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Ferreira IRS, de M Teixeira M, de Araújo AV, Bagagli E, Garces HG, Peters LP, Carvalho CM. Molecular detection of Paracoccidioides spp. in environmental samples from the Southwestern Amazon. Braz J Microbiol 2024; 55:837-842. [PMID: 38238556 PMCID: PMC10920595 DOI: 10.1007/s42770-024-01256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/09/2024] [Indexed: 03/09/2024] Open
Abstract
Paracoccidioidomycosis is an infection with the potential for environmental dissemination, especially in regions of hot and humid climate, where human cases have been recorded in the Southwestern Amazon of Brazil, specifically in the state of Acre. Despite studies providing information about the presence of these fungi in soil and animal samples, such as armadillos, further investigations are still needed to determine the epidemiological distribution of the genus Paracoccidioides. The aim of this study was to detect the occurrence of Paracoccidioides fungi in the Southwestern Amazon. To achieve this, 60 soil samples were collected from armadillo burrows on rural properties in the in the municipalities of Acrelândia, Bujari, Plácido de Castro, Rio Branco, Sena Madureira, and Senador Guiomard, located in the state of Acre, Brazil. Fungal DNA was extracted from these samples using the DNEASY® PowerSoil kit-Quiagen, followed by Nested PCR technique with ITS4 and ITS5 as external primers, and PBITS-E and PBITS-R as internal primers. DNA amplification products of about 380 bp compatible with Paracoccidioides spp. were detected in six samples (10%), being sequenced and identified as P. brasiliensis. These findings indicate that the soils of the Acre state could be considered a potential source for Paracoccidioides spp., suggesting that local infections are likely.
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Affiliation(s)
- Iasminy R Silva Ferreira
- Graduate Program in Biodiversity and Biotechnology, Federal University of Acre, Rio Branco, AC, 69920-900, Brazil.
| | - Marcus de M Teixeira
- Tropical Medicine Center, Faculty of Medicine, University of Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Atilon V de Araújo
- Graduate Program in Biodiversity and Biotechnology, Federal University of Acre, Rio Branco, AC, 69920-900, Brazil
| | - Eduardo Bagagli
- Department of Chemical and Biological Sciences, São Paulo State University "Júlio de Mesquita Filho", Botucatu, SP, 18618-687, Brazil
| | - Hans G Garces
- Department of Chemical and Biological Sciences, São Paulo State University "Júlio de Mesquita Filho", Botucatu, SP, 18618-687, Brazil
| | - Leila P Peters
- Center for Biological and Natural Sciences, Federal University of Acre, Rio Branco, AC, 69920-900, Brazil
| | - Clarice M Carvalho
- Graduate Program in Biodiversity and Biotechnology, Federal University of Acre, Rio Branco, AC, 69920-900, Brazil
- Center for Biological and Natural Sciences, Federal University of Acre, Rio Branco, AC, 69920-900, Brazil
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Hernández-Prieto JH, Martini VP, Iulek J. Structure of glyceraldehyde-3-phosphate dehydrogenase from Paracoccidioides lutzii in complex with an aldonic sugar acid. Biochimie 2024; 218:20-33. [PMID: 37709188 DOI: 10.1016/j.biochi.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/23/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
The pathogen Paracoccidioides lutzii (Pb01) is found in South America countries Colombia, Ecuador, Venezuela and Brazil, especially in the central, west, and north regions of the latter. It belongs to the Ajellomycetaceae family, Onygenales order, and is typically thermodimorphic, presenting yeast cells when it grows in animal tissues, but mycelia when in the environment, where it produces the infectious propagule. This fungus is one of the etiologic agents of Paracoccidioidomycosis (PCM), the most important endemic fungal infection in Latin America. Investigations on its genome have contributed to a better understanding about its metabolism and revealed the complexity of several metabolic glycolytic pathways. Glyceraldehyde-3-Phosphate Dehydrogenase from Paracoccidioides lutzii (PlGAPDH) is considered a moonlighting protein and participates in several biological processes of this pathogen. The enzyme was expressed and purified, as seen in SDS-PAGE gel, crystallized and had its three dimensional structure (3D) determined in complex with NAD+, a sulphate ion and d-galactonic acid, therefore, a type of 'GAA site'. It is the first GAPDH structure to show this chemical type in this site and how this protein can bind an acid derived from oxidation of a linear hexose.
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Affiliation(s)
| | | | - Jorge Iulek
- Department of Chemistry, State University of Ponta Grossa, Ponta Grossa, PR, 84030-900, Brazil.
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Benko LMP, Vieira da Silva MEDS, Falcão EMM, Freitas DFS, Calvet GA, Almeida MDA, Almeida-Paes R, Zancopé-Oliveira RM, do Valle ACF, de Macedo PM. Paracoccidioidomycosis and pregnancy: A 40-year single-center cohort study in the endemic area of Rio de Janeiro, Brazil. PLoS Negl Trop Dis 2023; 17:e0011645. [PMID: 37708219 PMCID: PMC10522026 DOI: 10.1371/journal.pntd.0011645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/26/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
The occurrence of acute paracoccidioidomycosis (PCM) in urban areas of the Rio de Janeiro state, Brazil, has emerged in recent years. Therefore, young populations, including pregnant women, are at a higher risk of infection. Furthermore, young women undergoing itraconazole treatment for PCM have increased chances to get pregnant because this medication may reduce the effectiveness of contraceptives. Acute PCM is invasive, reaching abdominal organs, posing a maternal-fetal risk. PCM treatment in pregnant women is also challenging due to the teratogenicity associated with the currently available oral drugs. There are scarce studies on PCM and pregnancy, mainly consisting of case reports and experimental murine models that highlight the severity of this association. We conducted a database research at a PCM reference center in Rio de Janeiro state from 1980 to 2020. We included patients diagnosed with PCM who were pregnant shortly before, at admission, or at any moment of their PCM follow-up care. Data related to pregnancy, childbirth, and the newborn were obtained from the Brazilian official public databases. We also reviewed the epidemiological and clinical features of these patients. During the study period, we identified 18 pregnant patients, with a median age of 26 years (range: 16-38). Among these cases, six (33.3%) were detected in the last 5 years, and 14 (77.8%) presented acute PCM, supporting the recent shift in the epidemiological profile towards acute PCM. Most pregnancies occurred during PCM treatment (n = 11, 61.1%), which led to challenges in the therapeutic management. Maternal-fetal complications occurred in some of these cases, including vaginal bleeding (n = 1), preeclampsia (n = 1), prematurity (n = 2), low birth weight (n = 4), and fetal deaths (n = 2). PCM during pregnancy presents a significant public health concern in the context of the emergence of acute PCM in urban areas.
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Affiliation(s)
- Lorena Macedo Pestana Benko
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | | - Eduardo Mastrangelo Marinho Falcão
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Dayvison Francis Saraiva Freitas
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Guilherme Amaral Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Marcos de Abreu Almeida
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | | - Antonio Carlos Francesconi do Valle
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Priscila Marques de Macedo
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
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Kruschewsky WLL, Patricio SA, Bahiense IC, Maifrede SB, Pôssa AP, de Camargo ZP, Rodrigues AM, Peçanha PM, Falqueto A, Grão-Velloso TR, Gonçalves SS. Paracoccidioidomycosis cases by Paracoccidioides lutzii in southeastern Brazil. Braz J Microbiol 2023; 54:1761-1767. [PMID: 37289316 PMCID: PMC10485217 DOI: 10.1007/s42770-023-01019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Paracoccidioidomycosis (PCM) is a systemic fungal disease caused by the thermodimorphic fungi Paracoccidioides spp. Their distribution is highly variable. Paracoccidioides lutzii is predominantly found in North and Middle-West Brazil and Ecuador. This study evaluated the clinicopathological characteristics of 10 patients diagnosed with PCM caused by P. lutzii in a reference center located in southeastern Brazil. DESIGN Double immunodiffusion assay (DID) was used to investigate 35 patients' sera with negative serology for P. brasiliensis against a P. lutzii CFA (cell-free antigen). RESULTS Out of the 35 retested patients, 10 (28.6%) were positive for P. lutzii CFA. Four patients did not report any displacement to P. lutzii endemic areas. Our results reinforce the importance of using different antigens when testing patients with clinical manifestations of PCM and negative serological tests for P. brasiliensis, primarily in cases of the report of displacement to or former residence in P. lutzii endemic regions. CONCLUSIONS The availability of tests for different Paracoccidioides species antigens is fundamental for reaching an adequate diagnosis, patient follow-up, and definition of prognosis.
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Affiliation(s)
- Wdson Luis Lima Kruschewsky
- Cassiano Antônio Moraes University Hospital (HUCAM), Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Suzana Alves Patricio
- Department of General and Specialized Surgery, Federal Fluminense University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Isabela Cruz Bahiense
- Infectious Diseases Postgraduate Program, Center for Research in Medical Mycology, Federal University of Espírito Santo (UFES), Espírito Santo, Brazil
| | - Simone Bravim Maifrede
- Center for Research in Medical Mycology, Department of Pathology, Federal University of Espírito Santo (UFES), Vitoria - ES, Brazil
| | - Ana Paula Pôssa
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 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
| | - Paulo Mendes Peçanha
- Cassiano Antônio Moraes University Hospital (HUCAM), Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
- Department of Clinical Medicine, Espírito Santo Federal University – UFES, Avenue Marechal Campos, 1468, Maruípe, Espírito Santo, Vitória CEP 29047-105 Brazil
| | - Aloísio Falqueto
- Cassiano Antônio Moraes University Hospital (HUCAM), Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
- Department of Social Medicine, Espírito Santo Federal University – UFES, Avenue Marechal Campos, Maruípe, Vitória, Espírito Santo 1468, CEP 29047-105 Brazil
| | - Tânia Regina Grão-Velloso
- Department of Clinical Dentistry Federal, University of Espírito Santo - UFES, Marechal Campos Avenue, CEP 29, Vitória-ES, 1468040-090 Brazil
| | - Sarah Santos Gonçalves
- Infectious Diseases Postgraduate Program, Center for Research in Medical Mycology, Federal University of Espírito Santo (UFES), Espírito Santo, Brazil
- Center for Research in Medical Mycology, Department of Pathology, Federal University of Espírito Santo (UFES), Vitoria - ES, Brazil
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Gomes Ferreira D, Gadêlha M, Ricardo Vissoci J, Negri M. Impact of invasive fungal infections in men from a state in southern Brazil: A geospatial analysis. Trop Med Int Health 2023; 28:771-779. [PMID: 37559424 DOI: 10.1111/tmi.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To analyse the records of male hospitalisation for fungal infections, including their spatial distribution and the main invasive epidemiological and sociodemographic characteristics in the State of Paraná, Brazil. METHODS Spatial analysis based on data from male admission records for invasive fungal infections (IFIs) in the State of Paraná, from 2015 to 2019. Data were taken from the hospital records obtained in the Hospital Information System of the Unified Health System, being collected, georeferenced and analysed to infer the existence of autocorrelation with the hospitalisation rates in the state. RESULTS From 2015 to 2019, there were 385 cases of IFIs in men, being more prevalent in white individuals aged 61-70 years. We observed that the metropolitan, southeast, central-eastern, north-central, northwestern and western regions formed high-high clusters, with regions with a high number of registered cases. In the regression, there was an association with socioeconomic and demographic factors that showed a correlation with the rates of hospitalisation for IFIs. CONCLUSION The study draws attention to Paraná as an endemic region for paracoccidioidomycosis, in addition to presenting high rates of nosocomial fungal infections. We also emphasise the importance of compulsory notification in the state and in the country to gain greater control over the incidence and prevalence of cases and to incentivise the creation of public policies for the prevention of IFIs.
