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Guevara A, Siqueira NP, de Sousa RP, Dos Santos TB, Assis SB, de Camargo ZP, Rodrigues AM, Hagen F, Hahn RC. Clinical response to prednisone in a severe case of infant-juvenile paracoccidioidomycosis. Rev Iberoam Micol 2024:S1130-1406(24)00005-6. [PMID: 38897873 DOI: 10.1016/j.riam.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/11/2024] [Accepted: 04/08/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Paracoccidioidomycosis is a neglected tropical disease caused by fungi of the genus Paracoccidioides. A wide range of symptoms is related to the disease; however, lungs and skin are the sites predominantly affected. The disease is mostly seen in people living in rural areas in Latin America. CASE REPORT We present a pediatric case of severe disseminated paracoccidioidomycosis that slowly responded to the antifungal treatment. Within three months, symptoms evolved into hepatosplenomegaly, necrotic cervical and abdominal lymph nodes, and splenic abscess. Clinical response to amphotericin B deoxycholate and itraconazole was slow, resulting in pleural and peritoneal cavity effusions, heart failure and shock. Amphotericin B deoxycholate was replaced by the liposomal formulation, with no response. Subsequently, prednisone was added to the treatment, which led to improvement in the clinical response. Serological Paracoccidioides antibody titers were atypical, with very low titers in the critical phase and significant increase during the convalescence phase. The infection was finally cleared up with amphotericin B deoxycholate, liposomal amphotericin B and the use of corticosteroids. Paracoccidioidomycosis serology was non-reactive two years post-discharge. CONCLUSIONS Due to the intense inflammatory response triggered by Paracoccidioides cells, giving low-dose prednisone for a short period of time modulated the inflammatory response and supported antifungal treatment.
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Affiliation(s)
- Armando Guevara
- Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Nathan Pereira Siqueira
- Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Ronaldo Pereira de Sousa
- Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Thiago Braga Dos Santos
- Pediatric Department, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Sandra Breder Assis
- Pediatric Department, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil; Júlio Muller University Hospital/Ebserh, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands; Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Microbiology, Utrecht, The Netherlands.
| | - Rosane Christine Hahn
- Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil; Júlio Muller University Hospital/Ebserh, Federal University of Mato Grosso, Cuiabá, Mato Grosso, 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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3
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Tasleem, Shanthi N, Mahato AK, Bahuguna R. Oral delivery of butoconazole nitrate nanoparticles for systemic treatment of chronic paracoccidioidomycosis: A future aspect. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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do Carmo Silva L, de Oliveira AA, de Souza DR, Barbosa KLB, Freitas e Silva KS, Carvalho Júnior MAB, Rocha OB, Lima RM, Santos TG, Soares CMDA, Pereira M. Overview of Antifungal Drugs against Paracoccidioidomycosis: How Do We Start, Where Are We, and Where Are We Going? J Fungi (Basel) 2020; 6:jof6040300. [PMID: 33228010 PMCID: PMC7712482 DOI: 10.3390/jof6040300] [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] [Received: 09/23/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Paracoccidioidomycosis is a neglected disease that causes economic and social impacts, mainly affecting people of certain social segments, such as rural workers. The limitations of antifungals, such as toxicity, drug interactions, restricted routes of administration, and the reduced bioavailability in target tissues, have become evident in clinical settings. These factors, added to the fact that Paracoccidioidomycosis (PCM) therapy is a long process, lasting from months to years, emphasize the need for the research and development of new molecules. Researchers have concentrated efforts on the identification of new compounds using numerous tools and targeting important proteins from Paracoccidioides, with the emphasis on enzymatic pathways absent in humans. This review aims to discuss the aspects related to the identification of compounds, methodologies, and perspectives when proposing new antifungal agents against PCM.
