidioides brasiliensis, the causative agent of paracoccidioidomycosis, one of the most important systemic endemic mycosis diagnosed in South America and Central America. Our findings showed an impaired anti-fibrotic effect of BMMSCs transplantation. This effect could be triggered by either the chronic inflammatory microenvironment induced by P. brasiliensis or by a direct interaction between BMMSCs and the fungus, resulting in an exacerbation of the pulmonary fibrosis. In fact, the pro-fibrotic effect exerted by BMMSCs was toned-down by the usage of the antifungal ITC.
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Affiliation(s)
- Julián Camilo Arango
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB)–Universidad de Antioquia, Medellín, Colombia
- School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Juan David Puerta-Arias
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB)–Universidad de Antioquia, Medellín, Colombia
| | - Paula Andrea Pino-Tamayo
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB)–Universidad de Antioquia, Medellín, Colombia
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, Unites States of America
| | | | - Mauricio Rojas
- Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, Unites States of America
| | - Ángel González
- School of Microbiology, Universidad de Antioquia, Medellín, Colombia
- Basic and Applied Microbiology Research Group (MICROBA), Universidad de Antioquia, Medellín, Colombia
- * E-mail:
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23
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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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24
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Fungal Pneumonias. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
The chapter reviews methods utilized for the isolation and characterization of a promising immunogen candidate, aiming at a human vaccine against paracoccidioidomycosis. Peptide P10 carries a T-CD4+ epitope and was identified as an internal sequence of the major diagnostic antigen known as gp43 glycoprotein. It successfully treated massive intratracheal infections by virulent Paracoccidioides brasiliensis in combination with chemotherapy.An introduction about the systemic mycosis was found essential to understand the various options that were considered to design prophylactic and therapeutic vaccine protocols using peptide P10.
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Affiliation(s)
- Carlos P Taborda
- Institute of Biomedical Sciences, Department of Microbiology, University of São Paulo, São Paulo, Brazil
- Laboratory of Medical Mycology IMTSP/LIM53/HCFMUSP, University of São Paulo, São Paulo, Brazil
| | - Luiz R Travassos
- Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, Rua Botucatu 862, 8th floor, São Paulo, 04021-001, Brazil.
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Puerta-Arias JD, Pino-Tamayo PA, Arango JC, González Á. Depletion of Neutrophils Promotes the Resolution of Pulmonary Inflammation and Fibrosis in Mice Infected with Paracoccidioides brasiliensis. PLoS One 2016; 11:e0163985. [PMID: 27690127 PMCID: PMC5045199 DOI: 10.1371/journal.pone.0163985] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/16/2016] [Indexed: 12/11/2022] Open
Abstract
Chronic stages of paracoccidioidomycosis (PCM) are characterized by granulomatous lesions which promote the development of pulmonary fibrosis leading to the loss of respiratory function in 50% of patients; in addition, it has been observed that neutrophils predominate during these chronic stages of P. brasiliensis infection. The goal of this study was to evaluate the role of the neutrophil during the chronic stages of experimental pulmonary PCM and during the fibrosis development and tissue repair using a monoclonal specific to this phagocytic cell. Male BALB/c mice were inoculated intranasally with 1.5x106 P. brasiliensis yeast cells. A monoclonal antibody specific to neutrophils was administered at 4 weeks post-inoculation followed by doses every 48h during two weeks. Mice were sacrificed at 8 and 12 weeks post-inoculation to assess cellularity, fungal load, cytokine/chemokine levels, histopathological analysis, collagen and expression of genes related to fibrosis development. Depletion of neutrophils was associated with a significant decrease in the number of eosinophils, dendritic cells, B cells, CD4-T cells, MDSCs and Treg cells, fungal load and levels of most of the pro-inflammatory cytokines/chemokines evaluated, including IL-17, TNF-α and TGF-β1. Recovery of lung architecture was also associated with reduced levels of collagen, high expression of TGF-β3, matrix metalloproteinase (MMP)-12 and -14, and decreased expression of tissue inhibitor metalloproteinase (TIMP)-2, and MMP-8. Depletion of neutrophils might attenuate lung fibrosis and inflammation through down-regulating TGF-β1, TNF-α, IL-17, MMP-8 and TIMP-2. These results suggest that neutrophil could be considered as a therapeutic target in pulmonary fibrosis induced by P. brasiliensis.