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Affiliation(s)
| | - Marina Gadêlha
- Post-graduate Program in Health Sciences, Universidade Estadual de Maringá, Maringá, Brazil
| | | | - Melyssa Negri
- Department of Clinical Analysis, Universidade Estadual de Maringá, Maringá, Brazil
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Zerbato V, Di Bella S, Pol R, D’Aleo F, Angheben A, Farina C, Conte M, Luzzaro F, Luzzati R, Principe L. Endemic Systemic Mycoses in Italy: A Systematic Review of Literature and a Practical Update. Mycopathologia 2023; 188:307-334. [PMID: 37294504 PMCID: PMC10386973 DOI: 10.1007/s11046-023-00735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/02/2023] [Indexed: 06/10/2023]
Abstract
Endemic systemic mycoses such as blastomycosis, coccidioidomycosis, histoplasmosis, talaromycosis, paracoccidioidomycosis are emerging as an important cause of morbidity and mortality worldwide. We conducted a systematic review on endemic systemic mycoses reported in Italy from 1914 to nowadays. We found out: 105 cases of histoplasmosis, 15 of paracoccidioidomycosis, 10 of coccidioidomycosis, 10 of blastomycosis and 3 of talaromycosis. Most cases have been reported in returning travelers and expatriates or immigrants. Thirtytwo patients did not have a story of traveling to an endemic area. Fortysix subjects had HIV/AIDS. Immunosuppression was the major risk factor for getting these infections and for severe outcomes. We provided an overview on microbiological characteristics and clinical management principles of systemic endemic mycoses with a focus on the cases reported in Italy.
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Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Riccardo Pol
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Francesco D’Aleo
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST “Papa Giovanni XXIII”, 24127 Bergamo, Italy
| | - Marco Conte
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Francesco Luzzaro
- Clinical Microbiology and Virology Unit, “A. Manzoni” Hospital, 23900 Lecco, Italy
| | | | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
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Rodrigues AM, Hagen F, Puccia R, Hahn RC, de Camargo ZP. Paracoccidioides and Paracoccidioidomycosis in the 21st Century. Mycopathologia 2023; 188:129-133. [PMID: 36633737 DOI: 10.1007/s11046-022-00704-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023]
Abstract
Paracoccidioidomycosis (PCM) defines a broad spectrum of human and animal diseases caused by Paracoccidioides species (Onygenales). In the twenty-first century, Paracoccidioides advanced from a monotypic taxon to a genus that harbors seven species, including P. brasiliensis sensu stricto, P. americana, P. restrepiensis, P. venezuelensis, P. lutzii, P. loboi, and P. cetii. Classic PCM, acquired upon inhalation of propagules from P. brasiliensis sensu stricto, P. americana, P. restrepiensis, P. venezuelensis, and P. lutzii, affects the human lungs and may progress to systemic granulomatous disease with tegumentary and visceral involvement. On the other hand, PCM loboi and PCM ceti caused by the unculturable P. loboi and P. cetii are subcutaneous mycoses, typically observed as keloid lesions in humans and dolphins. Such heterogeneity highlights the importance of recognizing species boundaries in Paracoccidioides to gain insights into the ecology, evolution, clinical features, and mitigation strategies to tackle the advance of PCM.
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Affiliation(s)
- Anderson Messias Rodrigues
- Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil.
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil.
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - Rosana Puccia
- Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
| | - Rosane Christine Hahn
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, MT, 78060900, Brazil
- Júlio Muller Hospital, EBSERH, Cuiabá, MT, Brazil
| | - Zoilo Pires de Camargo
- Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
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Lazzaretti GS, Sena LMDC, Corrêa A, Navarini D, Marcolan AM, Reichert PR. Paracoccidioidomycosis and Addison's syndrome - case report. Trop Doct 2023; 53:325-326. [PMID: 36718536 DOI: 10.1177/00494755231153197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Paracoccidioidomycosis is caused by a fungus (Paracoccidioides brasiliensis), which is endemic to Brazil. It is most frequently found in the lungs, with haematogenous and lymphatic spread. The condition is more prevalent in men, between 30 and 60 years old, commonly rural workers. It is the third leading cause of death among chronic infectious diseases today. The systemic disease has an insidious and nonspecific course, with adrenal involvement being observed in 5% of cases and requiring the destruction of 80% of the glands for symptoms of adrenal insufficiency to appear. Isolated involvement of this gland is quite rare. In this case report, however, our patient presented wasting and adrenal insufficiency with isolated adrenal involvement by the fungus.
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Affiliation(s)
| | | | - Allex Corrêa
- School of Medicine, 28129University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Daniel Navarini
- Department of Surgery, 28129University of Passo Fundo, School of Medicine, Passo Fundo, RS, Brazil
| | - Ana Maria Marcolan
- Department of Pathology, 28129University of Passo Fundo, School of Medicine, Passo Fundo, RS, Brazil
| | - Paulo Roberto Reichert
- Department of Surgery, 28129University of Passo Fundo, School of Medicine, Passo Fundo, RS, Brazil
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Hahn RC, Hagen F, Mendes RP, Burger E, Nery AF, Siqueira NP, Guevara A, Rodrigues AM, de Camargo ZP. Paracoccidioidomycosis: Current Status and Future Trends. Clin Microbiol Rev 2022; 35:e0023321. [PMID: 36074014 PMCID: PMC9769695 DOI: 10.1128/cmr.00233-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Paracoccidioidomycosis (PCM), initially reported in 1908 in the city of São Paulo, Brazil, by Adolpho Lutz, is primarily a systemic and neglected tropical mycosis that may affect individuals with certain risk factors around Latin America, especially Brazil. Paracoccidioides brasiliensis sensu stricto, a classical thermodimorphic fungus associated with PCM, was long considered to represent a monotypic taxon. However, advances in molecular taxonomy revealed several cryptic species, including Paracoccidioides americana, P. restrepiensis, P. venezuelensis, and P. lutzii, that show a preference for skin and mucous membranes, lymph nodes, and respiratory organs but can also affect many other organs. The classical diagnosis of PCM benefits from direct microscopy culture-based, biochemical, and immunological assays in a general microbiology laboratory practice providing a generic identification of the agents. However, molecular assays should be employed to identify Paracoccidioides isolates to the species level, data that would be complemented by epidemiological investigations. From a clinical perspective, all probable and confirmed cases should be treated. The choice of treatment and its duration must be considered, along with the affected organs, process severity, history of previous treatment failure, possibility of administering oral medication, associated diseases, pregnancy, and patient compliance with the proposed treatment regimen. Nevertheless, even after appropriate treatment, there may be relapses, which generally occur 5 years after the apparent cure following treatment, and also, the mycosis may be confused with other diseases. This review provides a comprehensive and critical overview of the immunopathology, laboratory diagnosis, clinical aspects, and current treatment of PCM, highlighting current issues in the identification, treatment, and patient follow-up in light of recent Paracoccidioides species taxonomic developments.
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Affiliation(s)
- Rosane Christine Hahn
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
- Júlio Muller Hospital, EBSERH, Cuiabá, Mato Grosso, Brazil
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - Rinaldo Poncio Mendes
- Faculdade de Medicina de Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Faculdade de Medicina, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Eva Burger
- Department of Microbiology and Immunology, Federal University of Alfenasgrid.411180.d (UNIFAL), Alfenas, Minas Gerais, Brazil
| | - Andreia Ferreira Nery
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
- Júlio Muller Hospital, EBSERH, Cuiabá, Mato Grosso, Brazil
| | - Nathan Pereira Siqueira
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Armando Guevara
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
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10
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Andrade-Silva J, Andrade-Silva LE, Paes HC, Alves L, Rosa A, Tenório BG, Ferreira MS, Felipe MSS, Teixeira MDM, Silva-Vergara ML. Molecular epidemiology of Paracoccidiodes spp. recovered from patients with paracoccidioidomycosis in a teaching hospital from Minas Gerais State of Brazil. PLoS Negl Trop Dis 2021; 15:e0009956. [PMID: 34843484 PMCID: PMC8659327 DOI: 10.1371/journal.pntd.0009956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/09/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Paracoccidioidomycosis (PCM) is caused by several species of the Paracoccidioides genus which can be differentiated by interspecific genetic variations, morphology and geographic distribution. Intraspecific variability correlation with clinical and epidemiological aspects of these species still remains unclear. This study aimed to sequence the loci GP43, exon 2 and ARF of 23 clinical isolates of Paracoccidioides spp. from patients in the Southeast Region of Brazil. Methodology and main findings GenBank was used to compare the present (23) with previous described sequences (151) that included ARF and GP43. It was identified a high polymorphism rate among the 23 isolates in comparison to the other 151. Among the isolates, 22 (95.66%) were S1/P. brasiliensis and 1 (4.34%) was identified as PS2/P. americana. A total of 45 haplotypes were found as follows: 19 from S1/P. brasiliensis (13 from the present study), 15 from P. lutzii, 6 from PS2/P. americana (1 from the present study), 3 from PS3/P. restrepiensis and 2 from PS4/P. venezuelensis. Moreover, exclusive haplotypes according to clinical origin and geographical area were found. S1/P. brasiliensis (HD = 0.655 and K = 4.613) and P. lutzii (HD = 0.649 and K = 2.906) presented the highest rate of polymorphism among all species, from which 12 isolates of the present study were clustered within S1b/P. brasiliensis. The GP43 locus showed a higher variability and was found to be the main reason for the species differentiation. Conclusions The results herein decribed show a high intraspecific genetic variability among S1/P. brasiliensis isolates and confirm the predominance of this species in the Southeast region of Brazil. The finding of exclusive haplotypes according to clinical origin and geographical area would suggest correlation between the molecular profile with the clinical form and geographic origin of patients with PCM. Paracoccidioidomycosis (PCM) is one of the most important systemic mycosis of Latin America. This disease can be caused by Paracoccidioides lutzii and four different phylogenetic species: S1/Paracoccidioides brasiliensis sensu stricto that harboring S1a and S1b, PS2/Paracoccidioides americana, PS3/Paracoccidioides restrepiensis and PS4/Paracoccidioides venezuelensis. Some of these species show differences in their main geographic region of predominance such as PS2/P. americana that can be found in Venezuela and Southern Brazil; PS3/P. restrepiensis and PS4/P. venezuelensis which are distributed in Colombia and Venezuela. However, and due to their wide geographical distribution, the species S1/P. brasiliensis and P. lutzii overlapping ecological niches and can be found in different regions of Brazil and other Latin American countries. Regarding eco-epidemiological aspects, the habitat is believed to be the soil due to the predominance of the disease among rural workers who become infected by inhaling infectious propagules during their farm activities. According to other authors, these species could have relation with the different PCM clinical presentation. This study aimed to describe the molecular epidemiology associated with clinical and epidemiological data of Paracoccidiodes spp. in the Minas Gerais State, located in the Southeast region, Brazil. Among the 23 isolates herein evaluated, 22 were S1/P. brasiliensis and 1 was identified as PS2/P. americana. A total of 45 haplotypes were found when these isolates were compared with other 151 deposited in the Genbank. The preliminar finding of exclusive haplotypes according to clinical origin and geographical area would suggest correlation between the molecular profile with the clinical form and geographic origin of patients with PCM. The GP43 locus showed a higher variability and was found to be the main promotor of species differentiation. The results herein described pointed out a high intraspecific genetic variability among S1/P. brasiliensis isolates and confirm the predominance of this species in the Southeast region of Brazil.