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Affiliation(s)
- Lívia do Carmo Silva
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
- Correspondence: (L.d.C.S.); (M.P.); Tel./Fax: +55-62-3521-1110 (M.P.)
| | - Amanda Alves de Oliveira
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Dienny Rodrigues de Souza
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Katheryne Lohany Barros Barbosa
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Kleber Santiago Freitas e Silva
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Marcos Antonio Batista Carvalho Júnior
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Olívia Basso Rocha
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Raisa Melo Lima
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Thaynara Gonzaga Santos
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605-050, GO, Brazil
| | - Célia Maria de Almeida Soares
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
| | - Maristela Pereira
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiânia 74690-900, GO, Brazil; (A.A.d.O.); (D.R.d.S.); (K.L.B.B.); (K.S.F.eS.); (M.A.B.C.J.); (O.B.R.); (R.M.L.); (T.G.S.); (C.M.d.A.S.)
- Correspondence: (L.d.C.S.); (M.P.); Tel./Fax: +55-62-3521-1110 (M.P.)
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5
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Riechelmann RS, Rodrigues LH, Avelar TM, Xander PA, da Costa GH, Cannoni LF, de Aguiar GB, Veiga JC. Isolated neuroparacoccidioidomycosis as a pseudotumoral lesion in the absence of systemic disease. Surg Neurol Int 2020; 11:151. [PMID: 32637204 PMCID: PMC7332495 DOI: 10.25259/sni_224_2020] [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: 04/27/2020] [Accepted: 05/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Paracoccidioidomycosis (PCM) is a systemic, progressive, noncontagious, and often chronic disease caused by the fungus Paracoccidioides brasiliensis that rarely affects the central nervous system (CNS). The condition is usually treated using antifungal drugs, and some cases may require surgery. Case Description: A 55-year-old man, a smoker, without known comorbidities, was referred to the neurosurgery team with a history of a single epileptic seizure a week before hospital admission followed by progressive right- sided hemiparesis. Head computed tomography and brain magnetic resonance imaging showed an intra-axial expansive lesion affecting the left parietal lobe, associated with extensive edema and a regional compressive effect producing slight subfalcine herniation that was initially managed as an abscess. After the failure of antibiotic treatment, the patient underwent a neurosurgical procedure for excision of the lesion. Histopathological analysis revealed that it was PCM and there was no evidence of impairment of other systems due to the disease. Conclusion: PCM can be a serious, debilitating disease and is potentially fatal. Although isolated CNS involvement is rare, it must be considered, especially in endemic areas, as late diagnosis and treatment severely decreases good outcome rates.
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Affiliation(s)
- Ricardo Salemi Riechelmann
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Leonardo Henrique Rodrigues
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Tiago Marques Avelar
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Paulo Adolfo Xander
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Guilherme Henrique da Costa
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Luiz Fernando Cannoni
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Guilherme Brasileiro de Aguiar
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
| | - Jose Carlos Veiga
- Department of Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Motta Júnior, São Paulo, Brazil
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Genaro LM, Coser LDO, Justo-Junior ADS, de Castro LF, Barreto AKF, Rizzato AE, Trabasso P, Mamoni RL, Pereira RM, Cintra ML, Santos LN, Carvalho MD, Ruas LP, Blotta MHDSL. Association between IL-27 and Tr1 cells in severe form of paracoccidioidomycosis. Cytokine 2020; 127:154962. [PMID: 31901599 DOI: 10.1016/j.cyto.2019.154962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/03/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
Interleukin-27, a cytokine of the IL-12 family, is secreted by antigen-presenting cells such as macrophages and dendritic cells (DCs). Recent studies suggest an anti-inflammatory role for IL-27 by inducing IL-10 producing Tr1 cells capable of inhibiting Th1 and Th17 type responses. Our study aimed to investigate the involvement of IL-27 and Tr1 cells in the immunomodulation of paracoccidioidomycosis (PCM), the most prevalent systemic mycosis in Brazil. The presence of IL-27 was evaluated in serum and biopsies of patients with PCM by ELISA, immunohistochemistry, and immunofluorescence. The presence of Tr1 in peripheral blood was analyzed by flow cytometry. In vitro assays were performed to verify the ability of P. brasiliensis yeast to induce IL-27 production by DCs and macrophages, as well as the polarization of lymphocytes to the Tr1 phenotype. Patients with the acute form and severe chronic form, the most severe and disseminated forms of PCM, presented higher serum concentrations of IL-27 and higher percentage of Tr1 cells compared to patients with mild chronic form. IL-27 was also detected in lesions of patients with PCM and associated with DCs and macrophages. P. brasiliensis Pb18 yeasts were able to induce IL-27 production by both DCs and macrophages. We found that DCs pulsed with Pb18 were able to induce Tr1 lymphocytes in vitro. Our data suggest that IL-27 and Tr1 cells could contribute to the deficient immune response to P. brasiliensis that leads to severe and disseminated forms of the disease.
