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Sepúlveda VE, Goldman WE, Matute DR. Genotypic diversity, virulence, and molecular genetic tools in Histoplasma. Microbiol Mol Biol Rev 2024; 88:e0007623. [PMID: 38819148 DOI: 10.1128/mmbr.00076-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
SUMMARYHistoplasmosis is arguably the most common fungal respiratory infection worldwide, with hundreds of thousands of new infections occurring annually in the United States alone. The infection can progress in the lung or disseminate to visceral organs and can be difficult to treat with antifungal drugs. Histoplasma, the causative agent of the disease, is a pathogenic fungus that causes life-threatening lung infections and is globally distributed. The fungus has the ability to germinate from conidia into either hyphal (mold) or yeast form, depending on the environmental temperature. This transition also regulates virulence. Histoplasma and histoplasmosis have been classified as being of emergent importance, and in 2022, the World Health Organization included Histoplasma as 1 of the 19 most concerning human fungal pathogens. In this review, we synthesize the current understanding of the ecological niche, evolutionary history, and virulence strategies of Histoplasma. We also describe general patterns of the symptomatology and epidemiology of histoplasmosis. We underscore areas where research is sorely needed and highlight research avenues that have been productive.
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Affiliation(s)
- Victoria E Sepúlveda
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William E Goldman
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel R Matute
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Mussin J, Giusiano G, Porras JC, Corredor Sanguña LH, Pividori MI. Carbon nanoparticle-based lateral flow assay for the detection of specific double-tagged DNA amplicons of Paracoccidioides spp. Mikrochim Acta 2024; 191:287. [PMID: 38671236 DOI: 10.1007/s00604-024-06367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
To overcome the limitations of current methods for diagnosing paracoccidioidomycosis (PCM), it is critical to develop novel diagnostic strategies that can be implemented in low-resource settings and dramatically improve turnaround times. This study focused on the development of a portable molecular test to screen for Paracoccidioides spp. The proposed approach integrated double-tagging polymerase chain reaction (PCR) and a paper-based lateral flow assay (LFA) for readout, using carbon nanoparticles as a signal generation system. Primers tagged with biotin and digoxigenin were employed to conduct the double-tagging PCR, which can be conveniently carried out on portable thermocyclers. This method can generate billions of tagged DNA copies from a single target molecule, which can be rapidly detected by the LFA platform, providing results within minutes. Avidin-modified carbon nanoparticles served as a signal generation system, enabling detection in the immunochromatographic assay. The LFA demonstrated the capability to detect double-tagged amplicons as low as 0.21 ng or 0.10 ng, depending on whether the results were assessed visually or with a smartphone equipped with an image processor. These findings suggest that the proposed approach holds great promise as a point-of-care diagnostic tool for the early and accurate detection of PCM in low-resource settings. The diagnostic test is rapid and inexpensive, requires minimal handling and can be easily introduced into the general practitioner's armoury for ambulatory screening of infection. This innovative approach has the potential to make a substantial contribution to PCM diagnosis, ultimately reducing morbidity and mortality associated with this disease.
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Affiliation(s)
- Javier Mussin
- Institute of Biotechnology and Biomedicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
- Instituto de Medicina Regional, Universidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Av. Las Heras 727, 3500, Resistencia, Chaco, Argentina.
| | - Gustavo Giusiano
- Instituto de Medicina Regional, Universidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Av. Las Heras 727, 3500, Resistencia, Chaco, Argentina
| | - Juan Carlos Porras
- Grup de Sensors I Biosensors, Departament de Química, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Luis Hernando Corredor Sanguña
- Instituto de Medicina Regional, Universidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Av. Las Heras 727, 3500, Resistencia, Chaco, Argentina
| | - María Isabel Pividori
- Institute of Biotechnology and Biomedicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
- Grup de Sensors I Biosensors, Departament de Química, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
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3
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Romiti R, Hirayama ALDS, Porro AM, Gonçalves HDS, Miot LDB, Durães SMB, Marques SA. Infections in the era of immunobiologicals. An Bras Dermatol 2024; 99:167-180. [PMID: 38238209 PMCID: PMC10943328 DOI: 10.1016/j.abd.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 03/11/2024] Open
Abstract
Immunobiologicals represent an innovative therapeutic option in dermatology. They are indicated in severe and refractory cases of different diseases when there is contraindication, intolerance, or failure of conventional systemic therapy and in cases with significant impairment of patient quality of life. The main immunobiologicals used in dermatology basically include inhibitors of tumor necrosis factor-alpha (anti-TNF), inhibitors of interleukin-12 and -23 (anti-IL12/23), inhibitors of interleukin-17 and its receptor (anti-IL17), inhibitors of interleukin-23 (anti-IL23), rituximab (anti-CD20 antibody), dupilumab (anti-IL4/IL13) and intravenous immunoglobulin. Their immunomodulatory action may be associated with an increase in the risk of infections in the short and long term, and each case must be assessed individually, according to the risk inherent to the drug, the patient general condition, and the need for precautions. This article will discuss the main risks of infection associated with the use of immunobiologicals, addressing the risk in immunocompetent and immunosuppressed patients, vaccination, fungal infections, tuberculosis, leprosy, and viral hepatitis, and how to manage the patient in the most diverse scenarios.
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Affiliation(s)
- Ricardo Romiti
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Adriana Maria Porro
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Heitor de Sá Gonçalves
- State Health Secretariat of Ceará, Centro de Dermatologia Dona Libânia, Fortaleza, CE, Brazil
| | - Luciane Donida Bartoli Miot
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Sandra Maria Barbosa Durães
- Department of Internal Medicine, Dermatology Unit, Faculty of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Silvio Alencar Marques
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Falcão EMM, Freitas DFS, Coutinho ZF, Quintella LP, Muniz MDM, Almeida-Paes R, Zancopé-Oliveira RM, de Macedo PM, do Valle ACF. Trends in the Epidemiological and Clinical Profile of Paracoccidioidomycosis in the Endemic Area of Rio de Janeiro, Brazil. J Fungi (Basel) 2023; 9:946. [PMID: 37755054 PMCID: PMC10532664 DOI: 10.3390/jof9090946] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a neglected endemic mycosis in Latin America. Most cases occur in Brazil. It is classified as PCM infection and PCM disease and is subdivided into chronic (adult type) or acute (juvenile type) disease, with the latter being less frequent and more severe. In 2016, we reported an increase in the numbers of patients diagnosed with acute PCM after a highway's construction. We conducted a study at INI-Fiocruz, a reference center for infectious diseases, including endemic mycoses, in Rio de Janeiro, Brazil, aiming to deepen the analysis of this new clinical and epidemiological profile of PCM. The authors developed a retrospective study including 170 patients diagnosed with PCM between 2010 and 2019. There was an increase in the number of atypical and severe forms, starting in 2014. In subsequent years, we detected a higher incidence of adverse outcomes with patients requiring more hospitalizations and an increased mortality rate. We estimate that PCM has become more severe throughout the Rio de Janeiro state, affecting a greater number of young individuals and leading to a greater number of and longer hospitalizations. Surveillance measures and close monitoring of future notification data in the state, with emphasis on children, adolescents, and young adults are necessary for a better understanding of the perpetuation of this public health challenge.