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Affiliation(s)
- Juan David Puerta-Arias
- Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Paula Andrea Pino-Tamayo
- Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Julián Camilo Arango
- Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
- School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Ángel González
- School of Microbiology, Universidad de Antioquia, Medellín, Colombia
- Basic and Applied Microbiology Research Group (MICROBA), Universidad de Antioquia, Medellín, Colombia
- * E-mail:
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Synchronous oral paracoccidioidomycosis and pulmonary tuberculosis in an immunocompetent patient. Mycopathologia 2015; 179:459-64. [PMID: 25652419 DOI: 10.1007/s11046-015-9868-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 01/27/2015] [Indexed: 12/30/2022]
Abstract
Paracoccidioidomycosis (PCM) and tuberculosis (TB) are chronic granulomatous infectious diseases, in which the main form of contraction is through inhalation of the microorganism-Paracoccidioides brasiliensis and Mycobacterium tuberculosis. Oral involvement of PCM is observed in up to 70 % of the cases and usually presents clinically as ulcerations with granular surface showing tiny hemorrhagic areas. Oral presentation of TB is rare with prevalence smaller than 0.5 % of all cases. Clinical presentation of oral TB mainly consists of single ulcers with irregular limits and necrotic base. A 70-year-old immunocompetent man presented simultaneously oral PCM and pulmonary TB. Medical history revealed a previous diagnosis of pulmonary TB; however, even under treatment for TB, the patient remained with oral lesions and intense pulmonary fibrosis. The physician requested P. brasiliensis serological analysis, which resulted positive. Although the combination of PCM and TB has been reported in the literature, it is still considered an uncommon condition and their diagnosis may represent a challenge to healthcare professionals because of the similarity between their clinical and radiological presentations.
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Costa AN, Marchiori E, Benard G, Araújo MS, Baldi BG, Kairalla RA, Carvalho CRR. Lung cysts in chronic paracoccidioidomycosis. J Bras Pneumol 2014; 39:368-72. [PMID: 23857700 PMCID: PMC4075841 DOI: 10.1590/s1806-37132013000300015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 02/15/2013] [Indexed: 11/21/2022] Open
Abstract
On HRCT scans, lung cysts are characterized by rounded areas of low attenuation in the lung parenchyma and a well-defined interface with the normal adjacent lung. The most common cystic lung diseases are lymphangioleiomyomatosis, Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. In a retrospective analysis of the HRCT findings in 50 patients diagnosed with chronic paracoccidioidomycosis, we found lung cysts in 5 cases (10%), indicating that patients with paracoccidioidomycosis can present with lung cysts on HRCT scans. Therefore, paracoccidioidomycosis should be included in the differential diagnosis of cystic lung diseases.
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Affiliation(s)
- André Nathan Costa
- University of São Paulo School of Medicine, Hospital das Clínicas, Heart Institute, Department of Pulmonology, São Paulo, Brazil.
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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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30
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Travassos LR, Taborda CP, Colombo AL. Treatment options for paracoccidioidomycosis and new strategies investigated. Expert Rev Anti Infect Ther 2014; 6:251-62. [DOI: 10.1586/14787210.6.2.251] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Costa AN, Benard G, Albuquerque ALP, Fujita CL, Magri ASK, Salge JM, Shikanai-Yasuda MA, Carvalho CRR. The lung in paracoccidioidomycosis: new insights into old problems. Clinics (Sao Paulo) 2013; 68:441-8. [PMID: 23778339 PMCID: PMC3634967 DOI: 10.6061/clinics/2013(04)02] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 12/03/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Chronic paracoccidioidomycosis can diffusely affect the lungs. Even after antifungal therapy, patients may present with residual respiratory abnormalities due to fungus-induced lung fibrosis. METHODS A cross-sectional analysis of 50 consecutive inactive, chronic paracoccidioidomycosis patients was performed using high resolution computed tomography, pulmonary function tests, ergospirometry, the six-minute walk test and health-related quality of life questionnaires. RESULTS Radiological abnormalities were present in 98% of cases, the most frequent of which were architectural distortion (90%), reticulate and septal thickening (88%), centrilobular and paraseptal emphysema (84%) and parenchymal bands (74%). Patients typically presented with a mild obstructive disorder and a mild reduction in diffusion capacity with preserved exercise capacity, including VO2max and six-minute walking distance. Patient evaluation with the Saint-George Respiratory Questionnaire showed low impairment in the health-related quality of life, and the Medical Research Council questionnaire indicated a low dyspnea index. There were, however, patients with significant oxygen desaturation upon exercise that was associated with respiratory distress compared with the non-desaturated patients. The initial counterimmunoelectrophoresis of these patients was higher and lung emphysema was more prominent; however, there were no differences in the interstitial fibrotic tomographic abnormalities, tobacco exposure, functional responses, exercise capacity or quality of life. CONCLUSIONS Inactive, chronic paracoccidioidomycosis patients show persistent and disseminated radiological abnormalities by high resolution computed tomography, short impairments in pulmonary function and low impacts on aerobic capacity and quality of life. However, there was a subset of individuals whose functional impairment was more severe. These patients present with higher initial serology and more severe emphysema, stressing the importance of adequate treatment associated with tobacco exposure cessation.