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Affiliation(s)
- Lívia Moreira Genaro
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil; Brazilian Biosciences National Laboratory, Brazilian Center for Research in Energy and Material, São Paulo, Brazil
| | - Lilian de Oliveira Coser
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Amauri da Silva Justo-Junior
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Lívia Furquim de Castro
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | | | - Plínio Trabasso
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Ronei Luciano Mamoni
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil; Faculty of Medicine of Jundiai, Jundiai, São Paulo 13202-550, Brazil
| | - Ricardo Mendes Pereira
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Maria Letícia Cintra
- Department of Pathology, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Luana Nunes Santos
- Brazilian Biosciences National Laboratory, Brazilian Center for Research in Energy and Material, São Paulo, Brazil
| | - Murilo de Carvalho
- Brazilian Biosciences National Laboratory, Brazilian Center for Research in Energy and Material, São Paulo, Brazil
| | - Luciana Pereira Ruas
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil; Brazilian Biosciences National Laboratory, Brazilian Center for Research in Energy and Material, São Paulo, Brazil
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Silva LBR, Taira CL, Dias LS, Souza ACO, Nosanchuk JD, Travassos LR, Taborda CP. Experimental Therapy of Paracoccidioidomycosis Using P10-Primed Monocyte-Derived Dendritic Cells Isolated From Infected Mice. Front Microbiol 2019; 10:1727. [PMID: 31417520 PMCID: PMC6685297 DOI: 10.3389/fmicb.2019.01727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/12/2019] [Indexed: 11/13/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is an endemic mycosis in Latin American caused by the thermodimorphic fungi of the genus Paracoccidioides spp. Notably, a Th1 immune response is required to control PCM. In this context, dendritic cells (DCs) seem to be essential players in capture, processing and presentation of Paracoccidioides antigens to naïve T cells and their further activation. We have previously demonstrated that differentiated DCs from bone marrow cells, pulsed with the immunoprotective peptide 10 (P10), effectively control experimental PCM immunocompetent and immunosuppressed mice. However, this procedure may not be infeasible or it is limited for the therapy of human patients. Therefore, we have sought a less invasive but equally effective approach that would better mimics the autologous transplant of DC in a human patient. Here, we isolated and generated monocyte differentiated dendritic cells (MoDCs) from infected mice, pulsed them with P-10, and used them in the therapy of PCM in syngeneic mice. Similar to the results using BMDCs, the P10-pulsed MoDCs stimulated the proliferation of CD4+ T lymphocytes, induced a mixed production of Th1/Th2 cytokines and decreased the fungal burden in murine lungs in the setting of PCM. The process of differentiating MoDCs derived from an infected host, and subsequently used for therapy of PCM is much simpler than that for obtaining BMDCs, and represents a more reasonable approach to treat patients infected with Paracoccidioides. The results presented suggest that P10-primed MoDC may be a promising strategy to combat complicated PCM as well as to significantly shorten the lengthy requirements for treatment of patients with this fungal disease.