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Affiliation(s)
- Juliana Andrade-Silva
- Infectious Diseases Unit, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, Brazil
| | | | - Hugo Costa Paes
- Faculty of Medicina, University of Brasília, Brasília, Brazil
| | - Lucas Alves
- Faculty of Medicina, University of Brasília, Brasília, Brazil
| | - Adair Rosa
- Faculty of Medicina, University of Brasília, Brasília, Brazil
| | | | - Marcelo Simão Ferreira
- Infectious diseases Unit, Internal Medicine Department Federal University of Uberlândia, Uberlândia, Brazil
| | | | | | - Mario León Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, Brazil
- * E-mail:
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11
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Maifrede SB, Kruschewsky WLL, Patrício SA, Falqueto A, Peçanha PM, Malaquias LCC, Pôssa AP, de Camargo ZP, Rodrigues AM, Gonçalves SS, Grão-Velloso TR. Screening paracoccidioidomycosis by double immunodiffusion test in a referred diagnostic center in Brazilian southeastern: an accessible tool. Infection 2021; 49:1257-1264. [PMID: 34580797 DOI: 10.1007/s15010-021-01704-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This article shows reports of the clinical-epidemiological characteristics and serological screening in patients assisted by a reference center for PCM care, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Brazil. METHODS The patient's sera with PCM were analyzed by DID test at the beginning and the end treatment. Clinical and demographic data were also collected to characterize the sample. RESULTS One hundred patients with a suspected diagnosis of PCM were evaluated. Serology by DID test was used as a screen in all patients. The test was positive for 79 patients (72 for Paracoccidioides brasiliensis and 7 for Paracoccidioides lutzii). Serology was negative in 21 sera, although all of them were diagnosed PCM by histopathologic or direct exam. Serological follow-up was performed during the treatment of all patients. After treatment, 58(58%) had negative serology and 33(33%) low levels of antibodies (≤ 1:16). CONCLUSION Our results indicate the importance of the DID test for the screening and monitoring of PCM and that the incidence of P. lutzii might be greater than expected in areas where it is not the predominant PCM species. Therefore, this article may contribute to improving the knowledge and clinical management about this disease.
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Affiliation(s)
- Simone Bravim Maifrede
- Center for Research in Medical Mycology, Pathology Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | | | - Suzana Alves Patrício
- Dentistry Department, Federal University of Espírito Santo (UFES), 1468, Marechal Campos Avenue, Vitória, ES, 29040-090, Brazil
| | - Aloísio Falqueto
- Medical Clinical Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | - Paulo Mendes Peçanha
- Medical Clinical Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | | | - Ana Paula Pôssa
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Sarah Santos Gonçalves
- Center for Research in Medical Mycology, Pathology Department, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | - Tânia Regina Grão-Velloso
- Dentistry Department, Federal University of Espírito Santo (UFES), 1468, Marechal Campos Avenue, Vitória, ES, 29040-090, Brazil.
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12
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Pereira EF, Gegembauer G, Chang MR, de Camargo ZP, Nunes TF, Ribeiro SM, de Carvalho LR, Maldonado BM, Mendes RP, Paniago AMM. Comparison of clinico-epidemiological and radiological features in paracoccidioidomycosis patients regarding serological classification using antigens from Paracoccidioides brasiliensis complex and Paracoccidioides lutzii. PLoS Negl Trop Dis 2020; 14:e0008485. [PMID: 32841237 PMCID: PMC7447013 DOI: 10.1371/journal.pntd.0008485] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/14/2020] [Indexed: 12/31/2022] Open
Abstract
Genotyping of the genus Paracoccidioides showed its diversity and geographical distribution. Four species constituting the Paracoccidioides brasiliensis complex and Paracoccidioides lutzii are etiological agents of paracoccidioidomycosis (PCM). However, there are no studies comparing the clinical and epidemiological aspects between PCM caused by the P. brasiliensis complex and by P. lutzii. Demographic and clinical data from 81 patients with PCM-confirmed by mycological and/or histopathological examination-from Mato Grosso do Sul state (Brazil) were studied. All patients underwent serology by immunodiffusion with antigens obtained from the P. brasiliensis complex (ExoPb and gp43) and Cell Free Antigens obtained from P.lutzii (CFAPl).The cases were classified regarding their serological profile into three groups: G1: PCM patients seropositive to ExoPb and/or gp43 and seronegative to CFAPl (n = 51), assumed to have PCM caused by P. brasiliensis complex; G2: PCM patients seronegative to gp43 and seropositive to CFAPl (n = 16), with PCM caused by P. lutzii; and G3: PCM patients seropositive to ExoPb or gp43 and seropositive to CFAPl (n = 14), with undetermined serological profile, was excluded from the analyses. The Fisher's exact test or the Mann-Whitney U test, and cluster analysis according to Ward's method and Euclidean distance were used to analyze the results. Patients with serological profile suggestive of P. lutzii lived predominantly in municipalities in the Central and Southern regions of the state, while those with serological profile indicative of the P. brasiliensis complex were distributed throughout the state. No differences were found between the two groups regarding gender, age, schooling, rural work, clinical form, severity, organs involved, intensity of pulmonary involvement, degree of anemia, erythrocyte sedimentation rate values, and therapeutic response. PCM patients with serological profile suggestive of P. lutzii and PCM patients with serological profile indicative of P. brasiliensis complex showed the same clinical and radiological presentations.
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Affiliation(s)
- Edy F. Pereira
- Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul state, Brazil
| | - Gregory Gegembauer
- Department of Microbiology, Immunology and Parasitology, Cell Biology Division, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo state, Brazil
| | - Marilene R. Chang
- Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul state, Brazil
| | - Zoilo P. de Camargo
- Department of Microbiology, Immunology and Parasitology, Cell Biology Division, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo state, Brazil
| | - Thiago F. Nunes
- Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul state, Brazil
| | - Sergio M. Ribeiro
- Faculdade de Medicina de Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo state, Brazil
| | - Lídia R. de Carvalho
- Institute of Biosciences, Botucatu—São Paulo State University (UNESP), Botucatu, São Paulo state, Brazil
| | - Bianca M. Maldonado
- Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul state, Brazil
| | - Rinaldo P. Mendes
- Faculdade de Medicina de Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo state, Brazil
| | - Anamaria M. M. Paniago
- Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul state, Brazil
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13
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Teixeira MDM, Cattana ME, Matute DR, Muñoz JF, Arechavala A, Isbell K, Schipper R, Santiso G, Tracogna F, Sosa MDLÁ, Cech N, Alvarado P, Barreto L, Chacón Y, Ortellado J, Lima CMD, Chang MR, Niño-Vega G, Yasuda MAS, Felipe MSS, Negroni R, Cuomo CA, Barker B, Giusiano G. Genomic diversity of the human pathogen Paracoccidioides across the South American continent. Fungal Genet Biol 2020; 140:103395. [PMID: 32325168 PMCID: PMC7385733 DOI: 10.1016/j.fgb.2020.103395] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/27/2020] [Accepted: 04/16/2020] [Indexed: 12/30/2022]
Abstract
Paracoccidioidomycosis (PCM) is a life-threatening systemic mycosis widely reported in the Gran Chaco ecosystem. The disease is caused by different species from the genus Paracoccidioides, which are all endemic to South and Central America. Here, we sequenced and analyzed 31 isolates of Paracoccidioides across South America, with particular focus on isolates from Argentina and Paraguay. The de novo sequenced isolates were compared with publicly available genomes. Phylogenetics and population genomics revealed that PCM in Argentina and Paraguay is caused by three distinct Paracoccidioides genotypes, P. brasiliensis (S1a and S1b) and P. restrepiensis (PS3). P. brasiliensis S1a isolates from Argentina are frequently associated with chronic forms of the disease. Our results suggest the existence of extensive molecular polymorphism among Paracoccidioides species, and provide a framework to begin to dissect the connection between genotypic differences in the pathogen and the clinical outcomes of the disease.
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Affiliation(s)
- Marcus de Melo Teixeira
- Northern Arizona University, Flagstaff, AZ, USA; Universidade de Brasília, Brasilia, Brazil.
| | - Maria Emilia Cattana
- Northern Arizona University, Flagstaff, AZ, USA; Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina
| | - Daniel R Matute
- Biology Department, University of North Carolina, Chapel Hill, NC, USA
| | - José F Muñoz
- Broad Institute of MIT and Harvard, Cambridge, USA
| | | | - Kristin Isbell
- Biology Department, University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | | | - Primavera Alvarado
- Servicio Autónomo Instituto de Biomedicina Dr. Jacinto Convit, Caracas, Venezuela
| | - Laura Barreto
- Instituto Superior de Formación Docente Salome Ureña, Santo Domingo, Dominican Republic
| | - Yone Chacón
- Hospital Señor del Milagro, Salta, Argentina
| | | | | | | | | | | | | | | | | | | | - Gustavo Giusiano
- Universidad Nacional del Nordeste, Resistencia, Chaco, Argentina.
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14
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Ashraf N, Kubat RC, Poplin V, Adenis AA, Denning DW, Wright L, McCotter O, Schwartz IS, Jackson BR, Chiller T, Bahr NC. Re-drawing the Maps for Endemic Mycoses. Mycopathologia 2020; 185:843-865. [PMID: 32040709 PMCID: PMC7416457 DOI: 10.1007/s11046-020-00431-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/24/2020] [Indexed: 01/19/2023]
Abstract
Endemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.
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Affiliation(s)
- Nida Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Ryan C Kubat
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Victoria Poplin
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Antoine A Adenis
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - David W Denning
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura Wright
- Geographic Research Analysis and Services Program, Division of Toxicology and Human Health Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Orion McCotter
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brendan R Jackson
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA.
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15
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Giusiano G, Aguirre C, Vratnica C, Rojas F, Corallo T, Cattana ME, Fernández M, Mussin J, de Los Angeles Sosa M. Emergence of acute/subacute infant-juvenile paracoccidioidomycosis in Northeast Argentina: Effect of climatic and anthropogenic changes? Med Mycol 2019; 57:30-37. [PMID: 29346653 DOI: 10.1093/mmy/myx153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/23/2017] [Indexed: 11/14/2022] Open
Abstract
Argentina has two endemic areas of paracoccidioidomycosis (PCM). Bordering Paraguay and Brazil, Northeast Argentina (NEA) comprises the area with the highest incidence where the chronic adult clinical form has historically been reported. Juvenile form in children and adolescents is rare in this area since only one case was reported in the last 10 years. Despite this, between 2010 and 2012, several cases of acute/subacute clinical forms in children aged 10 to 16 (median 12) were detected. In the last decade, the NEA region has been exposed to ecological variations as consequences of certain climatic and anthropogenic changes, including El Niño-Southern Oscillation phenomenon during 2009, and deforestation. The region has also suffered from the significant ecological effects of the construction of one of the biggest hydroelectric dams of South America. This study aims to describe clinical and epidemiological aspects of acute/subacute PCM cases detected in children from NEA and to discuss climatic and anthropogenic changes as possible contributing factors in the emergence of this disease in children. This acute/subacute PCM cluster was characterized by severe disseminated and aggressive presentations to localized form, with a high spectrum of clinical manifestations uncommonly observed. Due to the lack of experience in acute/subacute PCM in children in the studied area and the atypical clinical manifestations observed, the diagnosis was delayed. In order to avoid misdiagnosis, a higher level of suspicion is now required in NEA and countries bordering the southern part of the endemic area, which are affected by the changes discussed in this article.