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Affiliation(s)
- Eduardo Mastrangelo Marinho Falcão
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (D.F.S.F.); (P.M.d.M.); (A.C.F.d.V.)
| | - Dayvison Francis Saraiva Freitas
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (D.F.S.F.); (P.M.d.M.); (A.C.F.d.V.)
| | - Ziadir Francisco Coutinho
- Germano Sinval Faria School Health Center, Sergio Arouca National School of Public Health, Fiocruz, Rio de Janeiro 21040-900, Brazil;
| | - Leonardo Pereira Quintella
- Anatomical Pathology Service, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil;
| | - Mauro de Medeiros Muniz
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.d.M.M.); (R.A.-P.); (R.M.Z.-O.)
| | - Rodrigo Almeida-Paes
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.d.M.M.); (R.A.-P.); (R.M.Z.-O.)
| | - Rosely Maria Zancopé-Oliveira
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.d.M.M.); (R.A.-P.); (R.M.Z.-O.)
| | - Priscila Marques de Macedo
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (D.F.S.F.); (P.M.d.M.); (A.C.F.d.V.)
| | - Antonio Carlos Francesconi do Valle
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro 21040-900, Brazil; (D.F.S.F.); (P.M.d.M.); (A.C.F.d.V.)
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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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Costa RDS, Hygino da Cruz Jr LC, de Souza SR, Ventura N, Corrêa DG. Insights into Magnetic Resonance Imaging Findings in Central Nervous System Paracoccidioidomycosis: A Comprehensive Review. Res Rep Trop Med 2023; 14:87-98. [PMID: 37554584 PMCID: PMC10406117 DOI: 10.2147/rrtm.s391633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a infection caused by the thermodimorphic fungus Paracoccidioides spp. (P. lutzii and, mainly, P. brasiliensis). This infection predominantly affects rural male workers aged between 30 and 50 years old who deal with soil on daily activities. Clinically, the disease is classified as acute/subacute phase, which evolves rapidly, secondary to dissemination of the fungus through to the phagocytic-mononuclear system, leading to fever, weight loss, and anorexia, associated with hepatosplenomegaly and lymphadenopathy, which can be complicated with suppuration and fistulization; and chronic phase, which corresponds to 74% to 95% of symptomatic cases, with a common pulmonary involvement. Central nervous system involvement is almost always a characteristic of the chronic form. Inhalation is the most common route of primary infection, usually affecting the lungs, forming the primary complex. From the primary complex, hematogenic dissemination can occur to any organ, including the brain and spinal cord. Although PCM of the central nervous system diagnosis is usually based on histopathological analysis and the imaging features are not specific for PCM, computed tomography and magnetic resonance imaging can demonstrate evidences of granuloma, abscess, meningitis, or a combination of these lesions, contributing to a preoperative diagnosis, especially when considered in conjunction with epidemiology. In this article, we review the pathophysiology, clinical manifestations and imaging aspects of neuro-PCM.
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Affiliation(s)
- Rangel de Sousa Costa
- Department of Radiology, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
| | | | - Simone Rachid de Souza
- Department of Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Nina Ventura
- Department of Radiology, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
| | - Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil
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de Castro JDV. A new sign in paracoccidioidomycosis neuroimaging. Radiol Bras 2023; 56:XI-XII. [PMID: 37829582 PMCID: PMC10567089 DOI: 10.1590/0100-3984.2023.56.4e4-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
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Silva LBB, Brunaldi MO, Martinez R, Costa JACD. Peritonitis caused by paracoccidioides spp. in a patient on continuous ambulatory peritoneal dialysis - A case report. Braz J Infect Dis 2023; 27:102792. [PMID: 37488046 PMCID: PMC10412859 DOI: 10.1016/j.bjid.2023.102792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
Paracoccidioidomycosis is a systemic mycosis found mainly in South America and is the most prevalent endemic and systemic mycosis in Brazil. The purpose of this paper was to report the case of a male patient who developed peritonitis caused by Paracoccidioides spp. Forty-eight-year-old, male patient, with type I Diabetes mellitus and chronic kidney disease who was undergoing a Continuous Ambulatory Peritoneal Dialysis (CAPD) program. After eighteen months of peritoneal dialysis, the patient developed turbidity of the peritoneal fluid and was diagnosed with peritonitis. Direct mycological examination of the peritoneal fluid revealed yeasts with morphology suggestive of Paracoccidioides spp. The patient was treated with sulfamethoxazole-trimethoprim (1,600 mg/320 mg dose/day) for 61 days, but he died because a bacterial septic shock. The diagnosis of opportunistic PCM peritonitis was later confirmed by autopsy and Paracoccidioides spp. isolation. This is the first reported case of a patient on CAPD who experienced complications due peritonitis caused by opportunistic PCM.
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Affiliation(s)
- Lázaro Bruno Borges Silva
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Divisão de Nefrologia, Ribeirão Preto, SP, Brazil
| | - Mariângela Ottoboni Brunaldi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Patologia, Ribeirão Preto, SP, Brazil
| | - Roberto Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Divisão de Doenças Infecciosas e Tropicais, Ribeirão Preto, SP, Brazil
| | - José Abrão Cardeal da Costa
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Divisão de Nefrologia, Ribeirão Preto, SP, Brazil.
