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Fernández NB, Toranzo A, Farias L, Canteros CE. Mycological diagnosis of paracoccidioidomycosis in a hospital from a nonendemic area: classical and molecular methods. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:132-143. [PMID: 37721907 PMCID: PMC10569774 DOI: 10.7705/biomedica.6888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/05/2023] [Indexed: 09/20/2023]
Abstract
Introduction Paracoccidioidomycosis is a systemic mycosis endemic in Latin America. Climate change and host migration emphasize the need to optimize this infection diagnosis. Objective To evaluate the implementation of Paracoccidioides spp. DNA detection in the mycological diagnosis of patients with suspected paracoccidioidomycosis. Materials and methods It is a retrospective study with laboratory data from patients with clinical suspicion of paracoccidioidomycosis, who consulted a university hospital from a non-endemic area. Results We analyzed the laboratory results of samples from 19 patients with suspected paracoccidioidomycosis. Seventeen out of 19 patients were born in or had visited an endemic area in Latin America. Fourteen adult male patients were confirmed to have paracoccidioidomycosis by conventional diagnosis: the direct examination was positive in 12 samples while fungal growth was found only in 4. Anti-Paracoccidioides spp. antibodies were detected in 10 patients, 8 of them with proven paracoccidioidomycosis. Nested PCR for Paracoccidioides spp. detection was performed on clinical samples from 14 patients, and positive results were obtained for 9 out of 10 patients with the conventional diagnosis of paracoccidioidomycosis. Conclusions The incorporation of molecular techniques to detect Paracoccidioides spp. DNA complements the conventional diagnosis of paracoccidioidomycosis. This tool allows the prescription of antifungal treatment in those cases where the fungus is not observed in the clinical samples.
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Affiliation(s)
- Norma B Fernández
- Laboratorio de Micología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Adriana Toranzo
- Servicio Micosis Profundas, Departamento de Micología, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina.
| | - Luciana Farias
- Laboratorio de Micología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Cristina E Canteros
- Departamento de Micología, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina.
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Santana LM, Peçanha PM, Falqueto A, Kruschewsky WLM, Grão-Velloso TR, Gonçalves SS, Rosa-Júnior M. "Star of Bethlehem sign" in the analysis of the evolution of brain lesions during and after treatment for neuroparacoccidioidomycosis. Radiol Bras 2023; 56:195-201. [PMID: 37829584 PMCID: PMC10567095 DOI: 10.1590/0100-3984.2023.0030] [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: 03/31/2023] [Revised: 05/20/2023] [Accepted: 06/12/2023] [Indexed: 10/14/2023] Open
Abstract
Objective To describe the clinical and radiological evolution of lesions during and after treatment in patients diagnosed with neuroparacoccidioidomycosis (NPCM). Materials and Methods This was a retrospective study of the medical records, computed tomography scans, and magnetic resonance imaging (MRI) scans of patients with NPCM treated between September 2013 and January 2022. Results Of 36 cases of NPCM, eight were included in the study. One patient presented only with pachymeningeal and skull involvement, and seven presented with pseudotumors in the brain. Collectively, the eight patients presented with 52 lesions, of which 46 (88.5%) were supratentorial. There were 32 lesions with a diameter ≤ 1.2 cm, of which 27 (84.4%) disappeared during the treatment. In three cases, there were lesions > 1.2 cm that showed a characteristic pattern of evolution on MRI: an eccentric gadolinium contrast-enhanced nodule, with a subsequent decreased in the size and degree of contrast enhancement of the lesions. Conclusion In NPCM, supratentorial lesions seem to predominate. Lesions ≤ 1.2 cm tend to disappear completely during treatment. Lesions > 1.2 cm tend to present with a similar pattern, designated the "Star of Bethlehem sign", throughout treatment.