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Affiliation(s)
- Andre Nathan Costa
- Faculdade de Medicina, Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, São Paulo/SP, Brazil.
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32
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Souza MA, Carvalho FC, Ruas LP, Ricci-Azevedo R, Roque-Barreira MC. The immunomodulatory effect of plant lectins: a review with emphasis on ArtinM properties. Glycoconj J 2013; 30:641-57. [PMID: 23299509 PMCID: PMC3769584 DOI: 10.1007/s10719-012-9464-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/06/2012] [Accepted: 12/09/2012] [Indexed: 12/31/2022]
Abstract
Advances in the glycobiology and immunology fields have provided many insights into the role of carbohydrate-protein interactions in the immune system. We aim to present a comprehensive review of the effects that some plant lectins exert as immunomodulatory agents, showing that they are able to positively modify the immune response to certain pathological conditions, such as cancer and infections. The present review comprises four main themes: (1) an overview of plant lectins that exert immunomodulatory effects and the mechanisms accounting for these activities; (2) general characteristics of the immunomodulatory lectin ArtinM from the seeds of Artocarpus heterophyllus; (3) activation of innate immunity cells by ArtinM and consequent induction of Th1 immunity; (4) resistance conferred by ArtinM administration in infections with intracellular pathogens, such as Leishmania (Leishmania) major, Leishmania (Leishmania) amazonensis, and Paracoccidioides brasiliensis. We believe that this review will be a valuable resource for more studies in this relatively neglected area of research, which has the potential to reveal carbohydrate targets for novel prophylactic and therapeutic strategies.
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Affiliation(s)
- Maria A Souza
- Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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34
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Bayerl JS, Oliveira ARND, Peçanha PM, Falqueto A. Osteomielite de punho em paciente com paracoccidioidomicose disseminada: uma rara apresentação. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000400013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Paracoccidioidomicose é a micose sistêmica endêmica mais frequente no Brasil. No início, o paciente não desenvolve sintomas. Com a progressão da doença, o indivíduo pode apresentar envolvimento disseminado, sendo que o acometimento ósseo é extremamente raro. O objetivo deste artigo é avaliar as alterações ósseas encontradas em estudos de imagem em um paciente com osteomielite de punho decorrente de paracoccidioidomicose disseminada.
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35
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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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Godoy MCB, Viswanathan C, Marchiori E, Truong MT, Benveniste MF, Rossi S, Marom EM. The reversed halo sign: update and differential diagnosis. Br J Radiol 2012; 85:1226-35. [PMID: 22553298 DOI: 10.1259/bjr/54532316] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The reversed halo sign is characterised by a central ground-glass opacity surrounded by denser air-space consolidation in the shape of a crescent or a ring. It was first described on high-resolution CT as being specific for cryptogenic organising pneumonia. Since then, the reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, paracoccidioidomycosis, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. In this article, we present the spectrum of neoplastic and non-neoplastic diseases that may show the reversed halo sign and offer helpful clues for assisting in the differential diagnosis. By integrating the patient's clinical history with the presence of the reversed halo sign and other accompanying radiological findings, the radiologist should be able to narrow the differential diagnosis substantially, and may be able to provide a presumptive final diagnosis, which may obviate the need for biopsy in selected cases, especially in the immunosuppressed population.
