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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: 33] [Impact Index Per Article: 16.5] [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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Paracoccidioidomycosis diagnosed in bone marrow biopsy: Indicative of fungemia and unfavorable prognosis. Int J Infect Dis 2018; 74:29-30. [PMID: 29944929 DOI: 10.1016/j.ijid.2018.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 11/23/2022] Open
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Cerci JJ, Bogoni M, Buccheri V, Etchebehere ECSDC, Silveira TMBD, Baiocchi O, Neto CDACP, Sapienza MT, Marin JFG, Meneghetti JC, Novis Y, Souza CAD, Chiattone C, Torresan M, Ramos CD. Fluorodeoxyglucose-positron emission tomography staging can replace bone marrow biopsy in Hodgkin's lymphoma. Results from Brazilian Hodgkin's Lymphoma Study Group. Hematol Transfus Cell Ther 2018; 40:245-249. [PMID: 30128433 PMCID: PMC6098181 DOI: 10.1016/j.htct.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/06/2018] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate, in a large prospective multicenter study, whether 2-[18F]-fluoro-2-deoxy-d-glucose-positron emission tomography is sufficiently accurate to identify clinically important bone marrow involvement by Hodgkin's lymphoma to replace routine bone marrow biopsy in a developing tropical country. Methods Patients newly diagnosed with Hodgkin's lymphoma were recruited from six cancer centers in Brazil. All were staged by the results of positron emission tomography/computed tomography that were centrally reviewed and by iliac crest bone marrow biopsy. Patients were classified as having marrow disease if they had lymphoma identified by marrow biopsy histology or had focal 2-[18F]-fluoro-2-deoxy-d-glucose marrow uptake that resolved following chemotherapy. Results A total of 246 participants were recruited from six different centers and 62 (25.2%) were judged to have Hodgkin's lymphoma in the bone marrow. Positron emission tomography and biopsies were concordant in 206 patients (83%). Positron emission tomography correctly identified marrow disease in 59/62 patients (95.1%) and marrow biopsy in 25/62 patients (40.3%). In 22/62 (35.4%) patients, the two techniques were concordant in the diagnosis of marrow involvement. Of the forty discordant results, positron emission tomography found bone marrow involvement in 37 patients, upstaging 22 to stage IV and having an impact on therapeutic decision in nine cases given their reallocation from early to advanced stage. Three false negative positron emission tomography results were obtained with bone marrow biopsy giving positive findings. All three cases were classified as stage IV regardless of bone marrow findings implying no modification in the clinical management. The sensitivity, specificity and accuracy of positron emission tomography for detecting bone marrow disease were 95%, 100% and 98% and for bone marrow biopsy they were 40%, 100% and 84%, respectively. Conclusion We conclude that positron emission tomography can replace marrow biopsy in Brazilian patients with Hodgkin's lymphoma without compromising clinical management.
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Affiliation(s)
| | | | - Valeria Buccheri
- Universidade de São Paulo (USP), Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil
| | | | | | - Otavio Baiocchi
- Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | | | - Marcelo Tatit Sapienza
- Universidade de São Paulo (USP), Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil
| | | | - José Cláudio Meneghetti
- Universidade de São Paulo (USP), Hospital das Clínicas (HC), Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Yana Novis
- Hospital Sírio Libanês, São Paulo, SP, Brazil
| | | | | | - Marcia Torresan
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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Mendes RP, Cavalcante RDS, Marques SA, Marques MEA, Venturini J, Sylvestre TF, Paniago AMM, Pereira AC, da Silva JDF, Fabro AT, Bosco SDMG, Bagagli E, Hahn RC, Levorato AD. Paracoccidioidomycosis: Current Perspectives from Brazil. Open Microbiol J 2017; 11:224-282. [PMID: 29204222 PMCID: PMC5695158 DOI: 10.2174/1874285801711010224] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This review article summarizes and updates the knowledge on paracoccidioidomycosis. P lutzii and the cryptic species of P. brasiliensis and their geographical distribution in Latin America, explaining the difficulties observed in the serological diagnosis. OBJECTIVES Emphasis has been placed on some genetic factors as predisposing condition for paracoccidioidomycosis. Veterinary aspects were focused, showing the wide distribution of infection among animals. The cell-mediated immunity was better characterized, incorporating the recent findings. METHODS Serological methods for diagnosis were also compared for their parameters of accuracy, including the analysis of relapse. RESULTS Clinical forms have been better classified in order to include the pictures less frequently observesiod. CONCLUSION Itraconazole and the trimethoprim-sulfamethoxazole combination was compared regarding efficacy, effectiveness and safety, demonstrating that azole should be the first choice in the treatment of paracoccidioidomycosis.