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Affiliation(s)
- Larissa M. Santana
- Hospital Universitário Cassiano Antônio Moraes da
Universidade Federal do Espírito Santo (HUCAM/UFES/EBSERH), Vitória,
ES, Brazil
| | | | - Aloísio Falqueto
- Universidade Federal do Espírito Santo (UFES),
Vitória, ES, Brazil
| | - Wdson L. M. Kruschewsky
- Hospital das Clínicas da Faculdade de Medicina da
Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | | | | | - Marcos Rosa-Júnior
- Hospital Universitário Cassiano Antônio Moraes da
Universidade Federal do Espírito Santo (HUCAM/UFES/EBSERH), Vitória,
ES, Brazil
- Santi Medicina Diagnóstica, Vitória, ES, Brazil
- Hospital Meridional Vitória, Kora Saúde,
Vitória, ES, Brazil
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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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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Updates in Paracoccidioides Biology and Genetic Advances in Fungus Manipulation. J Fungi (Basel) 2021; 7:jof7020116. [PMID: 33557381 PMCID: PMC7915485 DOI: 10.3390/jof7020116] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/28/2022] Open
Abstract
The dimorphic fungi of the Paracoccidioides genus are the causative agents of paracoccidioidomycosis (PCM). This disease is endemic in Latin America and primarily affects workers in rural areas. PCM is considered a neglected disease, despite being a disabling disease that has a notable impact on the public health system. Paracoccidioides spp. are thermally dimorphic fungi that present infective mycelia at 25 °C and differentiate into pathogenic yeast forms at 37 °C. This transition involves a series of morphological, structural, and metabolic changes which are essential for their survival inside hosts. As a pathogen, the fungus is subjected to several varieties of stress conditions, including the host immune response, which involves the production of reactive nitrogen and oxygen species, thermal stress due to temperature changes during the transition, pH alterations within phagolysosomes, and hypoxia inside granulomas. Over the years, studies focusing on understanding the establishment and development of PCM have been conducted with several limitations due to the low effectiveness of strategies for the genetic manipulation of Paracoccidioides spp. This review describes the most relevant biological features of Paracoccidioides spp., including aspects of the phylogeny, ecology, stress response, infection, and evasion mechanisms of the fungus. We also discuss the genetic aspects and difficulties of fungal manipulation, and, finally, describe the advances in molecular biology that may be employed in molecular research on this fungus in the future.
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Tirado-Sánchez A, Franco-Paredes C, Bonifaz A. Subcutaneous Mycoses in Travelers. CURRENT TROPICAL MEDICINE REPORTS 2020; 7:141-152. [PMID: 35665217 PMCID: PMC9162435 DOI: 10.1007/s40475-020-00216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
Purpose of Review The increase in international travel in recent decades has contributed to the risk of acquiring diseases considered endemic to a region or country and the change in the epidemiology of these diseases. Endemic mycoses that may be acquired by travelers in the short or long term are endemic subcutaneous mycoses such as sporotrichosis and lobomycosis, while endemic systemic mycoses are a group of serious diseases including histoplasmosis and coccidioidomycosis. Herein, we review the current knowledge and highlight the most important aspects of these fungal infections in travelers. Recent Findings The most relevant advances in the study of these mycoses involve the epidemiological distribution; human mycoses can be fatal and there are few antifungal drugs available, increasing drug resistance, and a risk of emerging fungal diseases associated with climate change, as well as the increasing virulence, and the diagnostic strategies that may be limited in many countries. Summary Although endemic mycoses are relatively rare, they should be considered as potentially travel-related illnesses. A recent or late trip to an endemic country may guide the clinical suspicion, an early diagnosis, and the institution of effective therapy.
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Affiliation(s)
- Andrés Tirado-Sánchez
- Dermatology Service & Micology Department, Hospital General de México “Dr Eduardo Liceaga”, Dr. Balmis 148, colonia Doctores, PZ: 06720 Mexico City, Mexico
| | - Carlos Franco-Paredes
- Department of Medicine, Division of Infectious Diseases, Anschutz Medical Center, University of Colorado, Aurora, CO, USA
- Instituto Nacional de Salud, Hospital Infantil de México, Federico Gómez, Mexico City, Mexico
| | - Alexandro Bonifaz
- Dermatology Service & Micology Department, Hospital General de México “Dr Eduardo Liceaga”, Dr. Balmis 148, colonia Doctores, PZ: 06720 Mexico City, Mexico
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7
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Chamorro-Tojeiro S, González-Sarria A, Pedrosa EGG, Buitrago MJ, López-Vélez R. Acute pulmonary paracoccidioidomycosis in a traveler to Mexico. J Travel Med 2020; 27:5732464. [PMID: 32043134 DOI: 10.1093/jtm/taaa018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Sandra Chamorro-Tojeiro
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Elia Gómez G Pedrosa
- Microbiology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María J Buitrago
- Mycology Reference Laboratory, Instituto de Salud Carlos III, Majadahonda, Madrid. Spain
| | - Rogelio López-Vélez
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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8
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Pagliari C, Kanashiro-Galo L, Jesus ACC, Saldanha MG, Sotto MN. Paracoccidioidomycosis: characterization of subpopulations of macrophages and cytokines in human mucosal lesions. Med Mycol 2020; 57:757-763. [PMID: 30418569 DOI: 10.1093/mmy/myy120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 12/14/2022] Open
Abstract