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Affiliation(s)
- M C B Godoy
- Department of Diagnostic Radiology, University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
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37
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Benard G, Campos AF, Netto LC, Gonçalves LG, Machado LR, Mimicos EV, França FOS, Gryschek RCB. Treatment of severe forms of paracoccidioidomycosis: is there a role for corticosteroids? Med Mycol 2012; 50:641-8. [PMID: 22309459 DOI: 10.3109/13693786.2011.654135] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite their immunosuppressive effects, corticosteroids have long been used as adjunct therapy (aCST) in the treatment of infectious diseases. The rationale is that in certain infections it is necessary to decrease the exacerbated host's inflammatory response, which can otherwise result in tissue damage and organ dysfunction. In fact, a major concern in treating paracoccidioidomycosis (PCM) is the host's intense inflammatory response to Paracoccidioides brasiliensis, which can be further intensified by antifungal therapy. Depending on its localization, this immunological phenomenon may be life threatening or result in permanent sequels, as is the case for some patients with cerebral or laryngeal involvement. However, the literature on aCST in paracoccidioidomycosis treatment is scarce and as a result we present our recent experience in the management of four patients with severe PCM manifestations, i.e., cerebral paracoccidioidal granuloma, laryngeal stenosis, compressive abdominal mass, and exacerbated inflammatory response with tissue destruction. In addition to the antifungal therapy, these patients required aCST, which probably promoted their clinical improvement and/or prevented serious complications. We suggest that aCST: (a) can potentially help in the management of selected cases of severe forms of PCM, particularly when there is a risk of acute complications, and (b) that it can be used safely provided that the risk-benefit ratio is carefully weighed. Well-controlled, prospective studies of aCST in the treatment of severe cases of paracoccidioidomycosis are needed to better define its role in the management of PCM.
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Affiliation(s)
- Gil Benard
- Dermatology Division of the Hospital das Clínicas, University of São Paulo Medical School and Laboratory of Medical Mycology, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil.
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Abstract
Paracoccidioidomycosis, one of the most important endemic and systemic mycoses in Latin America, presents several clinical pictures. Epidemiological studies indicate a striking rarity of disease (but not infection) in females, but only during the reproductive years. This suggested a hormonal interaction between female hormones and the etiologic dimorphic fungus Paracoccidioides brasiliensis. Many fungi have been shown to use hormonal (pheromonal) fungal molecules for intercellular communication, and there are increasing numbers of examples of interactions between mammalian hormones and fungi, including the specific binding of mammalian hormones by fungal proteins, and suggestions of mammalian hormonal modulation of fungal behavior. This suggests an evolutionary conservation of hormonal receptor systems. We recount studies showing the specific hormonal binding of mammalian estrogen to proteins in P. brasiliensis and an action of estrogen to specifically block the transition from the saprophytic form to the invasive form of the fungus in vitro. This block has been demonstrated to occur in vivo in animal studies. These unique observations are consistent with an estrogen-fungus receptor-mediated effect on pathogenesis. The fungal genes responsive to estrogen action are under study.
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Colombo AL, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol 2011; 49:785-98. [PMID: 21539506 DOI: 10.3109/13693786.2011.577821] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although endemic mycoses are a frequent health problem in Latin American countries, clinical and epidemiological data remain scarce and fragmentary. These mycoses have a significant impact on public health, and early diagnosis and appropriate treatment remain important. The target population for endemic disease in Latin America is mostly represented by low-income rural workers with limited access to a public or private health system. Unfortunately, diagnostic tools are not widely available in medical centers in Latin America; consequently, by the time patients are diagnosed with fungal infection, many are already severely ill. Among immunocompromised patients, endemic mycoses usually behave as opportunistic infections causing disseminated rather than localized disease. This paper reviews the epidemiology of the most clinically significant endemic mycoses in Latin America: paracoccidioidomycosis, histoplasmosis, and coccidioidomycosis. The burdens of disease, typically affected populations, and clinical outcomes also are discussed.