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Affiliation(s)
- Leandro B R Silva
- USP-LIM53, Laboratory of Medical Mycology, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Cleison L Taira
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Lucas S Dias
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ana C O Souza
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Joshua D Nosanchuk
- Departments of Medicine (Division of Infectious Diseases) and Microbiology and Immunology, Albert Einstein College of Medicine, New York, NY, United States
| | - Luiz R Travassos
- Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos P Taborda
- USP-LIM53, Laboratory of Medical Mycology, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil.,Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Griffiths J, Lopes Colombo A, Denning DW. The case for paracoccidioidomycosis to be accepted as a neglected tropical (fungal) disease. PLoS Negl Trop Dis 2019; 13:e0007195. [PMID: 31095569 PMCID: PMC6522030 DOI: 10.1371/journal.pntd.0007195] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Arnaldo Lopes Colombo
- Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil
| | - David W. Denning
- The University of Manchester, Manchester, United Kingdom
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Global Action Fund for Fungal Infections, Geneva, Switzerland
- * E-mail: ,
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9
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Gomes Carvalho Neto E, Coletto A, Biazus PG, Pereira Dos Santos I, Rieder CRM, de Castro Ribeiro M. Neuroparacoccidioidomycosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e519. [PMID: 30568997 PMCID: PMC6278888 DOI: 10.1212/nxi.0000000000000519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Euripedes Gomes Carvalho Neto
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Aline Coletto
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Paula Ghidini Biazus
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Iuri Pereira Dos Santos
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Carlos R M Rieder
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
| | - Marlise de Castro Ribeiro
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (E.G.C.N., A.C., P.G.B., I.P.d.S.); Movement Disorders Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (C.R.M.R.); and Neuroimmunology Division, Irmandade Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre (M.d.C.R.)
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10
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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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11
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Silva LBR, Dias LS, Rittner GMG, Muñoz JE, Souza ACO, Nosanchuk JD, Travassos LR, Taborda CP. Dendritic Cells Primed with Paracoccidioides brasiliensis Peptide P10 Are Therapeutic in Immunosuppressed Mice with Paracoccidioidomycosis. Front Microbiol 2017; 8:1057. [PMID: 28659882 PMCID: PMC5469887 DOI: 10.3389/fmicb.2017.01057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 05/26/2017] [Indexed: 01/23/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is an endemic systemic mycosis in Latin America, with the highest prevalence in Brazil, Colombia, and Venezuela. Fungi of the Paracoccidioides genus are etiologic agents of the disease. The 15 amino acid peptide P10 is derived from gp43, the main diagnostic antigen of Paracoccidioides brasiliensis. We previously reported that P10-pulsed dendritic cells (DCs) induce a protective response against P. brasiliensis. Presently, dexamethasone-treated BALB/c mice were intratracheally infected with P. brasiliensis Pb18 to establish the therapeutic efficacy of P10-pulsed DCs. Immunosuppressed and infected animals that received DCs had a reduction in their fungal burden, and this result was most pronounced in mice receiving DCs primed with P10. The efficacy of therapeutic DCs was significantly augmented by concomitant treatment with trimethoprim-sulfamethoxazole. Additionally, primed-DCs with or without the antifungal drug induced a beneficial Th1-biased immune response and significantly reduced tissue damage. In conclusion, these studies with immunocompromised mice demonstrate that P10-pulsed DCs with or without concomitant antifungal drugs are potently effective in combating invasive PCM. These findings support further translational studies to validate the use of P10-primed DCs for PCM in immunocompetent and immunosuppressed hosts.