Mucosal lesions of paracoccidioidomycosis (PCM) are frequently described and clinically important. Macrophages are classified as M1 or M2. M1 are proinflammatory and M2 are related to chronicity. Dectin-1 recognizes β-glucan and plays an important role against fungal cells. The objective was to verify the presence of M1, M2, and dectin-1 and a possible correlation with Th1/Th2 cytokines in mucosal PCM lesions. In sum, 33 biopsies of oral PCM were submitted to histological and immunohistochemistry analysis, and positive cells were quantified. Eleven biopsies were characterized by compact granulomas (G1), 12 with loose granulomas (G2), and 10 with both kind of granulomas (G3). pSTAT-1 was equally increased in the three groups. G1 was characterized by an increased number of CD163+ macrophages. G2 presented similar number of arginase 1, iNOS, and CD163 expressing cells. G3 presented an increased number of cells expressing arginase 1 and CD163 over iNOS. G1 and G3 presented high number of cells expressing interferon (IFN)-γ; interleukin (IL) 5 was increased in G2 and G3; the expression of IL10 was similar among the three groups, and the expression of tumor necrosis factor (TNF)-α was higher in G3. G1 correlates to Th1 cytokines and pSTAT-1 and G2 correlates to Th2 cytokines. G3 presents both kinds of cytokines. We could not associate the expression of arginase-1, CD163, iNOS, and dectin-1 with the pattern of cytokines or kind of granuloma.
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Affiliation(s)
- C Pagliari
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, SP, Brazil
| | - L Kanashiro-Galo
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, SP, Brazil
| | - A C C Jesus
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, SP, Brazil
| | - M G Saldanha
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, BA, Brazil
| | - M N Sotto
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, SP, Brazil
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Ashraf N, Kubat RC, Poplin V, Adenis AA, Denning DW, Wright L, McCotter O, Schwartz IS, Jackson BR, Chiller T, Bahr NC. Re-drawing the Maps for Endemic Mycoses. Mycopathologia 2020; 185:843-865. [PMID: 32040709 PMCID: PMC7416457 DOI: 10.1007/s11046-020-00431-2] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/24/2020] [Indexed: 01/19/2023]
Abstract
Endemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.
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Affiliation(s)
- Nida Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Ryan C Kubat
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Victoria Poplin
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Antoine A Adenis
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - David W Denning
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura Wright
- Geographic Research Analysis and Services Program, Division of Toxicology and Human Health Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Orion McCotter
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brendan R Jackson
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA.
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Singi P, Rocha RP, de Carli ML, Hanemann JAC, Pereira AAC, Coelho LFL, Malaquias LCC. Different
DNA
methylation profile is demonstrated in paracoccidioidomycosis patients without oral lesions. Mycoses 2019; 62:1133-1139. [DOI: 10.1111/myc.13000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Paola Singi
- Department of Clinic and Surgery School of Dentistry Federal University of Alfenas Alfenas MG Brazil
| | - Raissa P. Rocha
- Graduate Program in Microbiology Federal University of Minas Gerais Belo Horizonte MG Brazil
| | - Marina L. de Carli
- Department of Clinic and Surgery School of Dentistry Federal University of Alfenas Alfenas MG Brazil
| | - João Adolfo C. Hanemann
- Department of Clinic and Surgery School of Dentistry Federal University of Alfenas Alfenas MG Brazil
| | - Alessandro A. C. Pereira
- Department of Pathology and Parasitology Institute of Biomedical Sciences Federal University of Alfenas Alfenas MG Brazil
| | - Luiz Felipe L. Coelho
- Department of Microbiology and Immunology Institute of Biomedical Sciences Federal University of Alfenas Alfenas MG Brazil
| | - Luiz Cosme C. Malaquias
- Department of Microbiology and Immunology Institute of Biomedical Sciences Federal University of Alfenas Alfenas MG Brazil
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11
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Estrada-Castañón R, Estrada-Chávez G, Chávez-López MDG. Diagnosis and Management of Fungal Neglected Tropical Diseases In Community Settings-Mycetoma and Sporotrichosis. Trop Med Infect Dis 2019; 4:E81. [PMID: 31100844 PMCID: PMC6631050 DOI: 10.3390/tropicalmed4020081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This is a retrospective, analytic observational study where we describe cases of sporotrichosis and mycetoma from Acapulco General Hospital and Community Dermatology Mexico C.A. over 25 years. Analysis of environmental features that favour the development of such diseases has been made, as well as the limitations in the study and treatment of such diseases in resource poor settings. METHODS We reviewed the information on 76 sporotrichosis and 113 mycetoma patients out of a total of 14,000 consultations at Acapulco General Hospital and from Community Dermatology clinics. We analysed the epidemiological and mycological characteristics and the investigations used for diagnosis such as direct examination, culture, intradermal test reactions, and biopsy. RESULTS In total 91 confirmed cases of actinomycetoma, 22 of eumycetoma and 76 of sporotrichosis have been identified including diagnostic studies for both diseases and their treatment. DISCUSSION The results obtained have been analysed and interpreted in patients with mycetoma and sporotrichosis in the state of Guerrero, México, along with limitations in their management in areas with limited economic and logistical resources. The prevalence of mycetoma in our setting is compared with other centres where patients from all over the country are seen. The possible causes for variations in prevalence in specific areas has been looked for, in one of the poorest states of the Mexican Republic.