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Affiliation(s)
- Gustavo Giusiano
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - Clarisa Aguirre
- Hospital Pediátrico Dr. Avelino Castelán, Resistencia, Argentina
| | | | - Florencia Rojas
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - Teresa Corallo
- Hospital Pediátrico Dr. Avelino Castelán, Resistencia, Argentina
| | - María Emilia Cattana
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - Mariana Fernández
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - Javier Mussin
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
| | - María de Los Angeles Sosa
- Departamento de Micología, Instituto de Medicina Regional, Universidad Nacional del Nordeste, CONICET, Resistencia, Argentina
- Laboratorio Central de Salud Pública, Corrientes, Argentina
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16
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Hahn RC, Rodrigues AM, Della Terra PP, Nery AF, Hoffmann-Santos HD, Góis HM, Fontes CJF, de Camargo ZP. Clinical and epidemiological features of paracoccidioidomycosis due to Paracoccidioides lutzii. PLoS Negl Trop Dis 2019; 13:e0007437. [PMID: 31163028 PMCID: PMC6548353 DOI: 10.1371/journal.pntd.0007437] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The fungus Paracoccidioides lutzii was recently included as a new causative species of paracoccidioidomycosis (PCM) and most cases have been reported from Brazil. According to available epidemiological information, P. lutzii is concentrated in the Middle-West region in Brazil, mainly in the state of Mato Grosso. However, clinical and laboratorial data available on patients infected with P. lutzii remain extremely limited. METHODOLOGY/MAIN FINDINGS This work describes the clinical manifestations of 34 patients suffering from PCM caused by P. lutzii, treated along 5 years (2011-2017) at a reference service center for systemic mycoses in Mato Grosso, Brazil. Adult rural workers (men), aged between 28 and 67 predominated. All patients had the chronic form of the disease, and the oral mucosa (n = 19; 55.9%), lymph nodes (n = 23; 67.7%), skin (n = 16; 47.1%) and lung (n = 28; 82.4%) were the most affected sites. Alcohol intake (n = 19; 55.9%) and smoking (n = 29; 85.3%) were frequent habits among the patients. No patient suffered from any other life-threatening disease, such as tuberculosis, cancer or other inflammatory or infectious parasitic diseases. The positivity in culture examination (97.1%) was higher than that found for the direct mycological examination (88.2%). Particularly, one patient presented fungemia at diagnosis, which lead to his death. The time elapsed between the initial symptoms and the initiation of treatment of PCM caused by P. lutzii was 19.7 (31.5) months, with most patients diagnosed 7 months after the symptoms' onset. CONCLUSIONS/SIGNIFICANCE Compared with the classical clinical-epidemiological profile of PCM caused by P. brasiliensis, the results of this descriptive study did not show significant clinical or epidemiological differences that could be attributed to the species P. lutzii. Future studies may confirm or refute the existence of clinical differences between the two fungal species.
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Affiliation(s)
- Rosane Christine Hahn
- Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Mycology/Research, Cuiabá, Mato Grosso, Brazil
- Federal University of Mato Grosso, Júlio Muller University Hospital, Mato Grosso, Brazil
- Federal University of São Paulo, Paulista School of Medicine, Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, São Paulo, São Paulo, Brazil
| | - Anderson Messias Rodrigues
- Federal University of São Paulo, Paulista School of Medicine, Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, São Paulo, São Paulo, Brazil
| | - Paula Portella Della Terra
- Federal University of São Paulo, Paulista School of Medicine, Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, São Paulo, São Paulo, Brazil
| | - Andréia Ferreira Nery
- Federal University of Mato Grosso, Júlio Muller University Hospital, Mato Grosso, Brazil
| | - Hugo Dias Hoffmann-Santos
- Federal University of Mato Grosso, Faculty of Medicine, Laboratory of Mycology/Research, Cuiabá, Mato Grosso, Brazil
| | - Hellen Meira Góis
- Federal University of Mato Grosso, Júlio Muller University Hospital, Mato Grosso, Brazil
| | | | - Zoilo Pires de Camargo
- Federal University of São Paulo, Paulista School of Medicine, Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, São Paulo, São Paulo, Brazil
- * E-mail:
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17
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Bossart GD, Romano TA, Peden-Adams MM, Schaefer AM, Rice CD, Fair PA, Reif JS. Comparative Innate and Adaptive Immune Responses in Atlantic Bottlenose Dolphins ( Tursiops truncatus) With Viral, Bacterial, and Fungal Infections. Front Immunol 2019; 10:1125. [PMID: 31231361 PMCID: PMC6558379 DOI: 10.3389/fimmu.2019.01125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/03/2019] [Indexed: 02/05/2023] Open
Abstract
Free-ranging Atlantic bottlenose dolphins (n = 360) from two southeastern U.S. estuarine sites were given comprehensive health examinations between 2003 and 2015 as part of a multi-disciplinary research project focused on individual and population health. The study sites (and sample sizes) included the Indian River Lagoon (IRL), Florida, USA (n = 246) and Charleston harbor and associated rivers (CHS), South Carolina, USA (n = 114). Results of a suite of clinicoimmunopathologic tests revealed that both populations have a high prevalence of infectious and neoplastic disease and a variety of abnormalities of their innate and adaptive immune systems. Subclinical infections with cetacean morbillivirus and Chlamydiaceae were detected serologically. Clinical evidence of orogenital papillomatosis was supported by the detection of a new strain of dolphin papillomavirus and herpesvirus by molecular pathology. Dolphins with cutaneous lobomycosis/lacaziasis were subsequently shown to be infected with a novel, uncultivated strain of Paracoccidioides brasiliensis, now established as the etiologic agent of this enigmatic disease in dolphins. In this review, innate and adaptive immunologic responses are compared between healthy dolphins and those with clinical and/or immunopathologic evidence of infection with these specific viral, bacterial, and fungal pathogens. A wide range of immunologic host responses was associated with each pathogen, reflecting the dynamic and complex interplay between the innate, humoral, and cell-mediated immune systems in the dolphin. Collectively, these studies document the comparative innate and adaptive immune responses to various types of infectious diseases in free-ranging Atlantic bottlenose dolphins. Evaluation of the type, pattern, and degree of immunologic response to these pathogens provides novel insight on disease immunopathogenesis in this species and as a comparative model. Importantly, the data suggest that in some cases infection may be associated with subclinical immunopathologic perturbations that could impact overall individual and population health.
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Affiliation(s)
- Gregory D. Bossart
- Georgia Aquarium, Atlanta, GA, United States
- Division of Comparative Pathology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Tracy A. Romano
- The Mystic Aquarium, a Division of Sea Research Foundation, Inc., Mystic, CT, United States
| | - Margie M. Peden-Adams
- Harry Reid Center for Environmental Studies, University of Nevada, Las Vegas, NV, United States
| | - Adam M. Schaefer
- Harbor Branch Oceanographic Institute at Florida Atlantic University, Ft. Pierce, FL, United States
| | - Charles D. Rice
- Graduate Program in Environmental Toxicology, Department of Biological Sciences, Clemson University, Clemson, SC, United States
| | - Patricia A. Fair
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - John S. Reif
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
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18
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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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19
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Vicente CR, Falqueto A. Differentiation of mucosal lesions in mucocutaneous leishmaniasis and paracoccidioidomycosis. PLoS One 2018; 13:e0208208. [PMID: 30475920 PMCID: PMC6258372 DOI: 10.1371/journal.pone.0208208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022] Open
Abstract
Mucocutaneous leishmaniasis and paracoccidioidomycosis are infectious diseases with similar epidemiological and clinical aspects. Cases of both diseases may manifest similar lesions in the mucosa. Therefore, the determination of distinguishing characteristics for the purpose of differential diagnosis is critical for better management of the diseases. The present study evaluated factors that assist in the differentiation of mucosal lesions between these diseases. This cross-sectional study included data from medical records of 122 cases of mucocutaneous leishmaniasis and 83 cases of paracoccidioidomycosis attended at the university hospital Cassiano Antonio Moraes, located in Vitória, Espírito Santo State, Brazil. Comparison between the diseases included the following variables: sex, age, time of disease evolution, location of the lesion and symptoms. Adults and males were affected by both diseases at higher rates. Lesions in the nasal region (95.1%; p-value = 0.000) and the pharynx (20.5%; p-value = 0.009) and nasal obstruction (34.4%; p-value = 0.000) were associated with leishmaniasis. Paracoccidioidomycosis was associated with lesions in the oral region (90.4%; p-value = 0.000), oral pain (16.9%; p-value = 0.000), and hoarseness (14.5%; p-value = 0.008). In leishmaniasis, lesions in oral regions were not associated with oral pain and were frequently located close to the nasal area. The manifestations cited above could improve the differential diagnosis of leishmaniasis and paracoccidioidomycosis, and thereby potentially aid in the choice of appropriate confirmatory diagnostic testing.
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Affiliation(s)
- Creuza Rachel Vicente
- Department of Social Medicine, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
- * E-mail:
| | - Aloisio Falqueto
- Department of Social Medicine, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
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20
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Tracogna MF, Fernández Lugo S, Gariboglio Vázquez ML, Fernández MS, Andriani ME, Presti SE, Arce V, López R, Iliovich E, Marques IA, Cattana ME. [Clinical and epidemiological characteristics of patients with paracoccidioidomycosis diagnosed in a hospital of Resistencia, Chaco]. Rev Argent Microbiol 2018; 51:144-147. [PMID: 30243524 DOI: 10.1016/j.ram.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/25/2018] [Accepted: 06/13/2018] [Indexed: 11/18/2022] Open
Abstract
In order to describe the clinical and epidemiological characteristics of paracoccidioidomycosis, a descriptive study of all the cases diagnosed by the Clinical Microbiology Service at Dr. Julio C. Perrando hospital in the city of Resistencia (Chaco Province, Argentina) was conducted. Between 2011 and 2014, 46 cases were detected. In the period 2013-2014, an almost 4-fold increase in the incidence rate was detected. The chronic form of the disease was predominant with an average age of 53 years. Serological tests in 39 out of 46 patients were performed. In 15 of 39 patients, serological tests were the only diagnostic tool while in 4 patients with a microbiological diagnosis serological tests were non-reactive. In patients from endemic areas with non-specific infectious syndrome it is important to include paracoccidioidomycosis in the differential diagnosis and to apply all available diagnostic tools to reach a timely diagnosis and to reduce the long-term sequelae and their socio-economic impact.