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Giusiano G, Tracogna F, Santiso G, Rojas F, Messina F, Sosa V, Chacón Y, Sosa MDLÁ, Mussin J, Cattana ME, Vazquez A, Formosa P, Fernández N, Piedrabuena M, Valdez R, Davalos F, Fernández M, Acuña A, Aguilera A, Guelfand L, Afeltra J, Garcia Effron G, Posse G, Amigot S, Serrano J, Sellares O, Álvarez C, Pineda G, Carnovale S, Zalazar L, Canteros C. Clinical and Demographic Features of Paracoccidioidomycosis in Argentina: A Multicenter Study Analysis of 466 Cases. J Fungi (Basel) 2023; 9:jof9040482. [PMID: 37108936 PMCID: PMC10145406 DOI: 10.3390/jof9040482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/01/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Information on paracoccidioidomycosis (PCM) in Argentina is fragmented and has historically been based on estimates, supported only by a series of a few reported cases. Considering the lack of global information, a national multicentric study in order to carry out a more comprehensive analysis was warranted. We present a data analysis including demographic and clinical aspects of a historical series of 466 cases recorded over 10 years (2012-2021). Patients were aged from 1 to 89 years. The general male: female (M:F) ratio was 9.5:1 with significant variation according to the age group. Interestingly, the age range 21-30 shows an M:F ratio of 2:1. Most of the cases (86%) were registered in northeast Argentina (NEA), showing hyperendemic areas in Chaco province with more than 2 cases per 10,000 inhabitants. The chronic clinical form occurred in 85.6% of cases and the acute/subacute form occurred in 14.4% of cases, but most of these juvenile type cases occurred in northwestern Argentina (NWA). In NEA, the incidence of the chronic form was 90.6%; in NWA, the acute/subacute form exceeded 37%. Diagnosis by microscopy showed 96% positivity but antibody detection displays 17% of false negatives. Tuberculosis was the most frequent comorbidity, but a diverse spectrum of bacterial, fungal, viral, parasitic, and other non-infectious comorbidities was recorded. This national multicenter registry was launched in order to better understand the current status of PCM in Argentina and shows the two endemic zones with a highly diverse epidemiology.
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Affiliation(s)
- Gustavo Giusiano
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia 3500, Argentina
- Hospital Pediátrico Juan Pablo II, Corrientes 3400, Argentina
| | | | - Gabriela Santiso
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Uspallata, Buenos Aires 2272, Argentina
| | - Florencia Rojas
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia 3500, Argentina
| | - Fernando Messina
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Uspallata, Buenos Aires 2272, Argentina
| | - Vanesa Sosa
- Servicio de Micología, Hospital Dr. Ramon Madariaga, Av. Marconi 3736, Posadas N3300, Argentina
| | - Yone Chacón
- Hospital Señor del Milagro, Salta 4400, Argentina
| | - Maria de Los Ángeles Sosa
- Laboratorio Central de Redes y Programas, Facultad de Ciencias Exactas y Naturales y Agrimensura, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Placido Martínez, Corrientes 1044, Argentina
| | - Javier Mussin
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia 3500, Argentina
| | | | - Andrea Vazquez
- Servicio de Microbiología, Hospital 4 de Junio Ramón Carrillo, Roque Sáenz Peña, Av. Malvinas Argentinas 1350, Sáenz Peña H3700, Argentina
| | - Patricia Formosa
- Hospital de Alta Complejidad Pte. J. D. Perón, Av. Pantaleón Gómez & Av. Dr. Nestor Kirchner, Formosa 3600, Argentina
| | - Norma Fernández
- Laboratorio de Micología, Hospital de Clínicas, José de San Martin, Buenos Aires 2351, Argentina
| | - Milagros Piedrabuena
- Laboratorio de Microbiología, Hospital San Martín, Pres. Juan Domingo Perón 450, Paraná 3100, Argentina
| | - Ruth Valdez
- Hospital Señor del Milagro, Salta 4400, Argentina
| | - Florencia Davalos
- Servicio de Microbiología, Hospital San Bernardo, Av. José Tobias 69, Salta 4400, Argentina
| | | | | | | | - Liliana Guelfand
- Sección Microbiología, Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires 1425, Argentina
| | - Javier Afeltra
- Unidad de Parasitología y Micología, Hospital General de Agudos José María Ramos Mejía, Ciudad Autónoma de Buenos Aires 1221, Argentina
| | - Guillermo Garcia Effron
- Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, CONICET, Santa Fe 2750, Argentina
| | - Gladys Posse
- Hospital Nacional Prof. Dr. A. Posadas, Buenos Aires 1684, Argentina
| | - Susana Amigot
- CEMAR Microbiología, Dir. Bioquímica, Secretaría de Salud Pública, Rosario 2020, Argentina
| | - Julian Serrano
- Sección Micología, Hospital Independencia, Av. Belgrano Nte. 660, Santiago del Estero 4200, Argentina
| | | | - Christian Álvarez
- División Micología-Laboratorio de Salud Pública de Tucumán, Tucumán 4000, Argentina
| | - Gloria Pineda
- Hospital Universitario Austral, Pilar, Buenos Aires 1500, Argentina
| | - Susana Carnovale
- Hospital de Pediatría S.A.M.I.C. Prof. Juan P. Garraham, Pichincha 1890, Buenos Aires 1245, Argentina
| | - Laura Zalazar
- Facultad de Humanidades, Universidad Nacional del Nordeste, Las Heras 727, Resistencia H3500COI, Argentina
| | - Cristina Canteros
- Departamento de Micología, INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires 1281, Argentina
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Peçanha-Pietrobom PM, Tirado-Sánchez A, Gonçalves SS, Bonifaz A, Colombo AL. Diagnosis and Treatment of Pulmonary Coccidioidomycosis and Paracoccidioidomycosis. J Fungi (Basel) 2023; 9:218. [PMID: 36836333 PMCID: PMC9959547 DOI: 10.3390/jof9020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Coccidioidomycosis (CM) and paracoccidioidomycosis (PCM) are systemic mycoses that are highly endemic in Latin America and have recently been included on the World Health Organization (WHO) Fungal Priority Pathogens List. Coccidioides immitis and Coccidioides posadasii are recognized as etiological agents of CM, with peculiarities in their geographic distribution. The genus Paracoccidioides now includes Paracoccidioides lutzii and the Paracoccidioides brasiliensis complex, which encompasses four phylogenetic species. In both diseases, pulmonary signs and symptoms are the main reasons for patients to seek medical assistance, and they are frequently misdiagnosed as tuberculosis. In this paper, we present a critical view of the strategies for diagnosis and clinical management of CM and PCM. Over the past few decades, there has been an increase in the number of reports of endemic fungal infections in areas previously thought to be "non-endemic" due to climate change and increased travel, among other factors. Learning to recognize their main epidemiological aspects and clinical manifestations is crucial so that clinicians can include them in the differential diagnosis of lung disease and avoid late diagnosis.