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Affiliation(s)
| | - Guadalupe Estrada-Chávez
- Department of Dermatology and Dermato-Oncology, Instituto Estatal de Cancerología "Dr. Arturo Beltrán Ortega", Health Secretary Guerrero, Faculty of Medicine, Universidad Autónoma de Guerrero Mexico, Community Dermatology Mexico C.A., 39850 Acapulco, Guerrero, Mexico.
| | - María de Guadalupe Chávez-López
- Department of Dermatology and Mycology Acapulco General Hospital, Health Secretary Guerrero, Community Dermatology Mexico C.A., 39355 Acapulco, Guerrero, Mexico.
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Steinbrück K, Fernandes R. Biliary Paracoccidioidomycosis: An Unusual Infection Simulating Malignant Neoplasm. Ann Hepatol 2019; 18:258-262. [PMID: 31113602 DOI: 10.5604/01.3001.0012.7935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/30/2018] [Indexed: 02/04/2023]
Abstract
Paracoccidioidomycosis is a systemic granulomatous disease caused by the dimorphic fungus Paracoccidioides brasiliensis and is restricted to Latin America. It normally affects lungs, skin and lymph nodes. Abdominal organs are usually not involved. In rare cases paracoccidioidomycosis may simulate neoplasm. Herein we describe our experience with four cases of paracoccidioidomycosis mimicking cholangiocarcinoma. To the best of our knowledge, this is the largest case series on this subject produced in English. Paracoccidioidomycosis must be considered as a differential diagnosis of cholangiocarcinoma, especially in individuals who come from endemic areas.
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Affiliation(s)
- Klaus Steinbrück
- Hepatobiliary Surgery, Bonsucesso Federal Hospital, Health Ministry, Rio de Janeiro, Brazil.
| | - Reinaldo Fernandes
- Hepatobiliary Surgery, Bonsucesso Federal Hospital, Health Ministry, Rio de Janeiro, Brazil
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13
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Vicente CR, Falqueto A. Differentiation of mucosal lesions in mucocutaneous leishmaniasis and paracoccidioidomycosis. PLoS One 2018; 13:e0208208. [PMID: 30475920 PMCID: PMC6258372 DOI: 10.1371/journal.pone.0208208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022] Open
Abstract
Mucocutaneous leishmaniasis and paracoccidioidomycosis are infectious diseases with similar epidemiological and clinical aspects. Cases of both diseases may manifest similar lesions in the mucosa. Therefore, the determination of distinguishing characteristics for the purpose of differential diagnosis is critical for better management of the diseases. The present study evaluated factors that assist in the differentiation of mucosal lesions between these diseases. This cross-sectional study included data from medical records of 122 cases of mucocutaneous leishmaniasis and 83 cases of paracoccidioidomycosis attended at the university hospital Cassiano Antonio Moraes, located in Vitória, Espírito Santo State, Brazil. Comparison between the diseases included the following variables: sex, age, time of disease evolution, location of the lesion and symptoms. Adults and males were affected by both diseases at higher rates. Lesions in the nasal region (95.1%; p-value = 0.000) and the pharynx (20.5%; p-value = 0.009) and nasal obstruction (34.4%; p-value = 0.000) were associated with leishmaniasis. Paracoccidioidomycosis was associated with lesions in the oral region (90.4%; p-value = 0.000), oral pain (16.9%; p-value = 0.000), and hoarseness (14.5%; p-value = 0.008). In leishmaniasis, lesions in oral regions were not associated with oral pain and were frequently located close to the nasal area. The manifestations cited above could improve the differential diagnosis of leishmaniasis and paracoccidioidomycosis, and thereby potentially aid in the choice of appropriate confirmatory diagnostic testing.