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Affiliation(s)
- Rinaldo Poncio Mendes
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Ricardo de Souza Cavalcante
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Sílvio Alencar Marques
- Department of Dermatology, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | | | - James Venturini
- Laboratory of Experimental Immunology, Department of Biological Science, Faculty of Science, São Paulo State University – UNESP, São Paulo, Brazil
| | - Tatiane Fernanda Sylvestre
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Anamaria Mello Miranda Paniago
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina – Federal University of Mato Grosso do Sul – UFMS, Brazil
| | | | - Julhiany de Fátima da Silva
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Alexandre Todorovic Fabro
- Unit of Experimental Research, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Sandra de Moraes Gimenes Bosco
- Department of Microbiology and Immunology – Instituto de Biociências de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Eduardo Bagagli
- Department of Microbiology and Immunology – Instituto de Biociências de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
| | - Rosane Christine Hahn
- Laboratory of Investigation and Mycology, Federal University of Mato Grosso, Faculty of Medicine Cuiabá, Mato Grosso, Brazil
| | - Adriele Dandara Levorato
- Department of Tropical Diseases, Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, São Paulo, Brazil
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Marques SA, Lastória JC, Camargo RMPD, Marques MEA. Paracoccidioidomycosis: acute-subacute clinical form, juvenile type. An Bras Dermatol 2017; 91:384-6. [PMID: 27438214 PMCID: PMC4938291 DOI: 10.1590/abd1806-4841.20164953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/16/2015] [Indexed: 11/22/2022] Open
Abstract
The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation.
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Affiliation(s)
- Silvio Alencar Marques
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - Botucatu (SP), Brazil
| | - Joel Carlos Lastória
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - Botucatu (SP), Brazil
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Nazha A, Khoury JD, Rampal RK, Daver N. Fibrogenesis in Primary Myelofibrosis: Diagnostic, Clinical, and Therapeutic Implications. Oncologist 2015; 20:1154-60. [PMID: 26304912 DOI: 10.1634/theoncologist.2015-0094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/22/2015] [Indexed: 01/28/2023] Open
Abstract
Primary myelofibrosis is a stem cell-derived clonal malignancy characterized by unchecked proliferation of myeloid cells, resulting in bone marrow fibrosis, osteosclerosis, and pathologic angiogenesis. Bone marrow fibrosis (BMF) plays a central role in the pathophysiology of the disease. This review describes current issues regarding BMF in primary myelofibrosis, including the pathophysiology and impact of abnormal deposition of excess collagen and reticulin fibers in bone marrow spaces, the modified Bauermeister and the European Consensus grading systems of BMF, and the prognostic impact of BMF on the overall outcome of patients with primary myelofibrosis. The impact of novel therapeutic strategies, including JAK-STAT inhibitors and allogeneic stem cell transplant, on BMF is discussed.