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Affiliation(s)
| | | | | | | | | | - Sara E Presti
- Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina
| | - Verónica Arce
- Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina
| | - Rosana López
- Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina
| | | | | | - María E Cattana
- Hospital Dr. Julio C. Perrando, Resistencia, Chaco, Argentina
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21
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Salzer HJF, Stoney RJ, Angelo KM, Rolling T, Grobusch MP, Libman M, López-Vélez R, Duvignaud A, Ásgeirsson H, Crespillo-Andújar C, Schwartz E, Gautret P, Bottieau E, Jordan S, Lange C, Hamer DH. Epidemiological aspects of travel-related systemic endemic mycoses: a GeoSentinel analysis, 1997-2017. J Travel Med 2018; 25:5067362. [PMID: 30085265 PMCID: PMC6628256 DOI: 10.1093/jtm/tay055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/15/2018] [Indexed: 11/13/2022]
Abstract
Background International travel has increased in the past few decades, placing more travellers at risk of acquiring systemic endemic mycoses. There are limited published data on systemic endemic mycoses among international travellers. We report epidemiological characteristics of non-migrant, international travellers who acquired systemic endemic mycoses during travel. Methods We analysed records of non-migrant international travellers with a confirmed diagnosis of histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis or talaromycosis reported from 1997 through 2017 to GeoSentinel, a global surveillance network now consisting of 70 travel or tropical medicine centres in 31 countries. Results Sixty-nine records met the inclusion criteria. Histoplasmosis was most frequently reported; the 51 travellers with histoplasmosis had the lowest median age (30 years; range: 8-85) and shortest median duration of travel (12 days; range: 5-154). Coccidioidomycosis was reported in 14 travellers; travellers with coccidioidomycosis were older (median 62 years; range: 22-78) and had the longest median number of days between return from travel and presentation to a GeoSentinel site (55 days; range: 17-273). Almost all travellers with coccidioidomycosis were exposed in the USA. Other systemic endemic mycoses were less frequently reported, including blastomycosis (three travellers) and talaromycosis (one traveller). Conclusions Although relatively rare, systemic endemic mycoses should be considered as potential travel-related infections in non-migrant international travellers. Epidemiological exposures should be used to guide diagnostic evaluations and treatment.
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Affiliation(s)
- Helmut J. F. Salzer
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Rhett J. Stoney
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Kristina M. Angelo
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Thierry Rolling
- Section of Infectious Diseases and Tropical Medicine, 1st Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michael Libman
- J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Hilmir Ásgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Clara Crespillo-Andújar
- National Referral Unit for Tropical and Travel Medicine, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III, Madrid, Spain
| | - Eli Schwartz
- The Center for Geographic Medicine and Internal Medicine ‘C’ Chaim Sheba Medical Center, Tel HaShomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philippe Gautret
- Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sabine Jordan
- Section of Infectious Diseases and Tropical Medicine, 1st Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
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do Valle ACF, Marques de Macedo P, Almeida-Paes R, Romão AR, Lazéra MDS, Wanke B. Paracoccidioidomycosis after Highway Construction, Rio de Janeiro, Brazil. Emerg Infect Dis 2018; 23:1917-1919. [PMID: 29048286 PMCID: PMC5652422 DOI: 10.3201/eid2311.170934] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Transmission of Paracoccidioides spp. fungi to humans is usually related to manipulation of soil. Rural workers are the most affected group. We report an outbreak of paracoccidioidomycosis after deforestation and massive earth removal during construction of a highway in Rio de Janeiro, Brazil. Extensive environmental disturbances might be involved in fungal transmission.
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Molina-Morant D, Sánchez-Montalvá A, Salvador F, Sao-Avilés A, Molina I. Imported endemic mycoses in Spain: Evolution of hospitalized cases, clinical characteristics and correlation with migratory movements, 1997-2014. PLoS Negl Trop Dis 2018; 12:e0006245. [PMID: 29447170 PMCID: PMC5831632 DOI: 10.1371/journal.pntd.0006245] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/28/2018] [Accepted: 01/18/2018] [Indexed: 12/04/2022] Open
Abstract
Endemic mycoses are systemic fungal infections. Histoplasmosis is endemic in all temperate areas of the world; coccidioidomycosis and paracoccidioidomycosis are only present in the American continent. These pathogens are not present in Spain, but in the last years there has been an increase of reported cases due to migration and temporary movements. We obtained from the Spanish hospitals records clinical and demographic data of all hospitalized cases between 1997 and 2014. There were 286 cases of histoplasmosis, 94 of Coccidioidomycosis and 25 of paracoccidioidomycosis. Overall, histoplasmosis was strongly related to HIV infection, as well as with greater morbidity and mortality. For the other mycoses, we did not find any immunosuppressive condition in most of the cases. Although we were not able to obtain data about clinical presentation of all the cases, the most frequently found was pulmonary involvement. We also found a temporal correlation between the Spanish population born in endemic countries and the number of hospitalized cases along this period. This study reflects the importance of imported diseases in non-endemic countries due to migratory movements.
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Affiliation(s)
- Daniel Molina-Morant
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Augusto Sao-Avilés
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Peçanha PM, Batista Ferreira ME, Massaroni Peçanha MA, Schmidt EB, Lamas de Araújo M, Zanotti RL, Potratz FF, Delboni Nunes NE, Gonçalves Ferreira CU, Delmaestro D, Falqueto A. Paracoccidioidomycosis: Epidemiological and Clinical Aspects in 546 Cases Studied in the State of Espírito Santo, Brazil. Am J Trop Med Hyg 2017; 97:836-844. [PMID: 28749757 PMCID: PMC5590575 DOI: 10.4269/ajtmh.16-0790] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 05/22/2016] [Indexed: 11/07/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is an endemic disease in the southeast region of Brazil, which includes the state of Espírito Santo (ES). This historic case series analyses 546 patients treated in this state from 1978 to 2012. Patients aged from 7 to 83 years, 509 males and 37 females, yielding a ratio of 13.7:1. Most of the patients (81.4%) originated from rural areas in ES, 71.0% being farmers. A higher concentration of cases was observed in municipalities located along the western range of the state. Sixty patients (11.0%) had an acute/subacute form of the disease, 485 (88.9%) had a chronic form, and one had a subclinical form. The most affected organs included the lungs, oropharyngeal mucosa, lymph nodes, skin, and larynx. The diagnosis was confirmed by histopathology in 252 (46.2%) cases, direct examination in 168 (30.7%), both exams in 111 (20.3%) and serology in 15 (2.8%). Tuberculosis, acquired immune deficiency syndrome, leishmaniasis, and intestinal parasites were the most frequently associated infectious diseases. From 328 patients followed up, total regression of the lesions was observed in 17.4%, partial regression in 77.4%, and no regression in 17 (5.2%) cases. Regarding the number of cases in this series, ES emerges as an important endemic area for PCM in Brazil.
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Affiliation(s)
- Paulo Mendes Peçanha
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Mayara Elisa Batista Ferreira
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Maria Angélica Massaroni Peçanha
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Edilaine Brandão Schmidt
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Mariceli Lamas de Araújo
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Raphael Lubiana Zanotti
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Felipe Fonseca Potratz
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Nilo Eduardo Delboni Nunes
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Carlos Urbano Gonçalves Ferreira
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Délio Delmaestro
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Aloísio Falqueto
- Infectious Diseases and Dermatology Units of the Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
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25
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de Macedo PM, Almeida-Paes R, Freitas DFS, Varon AG, Paixão AG, Romão AR, Coutinho ZF, Pizzini CV, Zancopé-Oliveira RM, Francesconi do Valle AC. Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro, Brazil. PLoS Negl Trop Dis 2017; 11:e0005500. [PMID: 28355221 PMCID: PMC5386294 DOI: 10.1371/journal.pntd.0005500] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/10/2017] [Accepted: 03/17/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Paracoccidioidomycosis (PCM) is a systemic mycosis caused by pathogenic dimorphic fungi of the genus Paracoccidioides. It is the most important systemic mycosis in Latin America and the leading cause of hospitalizations and death among them in Brazil. Acute PCM is less frequent but relevant because vulnerable young patients are affected and the severity is usually higher than that of the chronic type. METHODS The authors performed a retrospective cohort study from 2001 to 2009 including acute juvenile PCM patients from a reference center in Rio de Janeiro, Brazil. Clinical, epidemiological, diagnostic, therapeutic, and prognostic data were reported. RESULTS Twenty-nine patients were included. The average age was 23 years old and the male to female ratio was 1:1.07. All cases were referred from 3 of 9 existing health areas in the state of Rio de Janeiro, predominantly from urban areas (96.5%). Lymph nodes were the most affected organs (100%), followed by the skin and the spleen (31% each). Twenty-eight patients completed treatment (median 25 months) and progressed to clinical and serological cure; 1 death occurred. Twenty-four patients completed 48-month median follow-up. Four patients abandoned follow-up after the end of treatment. The most frequent sequela was low adrenal reserve. Paracoccidioides brasiliensis S1 was identified by partial sequencing of the arf and gp43 genes from 4 patients who presented a viable fungal culture. CONCLUSION Acute juvenile PCM is a severe disease with a high rate of complications. There are few cohort clinical studies of acute PCM in the literature. More studies should be developed to promote improvement in patients' healthcare.
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Affiliation(s)
- Priscila Marques de Macedo
- Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Dayvison Francis Saraiva Freitas
- Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Andréa Gina Varon
- Department of Inpatient Health Care, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Ariane Gomes Paixão
- Department of Inpatient Health Care, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Anselmo Rocha Romão
- Geoprocessing Laboratory, Institute of Scientific and Technological Communication and Information in Health, Fiocruz, Rio de Janeiro, Brazil
| | | | - Claudia Vera Pizzini
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | | - Antonio Carlos Francesconi do Valle
- Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
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Abstract
Oral fungal infections (mycoses) have come into particular prominence since the advent of infection with Human Immunodeficiency Virus (HIV), and recognition of the Acquired Immune Deficiency Syndrome (AIDS), as well as the phenomenal increase in world travel with increased exposure to infections endemic in the tropics. Paracoccidioidomycosis is a rare mycosis worldwide but common in Brazil and some other areas in Latin America. It can be life-threatening and can manifest with a spectrum of clinical presentations, including frequent oral lesions. This paper reviews the more recent information on Paracoccidioidomycosis, emphasizing those areas most relevant in dental science.
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Affiliation(s)
- Oslei Paes Almeida
- Department of Oral Pathology, Dental School of Piracicaba-UNICAMP, Av. Limeira 901, CEP 13.414.903-CP 52, Piracicaba, SP, Brazil.
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Sylvestre TF, Silva LRF, Cavalcante RDS, Moris DV, Venturini J, Vicentini AP, de Carvalho LR, Mendes RP. Prevalence and serological diagnosis of relapse in paracoccidioidomycosis patients. PLoS Negl Trop Dis 2014; 8:e2834. [PMID: 24787147 PMCID: PMC4006716 DOI: 10.1371/journal.pntd.0002834] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/16/2014] [Indexed: 11/30/2022] Open
Abstract
A review of 400 clinical records of paracoccidioidomycosis (PCM) patients, 93 with the acute/subacute (AF) and 307 with the chronic form (CF), attended from 1977 to 2011, selected as to the schedule of release for study by the Office of Medical Records at the University Hospital of the Faculdade de Medicina de Botucatu-São Paulo State University--UNESP, was performed to detect cases in relapse. The control of cure was performed by clinical and serological evaluation using the double agar gel immunodiffusion test (DID). In the diagnosis of relapse, DID, enzyme-linked immunosorbent assay (ELISA) and immunoblotting assay (IBgp70 and IBgp43) were evaluated. Out of 400 patients, 21 (5.2%) went through relapse, 18 of them were male and 3 were female, 6∶1 male/female ratio. Out of the 21 patients in relapse, 15 (4.8%) showed the CF, and 6 (6.4%) the AF (p>0.05). The sensitivity of DID and ELISA before treatment was the same (76.1%). DID presented higher sensitivity in pre-treatment (80%) than at relapse (45%; p = 0.017), while ELISA showed the same sensitivity (80% vs 65%; p = 0.125). The serological methods for identifying PCM patients in relapse showed low rates of sensitivity, from 12.5% in IBgp70 to 65.0% in IBgp43 identification and 68.8% in ELISA. The sensitivity of ELISA in diagnosing PCM relapse showed a strong tendency to be higher than DID (p = 0.06) and is equal to IBgp43 (p = 0.11). In sum, prevalence of relapse was not high in PCM patients whose treatment duration was based on immunological parameters. However, the used methods for serological diagnosis present low sensitivity. While more accurate serological methods are not available, we pay special attention to the mycological and histopathological diagnosis of PCM relapse. Hence, direct mycological, cytopathological, and histopathological examinations and isolation in culture for P. brasiliensis must be appropriately and routinely performed when the hypothesis of relapse is considered.