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Affiliation(s)
| | - Andrés Tirado-Sánchez
- Dermatology Service & Mycology Department, Hospital General de México, “Dr. Eduardo Liceaga”, Mexico City 06726, Mexico
- Internal Medicine Department, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Mexico City 07950, Mexico
| | - Sarah Santos Gonçalves
- Department of Pathology, Infectious Diseases Postgraduate Program, Federal University of Espírito Santo (UFES), Vitoria 29043900, Brazil
| | - Alexandro Bonifaz
- Internal Medicine Department, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Mexico City 07950, Mexico
| | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo 04039032, Brazil
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de Oliveira VF, Magri MMC, Levin AS, Silva GD. Systematic review of neuroparacoccidioidomycosis: The contribution of neuroimaging. Mycoses 2023; 66:168-175. [PMID: 36062632 DOI: 10.1111/myc.13525] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Advanced neuroimaging demonstrated that neurological involvement occurs in up to 30% of paracoccidioidomycosis (PCM) cases. Current knowledge of neuroparacoccidioidomycosis (NPCM) is based on a 2009 systematic review. However, in the last decade, several new cases have been published, with modern neuroimaging techniques. OBJECTIVES We believe a new systematic review is needed to summarise these advances. METHODS We searched PubMed/MEDLINE, Embase and LILACS for studies from January 2010 to May 2022. Case series and case reports of NPCM were included. We performed a metaproportion to estimate a summary proportion with 95% confidence intervals (CI). RESULTS Thirty-four studies including 104 patients were evaluated. We combined our data with the results from the previous review that included 257 cases, totalling 361 patients. We found no new important demographic, clinical or laboratory characteristics. On magnetic resonance imaging (MRI), we found that 72% (95%CI: 38-91) had hyperintensity on T1-weighted image; 84% (95%CI: 71%-92%) had hypointensity on T2-weighted image; 80% (95%CI: 66-89) had contrast enhancement with the classical ring-enhancing pattern. All 8 patients undergoing spectroscopy presented lipid peaks. We found a 16% mortality, lower than in the previous review (44%). CONCLUSION NPCM presents a characteristic pattern on MRI that may help to differentiate it from other causes of single or multiple brain lesions. Albeit there is a frequent pattern, it is not specific, as other granulomatous diseases may show similar findings. Advances in neuroimaging with early diagnosis and appropriate management of the disease may have contributed to reducing its mortality.
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Affiliation(s)
- Vítor Falcão de Oliveira
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcello Mihailenko Chaves Magri
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna S Levin
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme Diogo Silva
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Marinho Falcão EM, da Costa Medeiros M, Freitas AD, de Almeida Soares JC, Fernandes Pimentel MI, Quintella LP, Saraiva Freitas DF, de Macedo PM, do Valle ACF. Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn's disease. PLoS Negl Trop Dis 2023; 17:e0011023. [PMID: 36626374 PMCID: PMC9870162 DOI: 10.1371/journal.pntd.0011023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/23/2023] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic mycosis endemic in Latin America, mostly in Brazil. The involvement of the gastrointestinal tract is uncommon and usually associated with the acute form. Recently, a cluster of acute PCM cases has been described in Rio de Janeiro, Brazil. We report a 42-year-old male, resident of Rio de Janeiro, presenting chronic diarrhea and abdominal pain in the past 3 years, previously diagnosed as Chron´s disease. When immunosuppressive therapy was prescribed, the patient evolved with worsening of the previous symptoms in addition to odynophagia, 20 kg-weight loss, disseminated skin lesions, diffuse lymphadenopathy and adrenal insufficiency. Histopathological and mycological examination of a skin lesion were compatible with PCM. Itraconazole was prescribed in high doses (400 mg/day). After seven months of treatment, the patient presented with acute abdominal pain which led to an emergent appendectomy, revealing the presence of the fungus. After 24 months, the patient reached clinical cure and recovered from adrenal insufficiency. We emphasize the importance of PCM as a differential diagnosis in patients with chronic diarrhea. The risk of fungal infections should be considered prior to initiating immunosupressive therapies, particularly in endemic areas.
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Affiliation(s)
- Eduardo Mastrangelo Marinho Falcão
- Clinical Research Laboratory on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
- * E-mail:
| | - Manuela da Costa Medeiros
- Department of Inpatient Health Care, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Andrea d´Ávila Freitas
- Department of Inpatient Health Care, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - João Carlos de Almeida Soares
- Department of Gastroenterology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Maria Inês Fernandes Pimentel
- Laboratory of Clinical Research and Surveillance on Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Leonardo Pereira Quintella
- Anatomical Pathology Service, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Dayvison Francis Saraiva Freitas
- Clinical Research Laboratory on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Priscila Marques de Macedo
- Clinical Research Laboratory on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Antônio Carlos Francesconi do Valle
- Clinical Research Laboratory on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
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Silva LDC, Silva KSFE, Rocha OB, Barbosa KLB, Rozada AMF, Gauze GDF, Soares CMDA, Pereira M. Proteomic Response of Paracoccidioides brasiliensis Exposed to the Antifungal 4-Methoxynaphthalene-N-acylhydrazone Reveals Alteration in Metabolism. J Fungi (Basel) 2022; 9:jof9010066. [PMID: 36675887 PMCID: PMC9865261 DOI: 10.3390/jof9010066] [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: 11/25/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Paracoccidioidomycosis is a neglected mycosis with a high socioeconomic impact that requires long-term treatment with antifungals that have limitations in their use. The development of antifungals targeting essential proteins that are present exclusively in the fungus points to a potentially promising treatment. Methods: The inhibitor of the enzyme homoserine dehydrogenase drove the synthesis of N'-(2-hydroxybenzylidene)-4-methoxy-1-naphthohydrazide (AOS). This compound was evaluated for its antifungal activity in different species of Paracoccidioides and the consequent alteration in the proteomic profile of Paracoccidioides brasiliensis. Results: The compound showed a minimal inhibitory concentration ranging from 0.75 to 6.9 μM with a fungicidal effect on Paracoccidioides spp. and high selectivity index. AOS differentially regulated proteins related to glycolysis, TCA, the glyoxylate cycle, the urea cycle and amino acid metabolism, including homoserine dehydrogenase. In addition, P. brasiliensis inhibited protein synthesis and stimulated reactive oxygen species in the presence of AOS. Conclusions: AOS is a promising antifungal agent for the treatment of PCM, targeting important metabolic processes of the fungus.
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Affiliation(s)
- Lívia do Carmo Silva
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiás 74690-900, Brazil
- Correspondence: (L.d.C.S.); (M.P.); (K.S.F.e.S.); Tel.: +55-6235211110 (K.S.F.e.S.)
| | - Kleber Santiago Freitas e Silva
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiás 74690-900, Brazil
- Correspondence: (L.d.C.S.); (M.P.); (K.S.F.e.S.); Tel.: +55-6235211110 (K.S.F.e.S.)
| | - Olívia Basso Rocha
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiás 74690-900, Brazil
| | | | | | | | - Célia Maria de Almeida Soares
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiás 74690-900, Brazil
| | - Maristela Pereira
- Laboratory of Molecular Biology, Institute of Biological Sciences, Federal University of Goiás, Goiás 74690-900, Brazil
- Correspondence: (L.d.C.S.); (M.P.); (K.S.F.e.S.); Tel.: +55-6235211110 (K.S.F.e.S.)