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Affiliation(s)
- Leandro B R Silva
- Laboratory of Medical Mycology, Tropical Medicine Institute USP-LIM53, University of São PauloSão Paulo, Brazil
| | - Lucas S Dias
- Department of Microbiology, Institute of Biomedical Sciences, University of São PauloSão Paulo, Brazil
| | - Glauce M G Rittner
- Department of Microbiology, Institute of Biomedical Sciences, University of São PauloSão Paulo, Brazil
| | - Julián E Muñoz
- Department of Microbiology, Institute of Biomedical Sciences, University of São PauloSão Paulo, Brazil
| | - Ana C O Souza
- Department of Microbiology, Institute of Biomedical Sciences, University of São PauloSão Paulo, Brazil
| | - Joshua D Nosanchuk
- Department of Medicine, Albert Einstein College of Medicine, BronxNY, United States.,Department of Microbiology and Immunology, Albert Einstein College of Medicine, BronxNY, United States
| | - Luiz R Travassos
- Department of Microbiology, Immunology and Parasitology, Federal University of São PauloSão Paulo, Brazil
| | - Carlos P Taborda
- Laboratory of Medical Mycology, Tropical Medicine Institute USP-LIM53, University of São PauloSão Paulo, Brazil.,Department of Microbiology, Institute of Biomedical Sciences, University of São PauloSão Paulo, Brazil
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12
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Medina-Alarcón KP, Singulani JL, Voltan AR, Sardi JCO, Petrônio MS, Santos MB, Polaquini CR, Regasini LO, Bolzani VS, da Silva DHS, Chorilli M, Mendes-Giannini MJS, Fusco-Almeida AM. Alkyl Protocatechuate-Loaded Nanostructured Lipid Systems as a Treatment Strategy for Paracoccidioides brasiliensis and Paracoccidioides lutzii In Vitro. Front Microbiol 2017; 8:1048. [PMID: 28659880 PMCID: PMC5466964 DOI: 10.3389/fmicb.2017.01048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/26/2017] [Indexed: 12/04/2022] Open
Abstract
Dodecyl protocatechuate (dodecyl) is a derivative of protocatechuic acid (3,4-dihydroxybenzoic acid) that possesses anti-oxidant and antifungal properties. Nanostructured lipid systems (NLS) can potentiate the action of many antifungal agents, reducing the required dose and side effects by improving their activity. This work aimed to evaluate dodecyl protocatechuate loaded into a NLS (NLS+dodecyl) as a strategy for the treatment of Paracoccidioides brasiliensis and P. lutzii in vitro. Antifungal activity against P. brasiliensis and P. lutzii was evaluated using the microdilution technique. NLS+dodecyl showed high antifungal activity with a minimum inhibitory concentration ranging from 0.06 to 0.03 μg/mL; 4- to 16-fold higher than that of free dodecyl. NLS+dodecyl was able to inhibit fungal adhesion of the extracellular artificial matrix proteins (laminin and fibronectin), resulting in 82.4 and 81% inhibition, respectively, an increase of 8–17% compared with free dodecyl. These findings corroborate previous results demonstrating 65 and 74% inhibition of fungal adhesion in pulmonary fibroblast cells by dodecyl and NLS+dodecyl, respectively, representing a 9% increase in inhibition for NLS+dodecyl. Subsequently, cytotoxicity was evaluated using the 0.4% sulforhodamine B assay. NLS+dodecyl did not exhibit cytotoxicity in MRC5 (human pneumocyte) and HepG2 (human hepatic carcinoma) cells, thus increasing the selectivity index for NLS+dodecyl. In addition, cytotoxicity was evaluated in vivo using the Caenorhabditis elegans model; neither dodecyl nor NLS+dodecyl exhibited any toxic effects. Taken together, these results suggest that NLS can be used as a strategy to improve the activity of dodecyl against P. brasiliensis and P. lutzii because it improves antifungal activity, increases the inhibition of fungal adhesion in lung cells and the extracellular matrix in vitro, and does not exhibit any toxicity both in vitro and in vivo.