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Affiliation(s)
- Aziz Nazha
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, Ohio USA; Department of Hematopathology, and Leukemia Department, The University of Texas MD Anderson Cancer Center, Houston, Texas USA; Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph D Khoury
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, Ohio USA; Department of Hematopathology, and Leukemia Department, The University of Texas MD Anderson Cancer Center, Houston, Texas USA; Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raajit K Rampal
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, Ohio USA; Department of Hematopathology, and Leukemia Department, The University of Texas MD Anderson Cancer Center, Houston, Texas USA; Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Naval Daver
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, Ohio USA; Department of Hematopathology, and Leukemia Department, The University of Texas MD Anderson Cancer Center, Houston, Texas USA; Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Marques SA. Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating. An Bras Dermatol 2014; 88:700-11. [PMID: 24173174 PMCID: PMC3798345 DOI: 10.1590/abd1806-4841.20132463] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/18/2013] [Indexed: 11/22/2022] Open
Abstract
Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by fungi of
the genus Paracoccidioides. Due to its frequent tegument clinical expression,
paracoccidioidomycosis is an important disease for dermatologists, who must be
up-to-date about it. This article focuses on recent epidemiological data and
discusses the new insights coming from molecular studies, as well as those related to
clinical, diagnostic and therapeutic aspects. In the latter section, we give
particular attention to the guideline on paracoccidioidomycosis organized by
specialists in this subject.
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Pereira GH, Santos AQ, Park M, Muller PR, Padua S, Marchesi RF, Aldred VL. Bone Marrow Involvement in a Patient with Paracoccidioidomycosis: A Rare Presentation of Juvenile Form. Mycopathologia 2010; 170:259-61. [DOI: 10.1007/s11046-010-9314-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 04/21/2010] [Indexed: 11/25/2022]
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Abstract
Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidoides brasiliensis. The infection is endemic in subtropical areas of Latin America and has a high prevalence in Brazil. The disease is acquired by airborne inhalation of conidia and is frequently observed in adult male rural workers. The juvenile type of this mycosis is less prevalent (5-10% of clinical cases) and attacks both sexes. This clinical form occurs in children and adolescents and has a subacute course with fever, toxemia, loss of weight, adenopathy, hepatoesplenomegaly, anaemia and eosinophilia. Radiologic abnormalities in the lung fields may be seen. Mucous membrane lesions occasionally occur. The clinical presentation resembles severe tuberculosis, leukaemia or lymphoma. The diagnosis is confirmed by finding yeast-like elements of P. brasiliensis in microscopic examinations of wet preparations of specimens submitted for mycologic studies. The fungus grows slowly (20-30 days) and its isolation is difficult. Histologic and serologic studies may also assist in the diagnosis of this mycosis. Sulfonamides, ketoconazole, itraconazole, fluconazole and amphotericin B have been successfully used in the treatment of paracoccidioidomycosis. Itraconazole is the treatment of choice, being effective in more than 95% of cases. Co-trimoxazole is still frequently used especially in chronic progressive disease and as maintenance after a course of amphotericin B in severe cases of this mycosis.
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Resende LSR, Mendes RP, Bacchi MM, Marques SA, Barraviera B, Souza LR, Meira DA, Niéro-Melo L. Bone marrow necrosis related to paracoccidioidomycosis: the first eight cases identified at autopsy. Histopathology 2009; 54:486-9. [PMID: 19309401 PMCID: PMC2680265 DOI: 10.1111/j.1365-2559.2009.03245.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To report the first eight bone marrow necrosis (BMN) cases related to paracoccidioidomycosis (PCM) from patient autopsies with well-documented bone marrow (BM) histology and cytology. METHODS AND RESULTS A retrospective evaluation was performed on BM specimens from eight autopsied patients from Botucatu University Hospital with PCM-related BMN. Relevant BMN literature was searched and analysed. CONCLUSIONS All eight patients had acute PCM. Six had histological only (biopsies) and two cytological only (smears) specimens. Five biopsy specimens revealed severe and one mild coagulation patterned necrotic areas. Five had osteonecrosis. The cytological specimens also showed typical BMN patterns. Paracoccidioides brasiliensis yeast forms were visible within necrotic areas in all cases.
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Affiliation(s)
- Lucilene S R Resende
- Haematology Service of Clinical Department, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil.
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