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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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Paracoccidioidomycosis in people living with HIV/AIDS: A historical retrospective cohort study in a national reference center for infectious diseases, Rio de Janeiro, Brazil. PLoS Negl Trop Dis 2022; 16:e0010529. [PMID: 35704666 PMCID: PMC9239448 DOI: 10.1371/journal.pntd.0010529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/28/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is one of the main endemic systemic mycoses in Latin America, usually occurring in rural areas. When PCM occurs simultaneously with underlying immunosuppressive conditions, it can present as an opportunistic disease. Between 2000 and 2017, literature reported around 200 PCM cases in people living with HIV/AIDS (PLWHA). To address research gaps on this co-infection and to study its possible temporal changes in the last decade, we performed an active co-infection case search on the HIV/AIDS and PCM cohorts from a Brazilian reference center database from 1989 to 2019. We found 20 PLWHA among 684 PCM patients (2.92%), predominantly male (70.0%) and urban workers (80.0%). The median age of patients was higher in the 2010–2019 decade (p = 0.006). The occurrence of PCM in PLWHA was lower when compared with other fungal diseases. Although 50.0% of the patients had already been diagnosed with HIV infection and presented CD4+ T cell counts greater than 200/mm3 at the time of PCM diagnosis, the suspicion of immunosuppression in the context of atypical and more severe clinical forms of PCM revealed the diagnosis of HIV infection in 35.0% of the patients. Two (10.0%) patients had an evolution compatible with immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral therapy (ART).We highlight the importance of considering a PCM diagnosis in PLWHA to prevent a late-onset treatment and progression to severe manifestations and unfavorable outcomes. In addition, HIV investigation is recommended in PCM patients, especially those with atypical and more severe clinical presentations. Paracoccidioidomycosis (PCM) is a severe systemic mycosis caused by inhalation of fungi belonging to the genus Paracoccidioides present in the soil of endemic areas in Latin America. However, it is still a neglected disease, affecting vulnerable populations such as rural workers. In the last decade, there was an increase of acute PCM cases in young people living in urban areas of the endemic area of Rio de Janeiro, Brazil. This could increase the occurrence of PCM in people living HIV/AIDS (PLWHA) because they are more concentrated in these regions. When PCM and immunosuppression due to AIDS occur simultaneously, PCM can present as an opportunistic disease, with more severe, invasive, and atypical presentations. In these cases, late diagnosis and treatment can lead to higher risk of complications, sequelae, and deaths. PCM occurrence in PLWHA is scarcely reported in the literature. This study aims to describe the clinical profile of patients diagnosed with PCM and HIV co-infection from a 30-year historical cohort followed at a Brazilian reference center for infectious diseases. Our results revealed that the suspicion of this co-infection in patients with more severe clinical forms of PCM as well as routine HIV testing in PCM patients could help to prevent late-onset treatment and progression to unfavorable outcomes.
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Koehler A, Girardi FM, Neto LK, de Moraes PC, Junior VF, Scroferneker ML. Head and neck manifestations of paracoccidioidomycosis: A retrospective study of histopathologically diagnosed cases in two medical centers in southern Brazil. J Mycol Med 2022; 32:101292. [DOI: 10.1016/j.mycmed.2022.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/22/2022] [Accepted: 04/30/2022] [Indexed: 11/15/2022]
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Pereira FV, Alves KPDO, Altemani AMDAM, Reis F. Disseminated paracoccidioidomycosis with skull and mandible involvement in a heart transplant recipient. Rev Soc Bras Med Trop 2022; 55:e0110. [PMID: 35674557 PMCID: PMC9176728 DOI: 10.1590/0037-8682-0110-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/30/2022] [Indexed: 11/22/2022] Open
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Luberto L, Neroni B, Gandini O, Fiscarelli EV, Salvatori G, Roscilli G, Marra E. Genetic Vaccination as a Flexible Tool to Overcome the Immunological Complexity of Invasive Fungal Infections. Front Microbiol 2021; 12:789774. [PMID: 34975811 PMCID: PMC8715041 DOI: 10.3389/fmicb.2021.789774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has highlighted genetic vaccination as a powerful and cost-effective tool to counteract infectious diseases. Invasive fungal infections (IFI) remain a major challenge among immune compromised patients, particularly those undergoing allogeneic hematopoietic bone marrow transplantation (HSCT) or solid organ transplant (SOT) both presenting high morbidity and mortality rates. Candidiasis and Aspergillosis are the major fungal infections among these patients and the failure of current antifungal therapies call for new therapeutic aids. Vaccination represents a valid alternative, and proof of concept of the efficacy of this approach has been provided at clinical level. This review will analyze current understanding of antifungal immunology, with a particular focus on genetic vaccination as a suitable strategy to counteract these diseases.
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Affiliation(s)
- Laura Luberto
- Takis s.r.l., Rome, Italy
- *Correspondence: Laura Luberto,
| | - Bruna Neroni
- Cystic Fibrosis Diagnostic Section, U.O. Microbiology and Immunology Diagnostic, Department of Immunology and Laboratory Medicine, Children’s Hospital Bambino Gesù Organization IRCCS, Rome, Italy
| | - Orietta Gandini
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Ersilia Vita Fiscarelli
- Cystic Fibrosis Diagnostic Section, U.O. Microbiology and Immunology Diagnostic, Department of Immunology and Laboratory Medicine, Children’s Hospital Bambino Gesù Organization IRCCS, Rome, Italy
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Felipe CRA, Silva AD, Moreira Guimarães Penido MG. Disseminated Paracoccidioidomycosis in a Kidney Transplant Recipient. Cureus 2021; 13:e19007. [PMID: 34820246 PMCID: PMC8607338 DOI: 10.7759/cureus.19007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/05/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is an endemic fungal infection in Latin America, which manifests as an acute or chronic form and is more frequent in adult males. It is caused by Paracoccidioides brasiliensis or Paracoccidioides lutzii, which are thermodimorphic fungi. The disease can present as a severe and disseminated form involving the lungs, skin, lymph nodes, spleen, liver, and lymphoid organs of the gastrointestinal tract. Most of the primary infections are subclinical, and the cell-mediated immune response contains the infection. It is rare in transplant patients, and there are few cases described in the literature. In solid organ transplant patients, it usually results from the reactivation of a latent infection, manifesting itself after a few years of transplantation with frequent pulmonary and skin involvement. PCM is an endemic infection in Brazil; however, as it is not classified as a notifiable disease, there is no accurate database on its incidence, and case reports are important sources of information. Clinical disease in kidney transplant patients is rare and has a high mortality rate. In this scope, the present clinical case reports the challenges of the clinical management of disseminated PCM caused by Paracoccidioides brasiliensis in a kidney transplant recipient who used immunosuppressive drugs and was treated with Itraconazole.