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Affiliation(s)
- Kaila P Medina-Alarcón
- Mycology Laboratory and Nucleus of Proteomics, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State UniversityAraraquara, Brazil
| | - Junya L Singulani
- Mycology Laboratory and Nucleus of Proteomics, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State UniversityAraraquara, Brazil
| | - Aline R Voltan
- Mycology Laboratory and Nucleus of Proteomics, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State UniversityAraraquara, Brazil
| | - Janaina C O Sardi
- Mycology Laboratory and Nucleus of Proteomics, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State UniversityAraraquara, Brazil
| | - Maicon S Petrônio
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University, São José do Rio PretoAraraquara, Brazil
| | - Mariana B Santos
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University, São José do Rio PretoAraraquara, Brazil
| | - Carlos R Polaquini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University, São José do Rio PretoAraraquara, Brazil
| | - Luis O Regasini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University, São José do Rio PretoAraraquara, Brazil
| | - Vanderlan S Bolzani
- Department of Chemistry, Institute of Chemistry, São Paulo State UniversityAraraquara, Brazil
| | - Dulce H S da Silva
- Department of Chemistry, Institute of Chemistry, São Paulo State UniversityAraraquara, Brazil
| | - Marlus Chorilli
- School of Pharmaceutical Sciences, Department of Drugs and Medicines, São Paulo State UniversityAraraquara, Brazil
| | - Maria J S Mendes-Giannini
- Mycology Laboratory and Nucleus of Proteomics, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State UniversityAraraquara, Brazil
| | - Ana M Fusco-Almeida
- Mycology Laboratory and Nucleus of Proteomics, Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State UniversityAraraquara, Brazil
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13
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Landgraf TN, Fernandes FF, Peron G, Panunto-Castelo A. Therapeutic effect of monophosphoryl lipid A administration on Paracoccidioides brasiliensis-infected mice. Med Mycol 2017; 55:344-348. [PMID: 27639241 DOI: 10.1093/mmy/myw074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/28/2016] [Indexed: 11/14/2022] Open
Abstract
The lack of antifungals with low toxicity and short-term therapy for patients with paracoccidioidomycosis (PCM) led us to evaluate adjuvants in immunotherapeutic intervention. We have previously shown complete Freund's adjuvant (CFA) to be therapeutic on experimental PCM. Owing to CFA toxicity, here we tested adjuvants approved for clinical use or in preclinical phase in experimental mouse PCM. Of all, only monophosporyl lipid A (MPLA) demonstrates a beneficial effect, by reducing the fungal burden and increasing the concentrations of IFN-γ and TNF-α, which are immunoprotective in PCM. These results suggest that MPLA might improve intervention in PCM.
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Affiliation(s)
- Taise Natali Landgraf
- Department of Biochemistry and Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fabrício Freitas Fernandes
- Department of Cellular and Molecular Biology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Gabriela Peron
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas, Campinas, SP
| | - Ademilson Panunto-Castelo
- Department of Biology, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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14
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Eyer-Silva WDA, Santana AC, Silva GARD, Azevedo MCVMD, Barreto JLTMS, Neumann MA, Castro IJD, Basílio-de-Oliveira RP, Araujo LFD, Ré NZ, Oliveira FMD, Simas CJDA, Sarvat MAD, Ferry FRDA. Laryngeal paracoccidioidomycosis presenting as solitary true vocal fold disease. IDCases 2017; 10:71-74. [PMID: 28966914 PMCID: PMC5608563 DOI: 10.1016/j.idcr.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/10/2017] [Accepted: 09/12/2017] [Indexed: 11/13/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by Paracoccidioides brasiliensis or P. lutzii. It is a neglected tropical infectious disease that poses a major public health burden in endemic areas of Latin America. Mucosae of the upper digestive and respiratory tracts are commonly involved and many patients have disease at multiple mucosal sites, with or without lung involvement. Mucosal PCM presenting as solitary true vocal fold disease is relatively rare. We present the case of a 67-year-old Brazilian forest guard who presented with a 6-month history of hoarseness and globus pharyngeus due to a solitary left true vocal fold infiltration and vegetation diagnosed as PCM. Silent pulmonary disease was also present. A laryngoscopy video is offered as supplemental material to this report. He completely remitted after surgical removal and amphotericin B deoxycholate treatment.
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15
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Abstract
Considered to be an emerging endemic mycosis in Latin America, paracoccidioidomycosis
is characterized by a chronic course and involvement of multiple organs in
immunocompromised hosts. Infection sequelae are mainly related to pulmonary and
adrenal insufficiency. The host-parasite interaction results in different expressions
of the immune response depending on parasite pathogenicity, fungal load and genetic
characteristics of the host. A few controlled and case series reports have shown that
azoles and fast-acting sulfa derivatives are useful treatment alternatives in milder
forms of the disease. For moderate/severe cases, more prolonged treatments or even
parenteral routes are required especially when there is involvement of the digestive
tract mucosa, resulting in poor drug absorption. Although comparative studies have
reported that shorter treatment regimens with itraconazole are able to induce cure in
chronically-infected patients, there are still treatment challenges such as the need
for more controlled studies involving acute cases, the search for new drugs and
combinations, and the search for compounds capable of modulating the immune response
in severe cases as well as the paradoxical reactions.