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Affiliation(s)
- Tatiane Fernanda Sylvestre
- Tropical Diseases Department - Faculdade de Medicina de Botucatu – Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | | | - Ricardo de Souza Cavalcante
- Tropical Diseases Department - Faculdade de Medicina de Botucatu – Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | | | - James Venturini
- Laboratory of Experimental Immunology, Department of Biological Science, Faculty of Science, São Paulo State University – UNESP, São Paulo, Brazil
| | | | | | - Rinaldo Poncio Mendes
- Tropical Diseases Department - Faculdade de Medicina de Botucatu – Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
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Zurita Macalupú S. [Sporotrichosis and paracoccidioidomycosis in Peru: experiences in prevention and control]. Rev Peru Med Exp Salud Publica 2014; 31:352-357. [PMID: 25123878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/28/2014] [Indexed: 06/03/2023] Open
Abstract
The epidemiological picture of sporotrichosis and paracoccidioidomycosis in Peru and Latin America is sporadic, fragmented, and geographically limited, mainly due to lack of mandatory reporting and limited diagnostic coverage. However, research contributions related to understanding the interaction of these fungi, the response of the host and the environment, the use of spatial analysis that relates the distribution of these mycoses, population density and climate, contributes to the design of prevention and control strategies of these mycosis and suggest epidemiological risk maps management, based on the habitat of the fungus. This information will be used by doctors, tourists and people living in rural areas where mycoses are endemic. The aim of the paper is to present a review of the topic through research findings that contribute to the prevention and control of these mycosis.
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Affiliation(s)
- Susana Zurita Macalupú
- Laboratorio de Referencia Nacional de Micología, Instituto Nacional de Salud, Lima, Perú
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29
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Onda H, Komine M, Murata S, Ohtsuki M. Letter: Imported paracoccidioidomycosis in Japan. Dermatol Online J 2011; 17:11. [PMID: 22233747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
A 39-year-old man from Argentina, who had come to Japan 13 years previously, had been suffering from oral pain for several months. He was biopsied twice and treated with oral predonisolone without improvement. A number of white granular lesions with erosions were observed on the hard palate and buccal mucosa. Histopathological examination revealed a well-demarcated abscess with an accumulation of neutrophils, surrounded by epithelioid cell granulomas. Round eosinophilic bodies, considered to be fungal elements, positive for PAS and Grocott staining, were observed. Chest CT revealed cavities in the lung. A white yeast-like colony was cultured from bronchial lavage fluid and Paracoccidioides brasiliensis was identified. The patient was treated with liposomal amphotericin B followed by oral itraconazole 400 mg/day, with a favorable clinical course. Paracoccidioidomycosis, an imported mycosis, is rare in Japan and sometimes causes difficulty in diagnosis, resulting in inappropriate treatment.
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Barrozo LV, Benard G, Silva MES, Bagagli E, Marques SA, Mendes RP. First description of a cluster of acute/subacute paracoccidioidomycosis cases and its association with a climatic anomaly. PLoS Negl Trop Dis 2010; 4:e643. [PMID: 20361032 PMCID: PMC2846938 DOI: 10.1371/journal.pntd.0000643] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 02/09/2010] [Indexed: 11/19/2022] Open
Abstract
Background Identifying clusters of acute paracoccidioidomycosis cases could potentially help in identifying the environmental factors that influence the incidence of this mycosis. However, unlike other endemic mycoses, there are no published reports of clusters of paracoccidioidomycosis. Methodology/Principal Findings A retrospective cluster detection test was applied to verify if an excess of acute form (AF) paracoccidioidomycosis cases in time and/or space occurred in Botucatu, an endemic area in São Paulo State. The scan-test SaTScan v7.0.3 was set to find clusters for the maximum temporal period of 1 year. The temporal test indicated a significant cluster in 1985 (P<0.005). This cluster comprised 10 cases, although 2.19 were expected for this year in this area. Age and clinical presentation of these cases were typical of AF paracccidioidomycosis. The space-time test confirmed the temporal cluster in 1985 and showed the localities where the risk was higher in that year. The cluster suggests that some particularities took place in the antecedent years in those localities. Analysis of climate variables showed that soil water storage was atypically high in 1982/83 (∼2.11/2.5 SD above mean), and the absolute air humidity in 1984, the year preceding the cluster, was much higher than normal (∼1.6 SD above mean), conditions that may have favored, respectively, antecedent fungal growth in the soil and conidia liberation in 1984, the probable year of exposure. These climatic anomalies in this area was due to the 1982/83 El Niño event, the strongest in the last 50 years. Conclusions/Significance We describe the first cluster of AF paracoccidioidomycosis, which was potentially linked to a climatic anomaly caused by the 1982/83 El Niño Southern Oscillation. This finding is important because it may help to clarify the conditions that favor Paracoccidioides brasiliensis survival and growth in the environment and that enhance human exposure, thus allowing the development of preventive measures. Paracoccocidioidomycosis is acquired through inhalation of spores released from filamentous forms of Paracoccidioides brasiliensis presumably present in the soil of endemic areas. However, successful isolation of the fungus from these areas has been rare, making it difficult to determine the fungus's ecological niche and the environmental factors that might influence the rate of infection and disease. Identifying clusters of acute paracoccidioidomycosis cases could potentially help at identifying these factors. However, there are no published reports of paracoccidioidomycosis outbreaks. We describe an undetected cluster of acute paracoccidioidomycosis cases diagnosed in 1985 in São Paulo State, Brazil, and investigate its association with climate. We observed that soil water storage was atypically high in 1982/83, and that the absolute air humidity in 1984 was much higher than normal, which may have favored, respectively, antecedent fungal growth in soil and conidia liberation in 1984, the probable year of exposure. This atypically high soil water storage was due to the strongest El Niño event in the area in the last 50 years, which also caused atypically high precipitation in that area. Better knowledge of the conditions that favor the fungus's survival and growth in the environment and that enhance human exposure may facilitate the development of preventive measures.
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Affiliation(s)
- Ligia Vizeu Barrozo
- Department of Geography, School of Phylosophy, Literature and Human Sciences, University of São Paulo, São Paulo, São Paulo State, Brazil.
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Cermeño J, Cermeño J, Godoy G, Hernández I, Orellán Y, Blanco Y, Penna S, García L, Mender T, Gonsálvez M, López C, Hernández N, Longa I, Gottberg E, Basanta A, Castro M, Millán I, León W, Plaz F, Jahouhari C, Cabello I. Epidemiological study of paracoccidioidomycosis and histoplasmosis in a suburb of San Félix city, Bolívar state, Venezuela. Invest Clin 2009; 50:213-220. [PMID: 19662816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Epidemiologic studies of deep mycosis have been scarce in Bolivar state, where paracoccidioidomycosis and histoplasmosis are considered as endemic diseases. The aim of this study was to determine paracoccidioidomycosis and histoplasmosis prevalences in people from a suburb of San Féix, Bolívar state, Venezuela. Three-hundred volunteers agreed to participate in this study and they were inoculated with paracoccidioidine and histoplasmine. Identification and epidemiologic data were registered. Reading of skin tests after 24 hours was performed in 275 persons. Paracoccidioidine test was positive in 10.2% (n=28). A higher percentage of positive reactions in the age group of 40-50 years old (n=10; 35.7%) was observed. Bricklayers, farmers and miners were positive in 27.3% (3 out of 11), a higher percentage than in people with other occupations. Histoplasmine test was positive in 7.6% of cases (n=21). The higher percentage of reactivity was observed in the age group of 40-50 years old (n=9; 42.9%). There was a direct proportional relationship between staying time in the locality and H. capsulatum infection mainly in persons staying in the area for more than 30 years (p < 0.05). These results showed low prevalences of P. brasiliensis and H. capsulatum infection in this area.
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Affiliation(s)
- Julman Cermeño
- Escola de Ciencias de la Salud Dr. Francisco Battistini Casalta, Universidad de Oriente Núicleo Bolívar, Ciudad Bolívar , Venezuela.
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Morejón KML, Machado AA, Martinez R. Paracoccidioidomycosis in patients infected with and not infected with human immunodeficiency virus: a case-control study. Am J Trop Med Hyg 2009; 80:359-366. [PMID: 19270282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Epidemiologic and clinical data for 53 patients with paracoccidioidomycosis and co-infected with human immunodeficiency virus (HIV) (cases) were compared with those for 106 patients with endemic paracoccidioidomycosis (controls). The prevalence of Paracoccidioides brasiliensis co-infection was estimated in 1.4% in cases of acquired immunodeficiency syndrome (AIDS). Patients co-infected with HIV were younger, less involved in agricultural occupations; 83.7% had CD4+ cell count < 200 cells/microL. Paracoccidioidomycosis in co-infected patients usually showed a rapid progression, with more fever, frequent involvement of the lungs, and multiple extrapulmonary lesions. The response to antifungal therapy and deaths caused by paracoccidioidomycosis were similar in the two patient groups, but late relapses were more common in co-infected cases. Paracoccidioidomycosis in HIV-infected patients shows epidemiologic and clinical characteristics differing from those of the endemic disease and should be considered an AIDS-defining opportunistic infection in Latin America.
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Affiliation(s)
- Karen M Loro Morejón
- Division of Infectious and Tropical Diseases, Hospital das Clínicas and Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Tichellio AG, Mangiaterra M, Giusiano G. [Paracoccidioidomycosis in Formosa province (Argentina)]. Rev Argent Microbiol 2008; 40:24-29. [PMID: 18669049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Patients with paracoccidioidomycosis (PCM) compatible symptoms who attended Hospital Central de Formosa, were studied during 2 years. Three hundred and thirty five patients were selected, 264 male and 71 female, ages were between 25 and 79 years old. Twenty four patients were diagnosed, the prevalence observed was 7.16%. There was only one female positive case. Most patients (83%) had smoked for more than 10 years, 96% came from a rural area and 63% was alcoholic. Also a case of neuroparacoccidioidomycosis and a juvenile-type PCM case were detected. Specimens of mucocutaneous lesions were 100% positives. Immunodiffusion (IDGA) allowed the diagnostic in 22/249 patients. PCM and others infectious diseases with similar clinical manifestations coexist in Formosa province, for this reason differential diagnostic must be done.