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Affiliation(s)
| | - Aline D Silva
- Nephrology Center, Santa Casa de Belo Horizonte Hospital, Belo Horizonte, BRA
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Valentim FDO, Tsutsui GM, Abbade LPF, Marques SA. Disseminated paracoccidioidomycosis in a liver transplant patient. An Bras Dermatol 2021; 96:346-348. [PMID: 33775484 PMCID: PMC8178573 DOI: 10.1016/j.abd.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022] Open
Abstract
Paracoccidioidomycosis is an endemic systemic mycosis caused by Paracoccidioides brasiliensis complex and P. lutzii. It is a rare disease in non-HIV-induced immunosuppressed individuals. In organ transplant recipients, it is more frequently associated with immunosuppression after kidney transplantation. In a liver transplant patient, only one case has been published in the literature to date. The present report comprises the case of a 47-year-old female patient with disseminated skin lesions associated with signs and symptoms of systemic involvement of paracoccidioidomycosis that manifested one year after liver transplantation and under an immunosuppression regimen with tacrolimus and mycophenolate mofetil.
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Sinkos C, Grillo TG, Bonini ACM, Cardoso LG, Watanabe EM, Cavalcante RDS, Silva GF, Yamashiro FDS, Romeiro FG, Lima TB. Mixed and disseminated paracoccidioidomycosis after liver transplantation: Case report. Med Mycol Case Rep 2021; 32:25-29. [PMID: 33717862 PMCID: PMC7921753 DOI: 10.1016/j.mmcr.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/30/2021] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic granulomatous fungal infection rarely associated with solid organ transplantation. We report the second case of PCM in an adult after liver transplantation. A 47-year-old woman who had undergone liver transplantation was hospitalized for flu-like symptoms and multiple erythematous ulcerated skin papules. There was lymphadenopathy, pulmonary compromise, and quickly progression to septic shock. PCM was confirmed by skin biopsy and serologic tests, and a satisfactory response to amphotericin B was achieved.
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Affiliation(s)
- Camila Sinkos
- Department of Internal Medicine, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
| | - Thais Gagno Grillo
- Department of Internal Medicine, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
| | - Ana Clara Muraro Bonini
- Department of Internal Medicine, Hematology Division - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
| | - Lucas Gonçalves Cardoso
- Department of Pathology - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
| | - Erika Mayumi Watanabe
- Department of Tropical Diseases and Diagnostic Imaging - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
| | - Ricardo de Souza Cavalcante
- Department of Tropical Diseases and Diagnostic Imaging - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
| | - Giovanni Faria Silva
- Department of Internal Medicine, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
| | - Fabio da Silva Yamashiro
- Department of Internal Medicine, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
| | - Fernando Gomes Romeiro
- Department of Internal Medicine, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
| | - Talles Bazeia Lima
- Department of Internal Medicine, Gastroenterology Division - São Paulo State University (UNESP), Botucatu Medical School, Rubião Júnior S/N, 18618-970, São Paulo, Brazil
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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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Peçanha PM, Bahiense IC, Kruschewsky WLL, Biasutti C, Júnior CUGF, Pinheiro BG, Maifrede SB, Camargo ZPD, Rodrigues AM, Grão-Velloso TR, Falqueto A, Gonçalves SS. Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 associated with acquired immunodeficiency syndrome: A case report. Rev Iberoam Micol 2020; 38:5-8. [PMID: 33317932 DOI: 10.1016/j.riam.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/03/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is an endemic disease in Latin America. In immunocompetent hosts, PCM occurs in two main clinical forms: acute and chronic. However, in HIV-infected patients PCM may show up simultaneous manifestations of acute and chronic forms. CASE REPORT We present the case of a patient diagnosed with HIV who had disseminated skin lesions and generalized lymphadenopathy, as well as respiratory and central nervous system involvement. The PCM diagnosis was confirmed by direct KOH examination, double immunodiffusion and the isolation of the fungus in samples of an abscess in the subcostal region. The isolate was identified as Paracoccidioides brasiliensis S1 by species-specific PCR using primers for protein-coding gene GP43 (exon 2) followed by PCR-RFLP of the alpha-tubulin gene. CONCLUSIONS There are few data in literature reporting species-specific molecular identification of Paracoccidioides in HIV/PCM patients. Therefore, this case report may contribute to improve the knowledge about this severe disease, its causative cryptic species, and its consequences to patients.
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de-Souza-Silva CM, Hurtado FA, Tavares AH, de Oliveira GP, Raiol T, Nishibe C, Agustinho DP, Almeida NF, Walter MEMT, Nicola AM, Bocca AL, Albuquerque P, Silva-Pereira I. Transcriptional Remodeling Patterns in Murine Dendritic Cells Infected with Paracoccidioides brasiliensis: More Is Not Necessarily Better. J Fungi (Basel) 2020; 6:jof6040311. [PMID: 33255176 PMCID: PMC7712260 DOI: 10.3390/jof6040311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022] Open
Abstract
Most people infected with the fungus Paracoccidioides spp. do not get sick, but approximately 5% develop paracoccidioidomycosis. Understanding how host immunity determinants influence disease development could lead to novel preventative or therapeutic strategies; hence, we used two mouse strains that are resistant (A/J) or susceptible (B10.A) to P. brasiliensis to study how dendritic cells (DCs) respond to the infection. RNA sequencing analysis showed that the susceptible strain DCs remodeled their transcriptomes much more intensely than those from the resistant strain, agreeing with a previous model of more intense innate immunity response in the susceptible strain. Contrastingly, these cells also repress genes/processes involved in antigen processing and presentation, such as lysosomal activity and autophagy. After the interaction with P. brasiliensis, both DCs and macrophages from the susceptible mouse reduced the autophagy marker LC3-II recruitment to the fungal phagosome compared to the resistant strain cells, confirming this pathway’s repression. These results suggest that impairment in antigen processing and presentation processes might be partially responsible for the inefficient activation of the adaptive immune response in this model.
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Affiliation(s)
- Calliandra M. de-Souza-Silva
- Laboratory of Molecular Biology of Pathogenic Fungi, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, DF 70910-900, Brazil; (C.M.d.-S.-S.); (F.A.H.); (I.S.-P.)
| | - Fabián Andrés Hurtado
- Laboratory of Molecular Biology of Pathogenic Fungi, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, DF 70910-900, Brazil; (C.M.d.-S.-S.); (F.A.H.); (I.S.-P.)