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16
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Lipoxin Inhibits Fungal Uptake by Macrophages and Reduces the Severity of Acute Pulmonary Infection Caused by Paracoccidioides brasiliensis. Mediators Inflamm 2015; 2015:852574. [PMID: 26635449 PMCID: PMC4618125 DOI: 10.1155/2015/852574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/20/2015] [Indexed: 01/01/2023] Open
Abstract
Cysteinyl leukotrienes (CysLTs) and lipoxins (LXs) are lipid mediators that control inflammation, with the former inducing and the latter inhibiting this process. Because the role played by these mediators in paracoccidioidomycosis was not investigated, we aimed to characterize the role of CysLT in the pulmonary infection developed by resistant (A/J) and susceptible (B10.A) mice. 48 h after infection, elevated levels of pulmonary LTC4 and LXA4 were produced by both mouse strains, but higher levels were found in the lungs of susceptible mice. Blocking the CysLTs receptor by MTL reduced fungal loads in B10.A, but not in A/J mice. In susceptible mice, MLT treatment led to reduced influx of PMN leukocytes, increased recruitment of monocytes, predominant synthesis of anti-inflammatory cytokines, and augmented expression of 5- and 15-lipoxygenase mRNA, suggesting a prevalent LXA4 activity. In agreement, MTL-treated macrophages showed reduced fungal burdens associated with decreased ingestion of fungal cells. Furthermore, the addition of exogenous LX reduced, and the specific blockade of the LX receptor increased the fungal loads of B10.A macrophages. This study showed for the first time that inhibition of CysLTs signaling results in less severe pulmonary paracoccidioidomycosis that occurs in parallel with elevated LX activity and reduced infection of macrophages.
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17
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Cyclopalladated Compound 7a Induces Apoptosis- and Autophagy-Like Mechanisms in Paracoccidioides and Is a Candidate for Paracoccidioidomycosis Treatment. Antimicrob Agents Chemother 2015; 59:7214-23. [PMID: 26349827 DOI: 10.1128/aac.00512-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/26/2015] [Indexed: 12/14/2022] Open
Abstract
Paracoccidioidomycosis (PCM), caused by Paracoccidioides species, is the main cause of death due to systemic mycoses in Brazil and other Latin American countries. Therapeutic options for PCM and other systemic mycoses are limited and time-consuming, and there are high rates of noncompliance, relapses, toxic side effects, and sequelae. Previous work has shown that the cyclopalladated 7a compound is effective in treating several kinds of cancer and parasitic Chagas disease without significant toxicity in animals. Here we show that cyclopalladated 7a inhibited the in vitro growth of Paracoccidioides lutzii Pb01 and P. brasiliensis isolates Pb18 (highly virulent), Pb2, Pb3, and Pb4 (less virulent) in a dose-response manner. Pb18 was the most resistant. Opportunistic Candida albicans and Cryptococcus neoformans were also sensitive. BALB/c mice showed significantly lighter lung fungal burdens when treated twice a day for 20 days with a low cyclopalladated 7a dose of 30 μg/ml/day for 30 days after intratracheal infection with Pb18. Electron microscopy images suggested that apoptosis- and autophagy-like mechanisms are involved in the fungal killing mechanism of cyclopalladated 7a. Pb18 yeast cells incubated with the 7a compound showed remarkable chromatin condensation, DNA degradation, superoxide anion production, and increased metacaspase activity suggestive of apoptosis. Autophagy-related killing mechanisms were suggested by increased autophagic vacuole numbers and acidification, as indicated by an increase in LysoTracker and monodansylcadaverine (MDC) staining in cyclopalladated 7a-treated Pb18 yeast cells. Considering that cyclopalladated 7a is highly tolerated in vivo and affects yeast fungal growth through general apoptosis- and autophagy-like mechanisms, it is a novel promising drug for the treatment of PCM and other mycoses.