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Richini-Pereira VB, Bosco SDMG, Griese J, Theodoro RC, Macoris SAG, da Silva RJ, Barrozo L, Tavares PMES, Zancopé-Oliveira RM, Bagagli E. Molecular detection ofParacoccidioides brasiliensisin road-killed wild animals. Med Mycol 2008; 46:35-40. [PMID: 17885959 DOI: 10.1080/13693780701553002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Paracoccidioides brasiliensis infections have been little studied in wild and/or domestic animals, which may represent an important indicator of the presence of the pathogen in nature. Road-killed wild animals have been used for surveillance of vectors of zoonotic pathogens and may offer new opportunities for eco-epidemiological studies of paracoccidiodomycosis (PCM). The presence of P. brasiliensis infection was evaluated by Nested-PCR in tissue samples collected from 19 road-killed animals; 3 Cavia aperea (guinea pig), 5 Cerdocyon thous (crab-eating-fox), 1 Dasypus novemcinctus (nine-banded armadillo), 1 Dasypus septemcinctus (seven-banded armadillo), 2 Didelphis albiventris (white-eared opossum), 1 Eira barbara (tayra), 2 Gallictis vittata (grison), 2 Procyon cancrivorus (raccoon) and 2 Sphiggurus spinosus (porcupine). Specific P. brasiliensis amplicons were detected in (a) several organs of the two armadillos and one guinea pig, (b) the lung and liver of the porcupine, and (c) the lungs of raccoons and grisons. P. brasiliensis infection in wild animals from endemic areas might be more common than initially postulated. Molecular techniques can be used for detecting new hosts and mapping 'hot spot' areas of PCM.
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Affiliation(s)
- Virgínia Bodelão Richini-Pereira
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
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Cermeño-V JJ, Cermeño JR, Cova-V NM, Pérez GM. [Adrenocortical function in patients with systemic mycoses]. Invest Clin 2007; 48:341-8. [PMID: 17853793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The systemic mycoses like paracoccidioidomycosis and histoplasmosis, are the main cause of adrenal insufficiency in the countries where they arc endemic. In Venezuela an elevated frequency of these mycoses has been registered. The objective of this study was to evaluate the glucocorticoid adrenal function in patients with paracoccidioidomycosis and histoplasmosis hospitalized in the University Hospital "Ruiz y Pácz" of Ciudad Bolivar (Bolivar state) and in the Hospital "Luis Felipe Rojas Guevara", of El Tigre (Anzoátegui state), Venezuela, between January 2003 and January 2004. The test of fast stimulation with synthetic adrenocorticotrophin hormone (ACTH) was applied to a total of 12 patients with diagnosis of some of these mycoses and data of epidemiologic interest were taken. The proportion men:women was of 5:1, the average age was 35.1 +/- 0.37 years, similar to the control group. Basal plasmatic cortisol levels were within the normal rank in all the patients. After the injection of synthetic ACTH, an increase of plasmatic cortisol values in the same rank for patients with a normal adrenal function was observed, but it was significantly lower than the observed for the control group. These results suggest that there is an adrenal gland functional reserve diminution in patients with either Paracoccidioidomycosis or Histoplasmosis. In patients with systemic mycoses, it is important to evaluate the response to the test of fast stimulation with ACTH due to the frequency of impairment of the glucocorticoid adrenal function in our location.
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Pato AM, Giusiano G, Mangiaterra M. [Association of paracoccidioidomycosis with different pulmonary pathologies in a hospital in Corrientes Province, Argentina]. Rev Argent Microbiol 2007; 39:161-165. [PMID: 17987853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
For 2 years, a systematic research of paracoccidioidomycosis (PCM) had been conducted in a hospital in the city of Corrientes. The inclusion criterium used was: tuberculosis patients (TBC), presumptive or confirmed diagnosis of pulmonary cancer (CA), chronic obstructive pulmonary disease (COPD) and/or X-ray images compatible with pulmonary mycosis (XRC). Eighty four patients were studied: 57 (TBC), 1 (CA), 5 (COPD), 3 (TBC+CA), 4 (TBC+COPD), 4 (COPD+CA) and 10 (XRC). Serology tests by agar gel immunodiffusion (IDGA) were performed on all patients, whereas microbiological studies were performed on those cases in which clinical samples could be obtained. Ten PCM were diagnosed by IDGA; 4 associated to TBC, 1 to TBC+CA, 3 to COPD and only 2 to XRC. PCM was mycologically proven in 9 of these cases. Systematic research of PCM would lead to an early diagnosis and therefore, to better chances for a successful treatment.
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Affiliation(s)
- A M Pato
- Hospital Angela I. de Llano", Corrientes, Argentina
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Affiliation(s)
- Maria Aparecida Shikanai-Yasuda
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, Av. Enéias de Carvalho Aguiar 500, Térreo, Sala 4, 05403-000 São Paulo, SP.
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Abstract
Lobomycosis is a chronic dermal infection that presents a wide spectrum of clinical- dermatological manifestations, mainly characterized by the development of keloid lesions as well as nodular, verrucoid and sometimes ulcerous forms. The etiological agent at an international level, according to the consensus nomenclature, has been called Loboa loboi, even though recently it has been accommodated as Lacazia loboi. The present review extensively covers the clinical-epidemiological aspects as well as the most outstanding historical aspects, including the Venezuelan experience and the presentation of two new cases, which substantiate the Amazon basin as an endemic area for the disease.
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Affiliation(s)
- Alberto E Paniz-Mondolfi
- Laboratorio de Estudio de Antígenos, Instituto de Biomedicina, Universidad Central de Venezuela/Ministerio de Salud y Desarrollo Social, Caracas, Venezuela.
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Silveira LH, Domingos IH, Kouchi K, Itano EN, Silva EA, Landgraf VO, Werneck SM, Camargo ZP, Ono MA. Serological detection of antibodies against Paracoccidioides brasiliensis in dogs with leishmaniasis. Mycopathologia 2007; 162:325-9. [PMID: 17123030 PMCID: PMC2780595 DOI: 10.1007/s11046-006-0046-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 07/20/2006] [Indexed: 11/02/2022]
Abstract
The aim of this study was to detect antibodies against Paracoccidioides brasiliensis in dogs seropositive and seronegative for leishmaniasis. Sera from 836 dogs (449 positive and 387 negative to leishmaniasis) were analysed by ELISA and the immunodiffusion test using gp43 and exoantigen, respectively. The analysis of the 836 serum samples by ELISA and the immunodiffusion test showed a positivity of 67.8 % and 7.3%, respectively, for P. brasiliensis infection. The dogs positive to leishmaniasis showed a higher reactivity to gp43 (79.9%) and exoantigen (12.7%) than the negative ones (54.0% and 1.0%, respectively). The higher reactivity to P. brasiliensis antigens may be due to cross-reactivity or a co-infection of dogs by Leishmania and P. brasiliensis. The lower correlation (0.187) observed between reactivity to gp43 and Leishmania antigen reinforces the latter hypothesis.
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Affiliation(s)
- L. H. Silveira
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Campus Universitário, Londrina, Paraná 86051-980 Brazil
- Faculdades Luiz Meneghel, Bandeirantes, PR Brazil
| | - I. H. Domingos
- Centro de Controle de Zoonoses, Secretaria da Saúde, Campo Grande, MS Brazil
| | - K. Kouchi
- Centro de Controle de Zoonoses, Secretaria da Saúde, Campo Grande, MS Brazil
| | - E. N. Itano
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Campus Universitário, Londrina, Paraná 86051-980 Brazil
| | - E. A. Silva
- Centro de Controle de Zoonoses, Secretaria da Saúde, Campo Grande, MS Brazil
| | - V. O. Landgraf
- Laboratório Central (LACEN), Fundação da Saúde do Mato Grosso do Sul, Campo Grande, MS Brazil
| | - S. M. Werneck
- Laboratório Central (LACEN), Fundação da Saúde do Mato Grosso do Sul, Campo Grande, MS Brazil
| | - Z. P. Camargo
- Disciplina de Biologia Celular, Universidade Federal de São Paulo, São Paulo, Brazil
| | - M. A. Ono
- Departamento de Ciências Patológicas, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Campus Universitário, Londrina, Paraná 86051-980 Brazil
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Reif JS, Mazzoil MS, McCulloch SD, Varela RA, Goldstein JD, Fair PA, Bossart GD. Lobomycosis in Atlantic bottlenose dolphins from the Indian River Lagoon, Florida. J Am Vet Med Assoc 2006; 228:104-8. [PMID: 16426180 DOI: 10.2460/javma.228.1.104] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the prevalence of lobomycosis, a mycotic infection of dolphins and humans caused by a yeastlike organism (Lacazia loboi), among dolphins in the Indian River Lagoon in Florida. DESIGN Cross-sectional study. ANIMALS 146 Atlantic bottlenose dolphins. PROCEDURE Comprehensive health assessments of bottlenose dolphins in the Indian River Lagoon of Florida (n = 75) and in estuarine waters near Charleston, SC (71), were conducted during 2003 and 2004. Bottlenose dolphins were captured, examined, and released. Skin lesions were photographed and then biopsied. Tissue sections were stained with H&E and Gomori methenamine silver stains for identification of L. loboi. RESULTS 9 of 30 (30%) dolphins captured in the southern portion of the Indian River Lagoon had lobomycosis, whereas none of the 45 dolphins captured in the northern portion of the lagoon or of the 71 dolphins captured near Charleston, SC, did. Affected dolphins had low serum alkaline phosphatase activities and high acute-phase protein concentrations. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that lobomycosis may be occurring in epidemic proportions among dolphins in the Indian River Lagoon. Localization of the disease to the southern portion of the lagoon, an area characterized by freshwater intrusion and lower salinity, suggests that exposure to environmental stressors may be contributing to the high prevalence of the disease, but specific factors are unknown. Because only dolphins and humans are naturally susceptible to infection, dolphins may represent a sentinel species for an emerging infectious disease.
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Affiliation(s)
- John S Reif
- Division of Marine Mammal Research and Conservation, Harbor Branch Oceanographic Institution, 5600 US 1 North, Fort Pierce, FL 34946, USA
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Andrade RV, Da Silva SP, Torres FAG, Poças-Fonseca MJ, Silva-Pereira I, Maranhão AQ, Campos EG, Moraes LMP, Jesuíno RSA, Pereira M, Soares CMA, Walter MEMT, Carvalho MJA, Almeida NF, Brigido MM, Felipe MSS. Overview and perspectives on the transcriptome of Paracoccidioides brasiliensis. Rev Iberoam Micol 2005; 22:203-12. [PMID: 16499412 DOI: 10.1016/s1130-1406(05)70044-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Paracoccidioides brasiliensis is a dimorphic and thermo-regulated fungus which is the causative agent of paracoccidioidomycosis, an endemic disease widespread in Latin America that affects 10 million individuals. Pathogenicity is assumed to be a consequence of the dimorphic transition from mycelium to yeast cells during human infection. This review shows the results of the P. brasiliensis transcriptome project which generated 6,022 assembled groups from mycelium and yeast phases. Computer analysis using the tools of bioinformatics revealed several aspects from the transcriptome of this pathogen such as: general and differential metabolism in mycelium and yeast cells; cell cycle, DNA replication, repair and recombination; RNA biogenesis apparatus; translation and protein fate machineries; cell wall; hydrolytic enzymes; proteases; GPI-anchored proteins; molecular chaperones; insights into drug resistance and transporters; oxidative stress response and virulence. The present analysis has provided a more comprehensive view of some specific features considered relevant for the understanding of basic and applied knowledge of P. brasiliensis.