- Molecular Pathology Post-Graduation Program, University of Brasília Medical School, Brasília, DF 70910-900, Brazil
| | | | - Getúlio P. de Oliveira
- Division of Allergy and Inflammation, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Taina Raiol
- Fiocruz Brasília, Oswaldo Cruz Foundation, Brasília, DF 70904-130, Brazil;
| | - Christiane Nishibe
- Faculty of Computing, Federal University of Mato Grosso do Sul, Campo Grande, MS 79070-900, Brazil; (C.N.); (N.F.A.)
| | - Daniel Paiva Agustinho
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110-1093, USA;
| | - Nalvo Franco Almeida
- Faculty of Computing, Federal University of Mato Grosso do Sul, Campo Grande, MS 79070-900, Brazil; (C.N.); (N.F.A.)
| | | | - André Moraes Nicola
- Faculty of Medicine, University of Brasília, Brasília, DF 70910-900, Brazil;
| | - Anamélia Lorenzetti Bocca
- Laboratory of Applied Immunology, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, DF 70910-900, Brazil;
| | - Patrícia Albuquerque
- Laboratory of Molecular Biology of Pathogenic Fungi, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, DF 70910-900, Brazil; (C.M.d.-S.-S.); (F.A.H.); (I.S.-P.)
- Faculty of Ceilândia, University of Brasília, Brasília, DF 72220-275, Brazil;
- Correspondence: ; Tel.: +55-61-985830129
| | - Ildinete Silva-Pereira
- Laboratory of Molecular Biology of Pathogenic Fungi, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, Brasília, DF 70910-900, Brazil; (C.M.d.-S.-S.); (F.A.H.); (I.S.-P.)
- Molecular Pathology Post-Graduation Program, University of Brasília Medical School, Brasília, DF 70910-900, Brazil
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25
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Unraveling the susceptibility of paracoccidioidomycosis: Insights towards the pathogen-immune interplay and immunogenetics. INFECTION GENETICS AND EVOLUTION 2020; 86:104586. [PMID: 33039601 DOI: 10.1016/j.meegid.2020.104586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Paracoccidioidomycosis (PCM) is a life-threatening systemic mycosis caused by Paracoccidioides spp. This disease comprises three clinical forms: symptomatic acute and chronic forms (PCM disease) and PCM infection, a latent form without clinical symptoms. PCM disease differs markedly according to severity, clinical manifestations, and host immune response. Fungal virulence factors and adhesion molecules are determinants for entry, latency, immune escape and invasion, and dissemination in the host. Neutrophils and macrophages play a paramount role in first-line defense against the fungus through the recognition of antigens by pattern recognition receptors (PRRs), activating their microbicidal machinery. Furthermore, the clinical outcome of the PCM is strongly associated with the variability of cytokines and immunoglobulins produced by T and B cells. While the mechanisms that mediate susceptibility or resistance to infection are dictated by the immune system, some genetic factors may alter gene expression and its final products and, hence, modulate how the organism responds to infection and injury. This review outlines the main findings relative to this topic, addressing the complexity of the immune response triggered by Paracoccidioides spp. infection from preclinical investigations to studies in humans. Here, we focus on mechanisms of fungal pathogenesis, the patterns of innate and adaptive immunity, and the genetic and molecular basis related to immune response and susceptibility to the development of the PCM and its clinical forms. Immunogenetic features such as HLA system, cytokines/cytokines receptors genes and other immune-related genes, and miRNAs are likewise discussed. Finally, we point out the occurrence of PCM in patients with primary immunodeficiencies and call attention to the research gaps and challenges faced by the PCM field.
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26
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Passarin NDP, Pereira AAC, Passos BL, Gil CM, Preciliano Marques LN, Silveira GL, Bonafé S, Moreira Neto LJ. Prostatic involvement in disseminated paracoccidioidomycosis: An unusual presentation mimicking malignant neoplasm. Med Mycol Case Rep 2020; 28:46-48. [PMID: 32426216 PMCID: PMC7225591 DOI: 10.1016/j.mmcr.2020.04.006] [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: 02/18/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/24/2022] Open
Abstract
Paracoccidioidomycosis is a granulomatous fungal infection, endemic to Latin America, which has great economic impact. Prostatic involvement is rare and can simulate other conditions, which poses a diagnostic challenge for the clinician. This article describes the report of a case of disseminated paracoccidioidomycosis with prostatic involvement, initially confused with prostatic adenocarcinoma. We hope to contribute to the knowledge of this presentation as a differential diagnosis and reinforce the importance of thorough clinical investigation.
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Affiliation(s)
| | | | - Bruna Laginski Passos
- University Center of Maringá, Guedner Avenue, 1610, Maringá, Paraná, 87.050-390, Brazil
| | - Camila Mazeiro Gil
- University Center of Maringá, Guedner Avenue, 1610, Maringá, Paraná, 87.050-390, Brazil
| | | | - Giovana Locks Silveira
- University of South of Santa Catarina, Jose Acacio Moreira Avenue, 787, Tubarão, Santa Catarina, 88.704-900, Brazil
| | - Simone Bonafé
- University Center of Maringá, Guedner Avenue, 1610, Maringá, Paraná, 87.050-390, Brazil
| | - Luiz Jorge Moreira Neto
- University Center of Maringá, Guedner Avenue, 1610, Maringá, Paraná, 87.050-390, Brazil
- Corresponding author. Department of Medicine, University Center of Maringá (UniCesumar), 1610 Guedner Avenue, 87050-390 Maringá, PR, Brazil.
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27
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Soto-Febres F, Morales-Moreno A, Arenas J, Pérez-Lazo G. Paracoccidiodomycosis lung reactivation in a patient with signet-ring cell gastric adenocarcinoma after chemotherapy: Case report. IDCases 2020; 20:e00769. [PMID: 32420028 PMCID: PMC7215172 DOI: 10.1016/j.idcr.2020.e00769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/12/2020] [Indexed: 11/17/2022] Open
Abstract
Although the relationship between paracoccidioidomycosis (PCM) and solid tumors has been described more than 80 years ago, reports of PCM and gastric cancer are rare. PCM can present before or concomitantly with the diagnosis of cancer, and its clinical presentation may rise the suspicion of malignancies or be part of reactivation by immunosuppression. We present the case of a 52-year-old Peruvian man with a signet-ring cell (SRC) gastric adenocarcinoma who after 6 chemotherapy sessions with FLOT (docetaxel, oxaliplatin, leucovorin, 5-fluorouracil) presented rapidly growing lung nodules. The lung biopsy showed yeasts compatible with Paracoccidioides sp., so he received initial treatment with itraconazole and after gastrectomy maintenance therapy with trimethoprim/sulfamethoxazole accompanied by tomographic resolution of lesions.