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Affiliation(s)
- Creuza Rachel Vicente
- Department of Social Medicine, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
- * E-mail:
| | - Aloisio Falqueto
- Department of Social Medicine, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
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Giusiano G, Rojas F, Mussin J, Alegre L, de los Ángeles Sosa M. The Southern Endemic Zone of Paracoccidioidomycosis: Epidemiological Approach in Northeast Argentina. CURRENT FUNGAL INFECTION REPORTS 2018. [DOI: 10.1007/s12281-018-0324-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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de Arruda JAA, Schuch LF, Abreu LG, Silva LVDO, Mosconi C, Monteiro JLGC, Batista AC, Hildebrand LDC, Martins MD, Sobral APV, Rivero ERC, Gomes APN, Silva TA, Vasconcelos ACU, Mesquita RA. A multicentre study of oral paracoccidioidomycosis: Analysis of 320 cases and literature review. Oral Dis 2018; 24:1492-1502. [DOI: 10.1111/odi.12925] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/29/2018] [Accepted: 06/20/2018] [Indexed: 12/18/2022]
Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Lauren Frenzel Schuch
- Diagnostic Centre for Oral Diseases, School of Dentistry; Universidade Federal de Pelotas; Pelotas Brazil
| | - Lucas Guimarães Abreu
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | | | - Carla Mosconi
- Department of Stomathology (Oral Pathology), School of Dentistry; Universidade Federal de Goiás; Goiânia Brazil
| | | | - Aline Carvalho Batista
- Department of Stomathology (Oral Pathology), School of Dentistry; Universidade Federal de Goiás; Goiânia Brazil
| | - Laura de Campos Hildebrand
- Department of Oral Pathology, School of Dentistry; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry; Universidade Federal do Rio Grande do Sul; Porto Alegre Brazil
| | - Ana Paula Veras Sobral
- Department of Oral and Maxillofacial Pathology and Surgery, School of Dentistry; Universidade de Pernambuco; Camaragibe Brazil
| | - Elena Riet Correa Rivero
- Department of Pathology, Health Sciences Centre; Universidade Federal de Santa Catarina; Florianópolis Brazil
| | - Ana Paula Neutzling Gomes
- Diagnostic Centre for Oral Diseases, School of Dentistry; Universidade Federal de Pelotas; Pelotas Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, School of Dentistry; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | | | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
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16
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Trindade AH, Meira HC, Pereira IF, de Lacerda JCT, de Mesquita RA, Santos VR. Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients. Mycoses 2017; 60:521-525. [PMID: 28422366 DOI: 10.1111/myc.12622] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/29/2022]
Abstract
Paracoccidioidomycosis (PCM) is a rare fungal infection in the world, but endemic and acquired exclusively in Latin America, with the highest prevalence in South America and Brazil, particularly. Changes in oral cavity are common and constitute the first clinical manifestation in many patients. The aim of this study was to describe the prevalence of oral PCM and analyse the profile of the disease and patients. Retrospective research, consisting of information present in the medical records in the period 1998-2015, whose histopathological diagnosis was oral PCM. Fifty-five oral PCM cases were confirmed. Of these patients, 90.9% were males and 9.1% were females. The average age was 49.66 years and the most reported occupation was rural workers. The painful symptomatology was present in 61.82% of patients. Erythematous lesions were predominant in 73% of them. In single lesions (22 cases), the most common locations were jugal mucosa and tongue. In multiple involvement (30 cases), the most affected regions were lips, jugal mucosa and alveolar ridge. Epidemiology of PCM, was similar to several other studies, especially in Brazil. This is the most important fungal infection in Latin America and the recognition of oral lesions is extremely important, as is often the first and in many cases the only manifestation of the disease.