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Affiliation(s)
- Arnaldo Lopes Colombo
- Division of Infectious Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
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40
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Pujol-Riqué M, Ruiz S, Alonso-Tarrés C, Cañete C. [Pulmonary mycosis caused by Paracoccidioides brasiliensis: dangerous confusion with sarcoidosis]. RADIOLOGIA 2011; 53:560-3. [PMID: 21529860 DOI: 10.1016/j.rx.2010.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/06/2010] [Accepted: 07/08/2010] [Indexed: 11/18/2022]
Abstract
We present the case of a patient from South America with a lung disease that was initially diagnosed as sarcoidosis and treated with corticoids. Despite an initial improvement, the patient worsened gradually until his condition was finally attributed to paracoccidioidomycosis. This systemic mycosis has features in common with sarcoidosis, but the treatment differs drastically because corticoids can place the patient's life at risk.
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Affiliation(s)
- M Pujol-Riqué
- Servicio de Diagnóstico por la Imagen, Hospital General de l'Hospitalet, L'Hospitalet de Llobregat, Barcelona, España.
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41
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Paracoccidioidomycosis: High-resolution computed tomography–pathologic correlation. Eur J Radiol 2011; 77:80-4. [DOI: 10.1016/j.ejrad.2009.06.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Revised: 06/15/2009] [Accepted: 06/16/2009] [Indexed: 11/19/2022]
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Naranjo TW, Lopera DE, Diaz-Granados LR, Duque JJ, Restrepo AM, Cano LE. Combined itraconazole-pentoxifylline treatment promptly reduces lung fibrosis induced by chronic pulmonary paracoccidioidomycosis in mice. Pulm Pharmacol Ther 2010; 24:81-91. [PMID: 20851204 DOI: 10.1016/j.pupt.2010.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/22/2010] [Accepted: 09/09/2010] [Indexed: 02/06/2023]
Abstract
Fibrosis is a severe and progressive sequel of many pulmonary diseases, has no effective therapy at present and, consequently, represents a serious health problem. In Latin America, chronic pulmonary paracoccidioidomycosis (PCM) is one of the most important, prevalent and systemic fungal diseases that allows the development of lung fibrosis, with the additional disadvantage that this sequel may appear even after an apparently successful course of antifungal therapy. In this study, was propose the pentoxifylline as complementary treatment in the pulmonary PCM due to its immunomodulatory and anti-fibrotic properties demonstrated in vitro and in vivo in liver, skin and lung. Our objective was to investigate the possible beneficial effects that a combined antifungal (Itraconazole) and immunomodulatory (Pentoxifylline) therapy would have in the development of fibrosis in a model of experimental chronic pulmonary PCM in an attempt to simulate the naturally occurring events in human patients. Two different times post-infection (PI) were chosen for starting therapy, an "early time" (4 weeks PI) when fibrosis was still absent and a "late time" (8 weeks PI) when the fibrotic process had started. Infected mice received the treatments via gavage and were sacrificed during or upon termination of treatment; their lungs were then removed and processed for immunological and histopathologic studies in order to assess severity of fibrosis. When pulmonary paracoccidioidomycosis had evolved and reached an advanced stage of disease before treatment began (as normally occurs in many human patients when first diagnosed), the combined therapy (itraconazole plus pentoxifylline) resulted in a significantly more rapid reduction of granulomatous inflammation and pulmonary fibrosis, when compared with the results of classical antifungal therapy using itraconazole alone.
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Affiliation(s)
- Tonny W Naranjo
- Unidad de Micología Médica y Experimental, Corporación para Investigaciones Biológicas, Medellín, Colombia.
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Naranjo TW, Lopera DE, Diaz-Granados LR, Duque JJ, Restrepo A, Cano LE. Histopathologic and immunologic effects of the itraconazole treatment in a murine model of chronic pulmonary paracoccidioidomycosis. Microbes Infect 2010; 12:1153-62. [PMID: 20691804 DOI: 10.1016/j.micinf.2010.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/22/2010] [Accepted: 07/25/2010] [Indexed: 02/06/2023]
Abstract
A comparative study, based on histopathologic findings (inflammation, cellularity, and fibrosis) and immunologic parameters (pro-inflammatory and anti-inflammatory cytokines), was carried out in order to evaluate the effects of itraconazole (ITC) treatment and its starting time in a BALB/c murine model of chronic pulmonary paracoccidioidomycosis (PCM), induced by intranasal inoculation of Paracoccidioides brasiliensis (Pb) conidia. Two different groups of mice were exposed to ITC therapy beginning at the 4th or 8th week after Pb infection, respectively. ITC was administered daily, via gavage, for a period of sixty days. At weeks 0, 4, 8, 12 and 16 the animals were sacrificed and their lungs removed for histology staining with hematoxylin and eosin (H&E), Masson's trichromic and Gomori-Grocott; pulmonary levels of IL-1β, TNF-α, IFN-γ, IL-13 and TGF-β were also measured by ELISA. The development or absence of the principal pulmonary PCM sequela, lung fibrosis, was directly related to the therapy's starting time. This and other histopathologic findings were related to the behavior of cytokine levels.