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Affiliation(s)
- F Soto-Febres
- Infectious Diseases Unit, Guillermo Almenara Irigoyen National Hospital - EsSalud, Lima, Peru
| | - A Morales-Moreno
- Infectious Diseases Unit, Guillermo Almenara Irigoyen National Hospital - EsSalud, Lima, Peru
| | - J Arenas
- Anatomical and Surgical Pathology Service, Guillermo Almenara Irigoyen National Hospital - EsSalud, Lima, Peru
| | - G Pérez-Lazo
- Infectious Diseases Unit, Guillermo Almenara Irigoyen National Hospital - EsSalud, Lima, Peru
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28
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Peçanha-Pietrobom PM, Falqueto A, Rodrigues Gandarella AD, Moyzés JV, Rangel KA, Miranda LB, Hemerly MC, Careta RS, Peçanha PM. Case Report: Paracoccidioidomycosis in Solid Organ Transplantation: Disseminated Disease in a Liver Recipient and Literature Review. Am J Trop Med Hyg 2020; 101:1100-1106. [PMID: 31516118 DOI: 10.4269/ajtmh.18-1008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is an endemic systemic mycosis that is of great importance in Latin America. Its occurrence in solid organ transplantation (SOT) is rare, but with high mortality rate. In this report, we describe a case of PCM in a liver transplant recipient 19 months after transplantation. The patient presented with multiple skin abscesses, arthritis, osteolytic lesions, and pulmonary and adrenal involvement. Despite the presence of disseminated disease and the patient's immunosuppressed condition, the patient responded well to prolonged antifungal treatment with no sequelae, thus suggesting that early diagnosis and correct treatment may lead to favorable outcomes in SOT recipients with PCM.
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Affiliation(s)
- Paula M Peçanha-Pietrobom
- Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Aloisio Falqueto
- Infectious Diseases Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | | | - Júlia Vieira Moyzés
- Infectious Diseases Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | - Karoline Almeida Rangel
- Infectious Diseases Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | - Letícia Balarini Miranda
- Infectious Diseases Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | - Matheus Compart Hemerly
- Infectious Diseases Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | - Renata Scarpa Careta
- Department of Pathology, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | - Paulo Mendes Peçanha
- Infectious Diseases Unit, Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitoria, Brazil
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29
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Rahman R, Davies L, Mohareb AM, Peçanha-Pietrobom PM, Patel NJ, Solomon IH, Meredith DM, Tsai HK, Guenette JP, Bhattacharyya S, Urday S, Velásquez GE. Delayed Relapse of Paracoccidioidomycosis in the Central Nervous System: A Case Report. Open Forum Infect Dis 2020; 7:ofaa077. [PMID: 32258208 PMCID: PMC7112725 DOI: 10.1093/ofid/ofaa077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/26/2020] [Indexed: 12/05/2022] Open
Abstract
Paracoccidioidomycosis is a dimorphic fungal infection endemic in Latin America. We report a patient with a history of pulmonary paracoccidioidomycosis who presented with relapsed disease in the central nervous system 4 years after initial treatment. We review current treatment strategies for paracoccidioidomycosis and neuroparacoccidioidomycosis.
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Affiliation(s)
- Rifat Rahman
- Harvard Medical School, Boston, Massachusetts, USA
| | - Leela Davies
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amir M Mohareb
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nirav J Patel
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Isaac H Solomon
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David M Meredith
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Harrison K Tsai
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey P Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sebastian Urday
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gustavo E Velásquez
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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30
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Endemic Fungi in Transplant and Immunocompromised Hosts: Epidemiology, Diagnosis, Treatment, and Prevention. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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31
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Kauffman CA. Central Nervous System Infection with Other Endemic Mycoses: Rare Manifestation of Blastomycosis, Paracoccidioidomycosis, Talaromycosis, and Sporotrichosis. J Fungi (Basel) 2019; 5:jof5030064. [PMID: 31323746 PMCID: PMC6787720 DOI: 10.3390/jof5030064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/07/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022] Open
Abstract
The central nervous system (CNS) is not a major organ involved with infections caused by the endemic mycoses, with the possible exception of meningitis caused by Coccidioides species. When CNS infection does occur, the manifestations vary among the different endemic mycoses; mass-like lesions or diffuse meningeal involvement can occur, and isolated chronic meningitis, as well as widely disseminated acute infection that includes the CNS, are described. This review includes CNS infection caused by Blastomyces dermatitidis, Paracoccidioides brasiliensis, Talaromyces marneffei, and the Sporothrix species complex. The latter is not geographically restricted, in contrast to the classic endemic mycoses, but it is similar in that it is a dimorphic fungus. CNS infection with B. dermatitidis can present as isolated chronic meningitis or a space-occupying lesion usually in immunocompetent hosts, or as one manifestation of widespread disseminated infection in patients who are immunosuppressed. P. brasiliensis more frequently causes mass-like intracerebral lesions than meningitis, and most often CNS disease is part of disseminated infection found primarily in older patients with the chronic form of paracoccidioidomycosis. T. marneffei is the least likely of the endemic mycoses to cause CNS infection. Almost all reported cases have been in patients with advanced HIV infection and almost all have had widespread disseminated infection. Sporotrichosis is known to cause isolated chronic meningitis, primarily in immunocompetent individuals who do not have Sporothrix involvement of other organs. In contrast, CNS infection in patients with advanced HIV infection occurs as part of widespread disseminated infection.
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Affiliation(s)
- Carol A Kauffman
- Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
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32
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Impact of Paracoccidioides brasiliensis Coinfection on the Evolution of Schistosoma mansoni-Induced Granulomatous Liver Injury in Mice. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8319465. [PMID: 31019973 PMCID: PMC6451801 DOI: 10.1155/2019/8319465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/11/2019] [Accepted: 03/03/2019] [Indexed: 01/21/2023]
Abstract
The pathogens Schistosoma mansoni and Paracoccidioides brasiliensis share common geographic areas, determining infectious diseases with high mortality rates worldwide. Histopathological and immunological changes induced by each pathogen are well understood; however, the host responses to S. mansoni and P. brasiliensis coinfection are still unknown. Thus, we investigated liver damage and cytokines production in a murine model acutely and chronically coinfected with these pathogens. Fourty male Swiss mice were infected with S. mansoni and P. brasiliensis alone or coinfected. The animals were euthanized with 50 (acute infection) and 120 (chronic infection) days of infection. All infected animals exhibited liver inflammation. Intense granulomatous inflammation was detected in animals infected with S. mansoni alone and those coinfected. Productive and involutive granulomas were clearly observed in acute and chronic infections, respectively. Granuloma size was reduced in the acute phase and increased in the chronic phase of S. mansoni and P. brasiliensis coinfection, compared with animals infected only with S. mansoni. In the chronic phase of infection, the granulomatous inflammation in coinfected animals was characterized by intense neutrophils accumulation and reduced eosinophils number. IFN-γ, IL-2, IL-4, and IL-5 circulating levels were increased in all infected groups. Coinfected animals presented attenuated IFN-γ and IL-4 production in the acute and chronic infections. Taken together, our findings indicate that coinfected animals exhibited a differential modulation of granulomatous inflammation during the acute and chronic phases of infection, which was potentially associated with a divergent profile of cytokines production and migration of neutrophils and eosinophils in response to S. mansoni and P. brasiliensis antigenic stimulation.
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