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18
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Batista VG, Toledo MS, Straus AH, Mendes-Giannini MJS, Duarte AJS, Takahashi HK, Benard G. Glycolipid sensing and innate immunity in paracoccidioidomycosis. Mycopathologia 2014; 178:153-62. [PMID: 25026908 DOI: 10.1007/s11046-014-9783-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/26/2014] [Indexed: 11/26/2022]
Abstract
Distinct glycolipid profiles are described in microorganisms, which have been shown to modulate the innate immune system. We tested the hypothesis that glycosphingolipids from Paracoccidioides brasiliensis have immunomodulatory properties on monocytes and dendritic cells of two groups of healthy individuals, one cured of paracoccidioidomycosis in the past (CUR-I) and the other nonexposed to P. brasiliensis (HNE-I). Two classes of glycosphingolipids purified from yeast cells were evaluated: a neutral glycosphingolipid, monohexosylceramide (CMH), and acidic glycosylinositolphosphorylceramides (GIPCs). Both glycosphingolipids affected the functioning of innate immunity cells, interfering with the antigen presenting process: P. brasiliensis yeast cells phagocytosis, IL-10 secretion, and costimulatory molecules and recognition receptors expression by monocytes were altered, while dendritic cell antigen presentation to autologous T cells was markedly down-modulated as shown by reduced T-cell proliferative responses. The mechanisms by which CMH and GIPCs exert their effects differ since the target cells did not always respond similarly to the challenge with the glycosphingolipids. Moreover, CUR-I and HNE-I presented different responses to the glycosphingolipids. Differences not only in the glycosphingolipid structure (such as the polar head group or the ceramide moiety), but also in the innate immunity properties of CUR-I and HNE-I, may underlie these differences and contribute to individual's susceptibility or resistance to develop paracoccidioidomycosis.
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Affiliation(s)
- Vanessa G Batista
- Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of São Paulo, Av Dr. Eneas de Carvalho Aguiar 470, São Paulo, CEP 05403-000, Brazil
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19
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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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20
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Bocca AL, Amaral AC, Teixeira MM, Sato PK, Shikanai-Yasuda MA, Soares Felipe MS. Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues. Future Microbiol 2013; 8:1177-91. [DOI: 10.2217/fmb.13.68] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Acquired by inhalation of the thermal dimorphic fungi Paracoccidioides spp. conidia, paracoccidioidomycosis ranges from symptomatic to severe and potentially fatal disseminated disease. The main focus of this review is to highlight clinical aspects of paracoccidioidomycosis and, its pathogens’ diversity ecology and particularities. In addition, we present strategies for therapy, including DNA vaccines and nanostructured drugs. Molecular and morphological data supported the split of the Paracoccidioides genus into two species, Paracoccidioides brasiliensis and Paracoccidioides lutzii. An acute form of the disease affects approximately 5% of cases and involves the phagocytic mononuclear system, resulting in progressive lymphadenopathy. The chronic form affects adult men and frequently involves lungs, skin and mucous membranes, lymph nodes, and adrenal glands. The clinical manifestations depend on the ability of the host to control the fungal multiplication and dissemination. The long survival time of the fungus in the host tissues allows it to evade immune responses; therefore, successful treatment often requires long-time therapy. The consensus for treatment must consider the severity of the disease and includes sulfone derivatives, amphotericin B and azoles. Novel strategies for therapy, based on DNA vaccines and nanostructured drugs are also presented and discussed in this review.
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Affiliation(s)
| | - André Corrêa Amaral
- Biotechnology, Institute of Tropical Pathology & Public Health, Universidade Federal de Goiás, Goiania, GO, Brazil
| | | | - Paula Keiko Sato
- Laboratory of Clinical Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, Brazil
| | - Maria Aparecida Shikanai-Yasuda
- Laboratory of Clinical Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, Brazil
- Department of Infectious & Parasitic Diseases, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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