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Affiliation(s)
- Tonny W Naranjo
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia.
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Pinzan CF, Ruas LP, Casabona-Fortunato AS, Carvalho FC, Roque-Barreira MC. Immunological basis for the gender differences in murine Paracoccidioides brasiliensis infection. PLoS One 2010; 5:e10757. [PMID: 20505765 PMCID: PMC2873977 DOI: 10.1371/journal.pone.0010757] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 04/29/2010] [Indexed: 01/09/2023] Open
Abstract
This study aimed to investigate the immunological mechanisms involved in the gender distinct incidence of paracoccidioidomycosis (pcm), an endemic systemic mycosis in Latin America, which is at least 10 times more frequent in men than in women. Then, we compared the immune response of male and female mice to Paracoccidioides brasiliensis infection, as well as the influence in the gender differences exerted by paracoccin, a P. brasiliensis component with carbohydrate recognition property. High production of Th1 cytokines and T-bet expression have been detected in the paracoccin stimulated cultures of spleen cells from infected female mice. In contrast, in similar experimental conditions, cells from infected males produced higher levels of the Th2 cytokines and expressed GATA-3. Macrophages from male and female mice when stimulated with paracoccin displayed similar phagocytic capability, while fungicidal activity was two times more efficiently performed by macrophages from female mice, a fact that was associated with 50% higher levels of nitric oxide production. In order to evaluate the role of sexual hormones in the observed gender distinction, we have utilized mice that have been submitted to gonadectomy followed by inverse hormonal reconstitution. Spleen cells derived from castrated males reconstituted with estradiol have produced higher levels of IFN-γ (1291±15 pg/mL) and lower levels of IL-10 (494±38 pg/mL), than normal male in response to paracoccin stimulus. In contrast, spleen cells from castrated female mice that had been treated with testosterone produced more IL-10 (1284±36 pg/mL) and less IFN-γ (587±14 pg/mL) than cells from normal female. In conclusion, our results reveal that the sexual hormones had a profound effect on the biology of immune cells, and estradiol favours protective responses to P. brasiliensis infection. In addition, fungal components, such as paracoccin, may provide additional support to the gender dimorphic immunity that marks P. brasiliensis infection.
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Affiliation(s)
- Camila Figueiredo Pinzan
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Luciana Pereira Ruas
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | | | - Fernanda Caroline Carvalho
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Maria-Cristina Roque-Barreira
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
- * E-mail:
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Fungal pneumonias. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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González A, Yáñez A, Gozalbo D, Gil ML. MyD88 is dispensable for resistance toParacoccidioides brasiliensisin a murine model of blood-borne disseminated infection. ACTA ACUST UNITED AC 2008; 54:365-74. [DOI: 10.1111/j.1574-695x.2008.00487.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Computed Tomography Findings in Patients With Tracheal Paracoccidioidomycosis. J Comput Assist Tomogr 2008; 32:788-91. [DOI: 10.1097/rct.0b013e3181506752] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
A pulmonary cavity is a gas-filled area of the lung in the center of a nodule or area of consolidation and may be clinically observed by use of plain chest radiography or computed tomography. Cavities are present in a wide variety of infectious and noninfectious processes. This review discusses the differential diagnosis of pathological processes associated with lung cavities, focusing on infections associated with lung cavities. The goal is to provide the clinician and clinical microbiologist with an overview of the diseases most commonly associated with lung cavities, with attention to the epidemiology and clinical characteristics of the host.
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González A, Caro E, Muñoz C, Restrepo A, Hamilton AJ, Cano LE. Paracoccidioides brasiliensis conidia recognize fibronectin and fibrinogen which subsequently participate in adherence to human type II alveolar cells: Involvement of a specific adhesin. Microb Pathog 2008; 44:389-401. [DOI: 10.1016/j.micpath.2007.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 11/07/2007] [Accepted: 11/09/2007] [Indexed: 11/24/2022]
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50
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