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Affiliation(s)
- Rosângela V Andrade
- Laboratorio de Biologia Molecular, Departamento de Biologia Celular, Universidade de Brasília, Brasilia, DF, 70910-900, Brazil
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Paniago AMM, de Freitas ACC, Aguiar ESA, Aguiar JIA, da Cunha RV, Castro ARCM, Wanke B. Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12 cases observed in an endemic region in Brazil. J Infect 2005; 51:248-52. [PMID: 16230222 DOI: 10.1016/j.jinf.2005.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the clinical characteristics of 12 patients with paracoccidioidomycosis (PCM) and human immunodeficiency virus (HIV) infection. METHODS The clinical manifestations, diagnosis, treatment, and outcome of PCM in 12 patients infected with HIV attended at a University Hospital of Mato Grosso do Sul, Brazil, were evaluated. RESULTS All patients were men, mean age 36.1 years old, and 11 had a diagnosis other than PCM as the aids-defining illness. Lymph nodes were the organs most often involved (10 patients, 83.3%), followed by lung involvement, usually with an interstitial pattern (seven patients, 58.3%), papule-nodular skin lesions with central ulceration in six (50%) and ulcerated lesions of oral mucous membrane in five (41.6%) patients. Pleural involvement occurred in one patient who presented large pleural effusion beside a pathologic rib fracture caused by P. brasiliensis. Seven patients showed involvement in more than one extrapulmonary organ. In eight (66.6%) cases the diagnosis was established by direct microscopy of clinical specimens. All patients used trimethoprim-sulfamethoxazole and seven patients were also treated with amphotericin B. Eight patients died with progressive PCM manifestations. CONCLUSION Our review demonstrates that PCM, an endemic systemic mycosis in Brazil, when associated with AIDS, behaves clinically as an opportunistic disease.
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Abstract
Paracoccidioidomycosis (PCM) is endemic in Latin America and in countries like Brazil it carries a high mortality rate. The fungus' habitat has not been precisely determined. The present study aims to identify ecologic correlates based on PCM distribution in a hyper-endemic area in southeastern Brazil. The Geographic Information System (GIS) and spatial statistics were used to associate environmental attributes, human population density and, PCM distribution. By means of the Pearson r correlation coefficient, the highest statistically significant associations with prevalence density were the percent area (by county) of: basaltic rocks (r=0.63; P <0.0001), Podzolic soils (r= -0.48; P <0.001), Latosol soils (r=0.40; P <0.01), mean annual precipitation between 1500 and 1600 mm (r = 0.46; P < 0.001) and, mean precipitation during the wet season between 940 and 1040 mm (r= -0.44; P <0.01). Soil texture and precipitation analyzed together reached r=0.61 (P <0.000002) for fine-textured soils with annual precipitation above 1400 mm. Environmental correlates indicate that moisture availability plays an important role in PCM distribution.
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Affiliation(s)
- Ligia Barrozo Simões
- Departamento de Microbiologia e Imunologia, Instituto de Biociências, Universidade Estadual Paulista/UNESP, Botucatu, SP, Brazil
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Verli FD, Marinho SA, Souza SCD, Figueiredo MAZD, Yurgel LS. [Clinical-epidemiologic profile of paracoccidioidomycosis at the Stomatology Department of São Lucas Hospital, Pontificia Universidade Católica of Rio Grande do Sul]. Rev Soc Bras Med Trop 2005; 38:234-7. [PMID: 15895174 DOI: 10.1590/s0037-86822005000300005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of the article was to describe clinical and epidemiological features of 61 oral paracoccidioidomycosis cases from the Stomatology Department of São Lucas Hospital, analyzed from July 1976 to June 2004. The State of Rio Grande do Sul is an endemic region due to ecoepidemiologic conditions, that are favorable for the development of the yeast. Men are the most affected gender, with 58 (95%) affected compared to 3 (5%) women. Ii is most prevalent (70.5%) between 40 and 59 years of age. Agricultural labor was the most common occupation with 27/61 (44.3%) patients. Tobacco smoking was prevalent in 52 (85.3%) of the sample, and alcoholism was a frequent finding. All the patients showed stomatologic manifestations, with ulcers and mulberry-like stomatitis the most prevalent, these oral lesions were also observed in many anatomical sites. Alterations were present in 32 (65.3%) of the pulmonary radiographs.
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Affiliation(s)
- Flaviana Dornela Verli
- Clínica da Pontifícia, Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Abstract
A systemic and endemic emerging mycosis in Latin America, paracoccidioidomycosis, is characterised by its chronicity and by the severity of the disseminated form in healthy individuals, as well as in immunocompromised individuals co-infected with HIV, resulting, in the latter, in a mortality rate in the range of 30 - 45%. The long (several years) duration of treatment results from the immunosuppression induced by the disease or from the survival capacity of the fungus in tissue. A few controlled studies and case reports have shown that fast-acting azolic and sulfa derivatives are useful treatment alternatives for patients presenting milder forms of the disease. However, when using such drugs, treatment regimens of longer duration are required for the maintenance of patients with more severe forms. The search for new alternatives for treating the most severe forms is an ongoing challenge. Novel treatments may be found among new classes of drugs, drug combinations, or agents capable of modulating the immune response, such as a peptide derived from the 43-kDa Paracoccidioides brasiliensis glycoprotein.
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Cermeño JR, Cermeño JJ, Hernández I, Godoy G, Cermeño JJ, Cabello I, Orellán Y, Blanco Y, Penna S. Histoplasmine and paracoccidiodine epidemiological study in Upata, Bolívar state, Venezuela. Trop Med Int Health 2005; 10:216-9. [PMID: 15730504 DOI: 10.1111/j.1365-3156.2004.01376.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence of histoplasmosis and paracoccidiomycosis in Upata, a city in Bolivar state, Venezuela. METHODS Cutaneous tests on 397 volunteers, 204 with histoplasmine and 193 with paracoccidioidine. Epidemiological data were collected in a protocol sheet. Readings were performed at 24 and 48 h post-injection, by the same observer, and a positive reaction was defined as hardened papule of 5 mm or more. RESULTS Histoplasmine tests were positive in 19.6% and 34.0% at 24 and 48 h after antigens injection with a significant increase of reactivity (P=0.0019). Paracoccidiodine tests were positive in 11.3% and 19.7% at 24 and 48 h respectively and this difference was also significant (P=0.004). Risk factors which could explain these levels of reactivity could not be clearly identified. Cultures and animal inoculation from soil samples for fungus isolation were negative. CONCLUSIONS Paracoccidioidomycoses and histoplasmosis are endemic in Upata.
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Affiliation(s)
- Julman R Cermeño
- Departamento de Parasitología y Microbiología, Universidad de Oriente, Bolívar, Venezuela.
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Fornajeiro N, Maluf MLF, Takahachi G, Svidzinski TIE. [Paracoccidioidomycosis epidemiological survey using gp43, in two cities of northwestern region of Paraná, Brazil]. Rev Soc Bras Med Trop 2005; 38:191-3. [PMID: 15821799 DOI: 10.1590/s0037-86822005000200014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An epidemiological survey was performed in 118 workers from northwestern Paraná state using gp43 as antigen, the positivity was 43%. This result, plus the weather conditions, which are favorable for fungus development, underscores that this region is an endemic area for paracoccidioidomycosis and is a reservoir of Paracoccidioides brasiliensis.
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Affiliation(s)
- Nair Fornajeiro
- Laboratório de Ensino e Pesquisa em Análises Clínicas, Universidade Estadual de Maringá, Maringá, PR
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48
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Cermeño JR, Hernández I, Godoy G, Cabello I, Cermeño JJ, Orellán Y, Blanco Y. [Mycoses at Hospital Universitario "Ruiz y Páez", Ciudad Bolívar, Venezuela, 2002]. Invest Clin 2005; 46:37-42. [PMID: 15782535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
To estimate the prevalence of mycoses in the Universitary Hospital "Ruiz y Páez" (Bolivar State, Venezuela) during 2002, a retrospective study was carried out. Four hundred and fifty six mycoses were diagnosed in 250,956 patients. The most frequent mycoses, the cutaneous form (94.5%), were produced by dermatophytes, Malassezia furfur and Candida spp. in 90%. Deep mycoses were detected in 4.7% and consisted of histoplasmosis (2.6%), paracoccidioidomycosis (1.7%) and cryptococcosis (0.4%). Several patients with deep mycoses presented HIV infection, tuberculosis and hematological disorders (neoplasias among them). The frequency of mycoses in the general population that attend the Hospital Universitario "Ruiz y Páez" is low, superficial mycoses are predominant, and some conditions seem to predispose to deep mycoses.
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Affiliation(s)
- Julman R Cermeño
- Grupo de Micología Experimental y Clínico Bolívar, Departamento de Parasitologia y Microbiología, Escuela de Ciencias de la Salud "Francisco Battistini", Núcleo Bolívar, Universidad de Oriente, Ciudad Bolívar, Estado Bolívar, Venezuela.
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Nascimento E, Martinez R, Lopes AR, de Souza Bernardes LA, Barco CP, Goldman MHS, Taylor JW, McEwen JG, Nobrega MP, Nobrega FG, Goldman GH. Detection and selection of microsatellites in the genome of Paracoccidioides brasiliensis as molecular markers for clinical and epidemiological studies. J Clin Microbiol 2005; 42:5007-14. [PMID: 15528688 PMCID: PMC525212 DOI: 10.1128/jcm.42.11.5007-5014.2004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Paracoccidioides brasiliensis, a thermodimorphic fungus, is the causative agent of the prevalent systemic mycosis in Latin America, paracoccidioidomycosis (PCM). Here, we describe the microsatellite patterns observed in a collection of P. brasiliensis random sequence tags. We identified 1,117 microsatellite patterns in about 3.8 Mb of unique sequences (0.47% of the total DNA used in the analysis). The majority of these microsatellites (87.5%) are found in noncoding sequences. We used two polymorphic microsatellites located on noncoding and coding sequences, as well as two microsatellites located on introns, as molecular markers to discriminate P. brasiliensis isolates, to look for relationships between the genetic background of the strains and the types of human disease they cause. We did not observe any correlation between the clinical form of human PCM and four simple sequence repeat patterns analyzed.
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Affiliation(s)
- Erika Nascimento
- Departamento de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Brazil
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Pereira RM, Bucaretchi F, Barison EDM, Hessel G, Tresoldi AT. Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome. Rev Inst Med Trop Sao Paulo 2004; 46:127-31. [PMID: 15286812 DOI: 10.1590/s0036-46652004000300002] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
From February, 1981 to May, 2001, 63 children under 15 y old (ages 2 - 15 y, median = 8 y, mean +/- 1 SD = 8 +/- 3 y) presenting 70 episodes of Paracoccidioidomycosis were admitted. The main clinical manifestations and laboratory features observed upon admission were: lymph node enlargement (87.1%), fever (75.7%), weakness (48.6%), pallor (41.4%), hepatomegaly (40%), splenomegaly (35.7%), anemia (90%), hypergammaglobulinemia (88.5%), eosinophilia (75.5%) and hypoalbuminemia (72.5%). Moderate to severe malnutrition was detected in 35.7% of the episodes (Gomez's criterion). Radiographic and technetium studies showed bone lesions in 20 of the episodes, most of them being multiple lytic lesions, involving both long (70%) and plain bones (30%). First line treatment consisted of an association of sulfametoxazole-trimethoprin, which was used, exclusively, in 50 episodes. Follow-up of hemoglobin levels, number of eosinophils in the peripheral blood, albumin and gammaglobulin serum levels revealed significant sequential improvement one and six months after hospital admission, being quite useful to evaluate treatment effectiveness. Six patients died (9.3%) and four developed sequelae (6.3%). In conclusion, the juvenile and disseminated forms can be observed in about 70% of the episodes of PCM occurring in children younger than 15 y old, most of them presenting with a febrile lymphoproliferative syndrome associated to anemia, eosinophilia and hypergammaglobulinemia.
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Affiliation(s)
- Ricardo Mendes Pereira
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil.
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