Paracoccidioidomycosis: Current Perspectives from Brazil

Abstract

Background:This review article summarizes and updates the knowledge on paracoccidioidomycosis. P lutzii and the cryptic species of P. brasiliensis and their geographical distribution in Latin America, explaining the difficulties observed in the serological diagnosis.Objectives:Emphasis has been placed on some genetic factors as predisposing condition for paracoccidioidomycosis. Veterinary aspects were focused, showing the wide distribution of infection among animals. The cell-mediated immunity was better characterized, incorporating the recent findings.Methods:Serological methods for diagnosis were also compared for their parameters of accuracy, including the analysis of relapse.Results:Clinical forms have been better classified in order to include the pictures less frequently observesiod.Conclusion:Itraconazole and the trimethoprim-sulfamethoxazole combination was compared regarding efficacy, effectiveness and safety, demonstrating that azole should be the first choice in the treatment of paracoccidioidomycosis.

New Insights on Pulmonary Paracoccidioidomycosis

“…Overall rates of 1 to 4 cases per 100,000 inhabitants per year are estimated to occur in geographic areas with stabilized endemicity, and 9 to 40 cases per 100,000 inhabitants per year in hyperendemic areas. 28,29 However, there is speculation that at least 10 million habitants of endemic areas have been infected by Paracoccidioides spp. Indeed, surveys based on skin tests performed using the gp43KDa antigen of P. brasiliensis demonstrated a PCM infection prevalence rate of 45.8% in an endemic rural area of the Southeast region in Brazil.…”

“…127 Some limitations of serological tests must be considered: (1) there is no commercial system available, and all available tests are based on systems developed in house with large variability between different laboratories, (2) there is no validated serological technique for species other than P. brasiliensis, and (3) there is lower sensitivity in immunosuppressive conditions. 18,29,128,129 Other assays have been validated but are only available in research centers, such as indirect immunofluorescence, immunoenzymatic tests (enzyme-linked immunosorbent assay [ELISA], magnetic ELISA, inhibition ELISA), dot blotting, and western blotting. PCR-based methods and assays for detecting specific P. brasiliensis antigens (gp43 and gp70) may help especially in clinical specimens with low burden of fungi and probably in immunocompromised hosts, but they are not available in most laboratories.…”

Avaliação do efeito terapêutico de plasmídeos vacinais contendo o gene da proteína de estresse térmico de 60kDa de <i>Paracoccidioides brasiliensis</i> na paracoccidioidomicose experimental em camundongos

“…Por ano no Brasil a incidência está entre 0,71 e 3,7 casos novos/100.000 habitantes. Dados de Rondônia mostraram a existência de uma incidência de 9,4 casos novos/100.000 habitantes, com cidades com incidência atingindo valores próximos a 40 casos novos/100.000 habitantes (MENDES et al, 2017;SHIKANAI-YASUDA et al, 2017).…”

“…Nos casos onde há a disseminação do fungo, outros órgãos afetados são as glândulas adrenais e o cérebro. A inflamação crônica leva progressivamente a uma perda de função devido a substituição do tecido funcional por um tecido fibroso cicatricial que não desempenha a função do órgão (MARTINEZ, 2017;MENDES et al, 2017;SHIKANAI-YASUDA et al, 2017).…”

Remodelamento vascular e parenquimatoso induzido pela paracoccidioidomicose experimental

“…O CATE direito precisa ser realizado em centros especializados e apresenta certa morbidade (1,1%) e mortalidade (0,055%) (70,72).Diante do exposto, o grande desafio clínico da PCM é o diagnóstico precoce e tratamento das sequelas pulmonares. Mais de 50% dos pacientes com PCM desenvolvem algum grau de fibrose pulmonar e um quarto deles apresentam adicional fibrose "de novo"(37,74,75), corroborando a ideia da adicional ativação miofibroblástica pós-cura da infecção paracoccidioidomicótica. Ademais, 80% dos pacientes revelam alterações vasculares com diagnóstico de hipertensão pulmonar em até 30% deles(66)(67)(68)76).…”