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Affiliation(s)
- Aline Heloísa Trindade
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Henrique Côrtes Meira
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Igor Figueiredo Pereira
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Ricardo Alves de Mesquita
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vagner Rodrigues Santos
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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17
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Martinez R. New Trends in Paracoccidioidomycosis Epidemiology. J Fungi (Basel) 2017; 3:jof3010001. [PMID: 29371520 PMCID: PMC5715958 DOI: 10.3390/jof3010001] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/22/2016] [Accepted: 12/28/2016] [Indexed: 12/02/2022] Open
Abstract
Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America and more prevalent in South America. The disease is caused by the dimorphic fungus Paracoccidioides spp. whose major hosts are humans and armadillos. The fungus grows in soil and its infection is associated with exposure to the rural environment and to agricultural activities, with a higher risk in coffee and tobacco plantations. Population studies assessing the reactivity to Paracoccidioides spp. antigens by intradermal reaction or serological tests have detected previous subclinical infections in a significant proportion of healthy individuals living in various endemic countries. Paracoccidioidomycosis-disease is manifested by a small minority of infected individuals. The risk of developing the disease and its type of clinical form are related to the personal and life style characteristics of infected individuals, including genetic background, age, sex, ethnicity, smoking habit, alcohol drinking, and eventual cellular immunosuppression. Brazil, Colombia, Venezuela, Argentina, and Ecuador have endemic areas that had already been defined in the 20th century. The incidence of paracoccidioidomycosis can be altered by climate phenomena and mainly by human migration and occupation of poorly explored territories. In Brazil, the endemy tends to expand towards the North and Center-West around the Amazon Region.
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Affiliation(s)
- Roberto Martinez
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School, Universidade de São Paulo, Sao Paulo 14049-900, Brazil.
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Mukkada S, Kirby J, Apiwattanakul N, Hayden RT, Caniza MA. Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings. CURRENT CLINICAL MICROBIOLOGY REPORTS 2016; 3:120-131. [PMID: 27672551 PMCID: PMC5034939 DOI: 10.1007/s40588-016-0038-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fungal diseases are an important cause of mortality in immunocompromised hosts, and their incidence in pediatric cancer patients in low- to middle-income countries is underestimated. In this review, we present relevant, up-to-date information about the most common opportunistic and endemic fungal diseases among children with cancer, their geographic distribution, and recommended diagnostics and treatment. Efforts to improve the care of children with cancer and fungal disease must address the urgent need for sustainable and cost-effective solutions that improve training, fungal disease testing capability, and the use of available resources. We hope that the collective information presented here will be used to advise healthcare providers, regional and country health leaders, and policymakers of the current challenges in diagnosing and treating fungal infections in children with cancer in low- to middle-income countries.
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Affiliation(s)
- Sheena Mukkada
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
- Division of Infectious Diseases, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Jeannette Kirby
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nopporn Apiwattanakul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Randall T. Hayden
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Miguela A. Caniza
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN, USA
- International Outreach Program, St. Jude Children's Research Hospital, Memphis, TN, USA
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Abstract
The epidemiological characteristics of paracoccidioidomycosis were reviewed and
updated. The new endemic areas in Brazil were discussed in the section regarding the
geographic distribution of the mycosis. Subclinical infection with
Paracoccidioides brasiliensis was discussed on the basis of skin
test surveys with antigens of the fungus, seroepidemiological studies, and disease
cases outside Latin America. Large case series permitted a comparison of the
prevalence of the mycosis in different regions, its estimated incidence and risk
factors for the development of the disease. Aspects modulating the expression of the
clinical forms of paracoccidioidomycosis are also presented. This review also deals
with diseases associated with the mycosis, opportunistic paracoccidioidomycosis,
lethality, mortality and infection and disease in animals.
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Affiliation(s)
- Roberto Martinez
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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20
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Common and Dangerous Skin Infections. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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de Carli ML, Cardoso BCB, Malaquias LCC, Nonogaki S, Pereira AAC, Sperandio FF, Hanemann JAC. Serum antibody levels correlate with oral fungal cell numbers and influence the patients' response to chronic paracoccidioidomycosis. Mycoses 2015; 58:356-61. [DOI: 10.1111/myc.12325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Marina Lara de Carli
- Department of Clinic and Surgery; School of Dentistry; Federal University of Alfenas; Alfenas MG Brazil
| | | | - Luiz Cosme Cotta Malaquias
- Department of Immunology and Microbiology; Institute of Biomedical Sciences; Federal University of Alfenas; Alfenas MG Brazil
| | - Suely Nonogaki
- Pathology Center; Adolfo Lutz Institute; São Paulo SP Brazil
| | | | - Felipe Fornias Sperandio
- Department of Pathology and Parasitology; Institute of Biomedical Sciences; Federal University of Alfenas; Alfenas MG Brazil
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