Twenty-seven mycologically proven cases of paracoccidioidomycosis (PCM) were treated with itraconazole (100-200 mg/day in month 1 and 100 mg/day until month 6-8) and evaluated clinically and serologically, up to 3.5 years post-therapy, using Dot-blot and ELISA for measuring the titers of IgG, IgA and IgM anti-P.brasiliensis antibodies and Western-blot for determining IgG, IgA and IgM antibodies against the antigen components of the fungus. Before treatment, 81.5% (Dot-blot) and 84% (ELISA) of the patients presented elevated IgG anti-P.brasiliensis antibody titers which dropped slightly with treatment. On the other hand, the percentages of pre-treatment high-titered sera for IgA and IgM anti-P.brasiliensis were lower (51.9% and 51.8%: Dot-blot; 16.5 and 36%: ELISA, respectively) but the titers tended to become negative more frequently with treatment. Prior to treatment, the percentages of positivity for IgG, IgA and IgM anti-P.brasiliensis antibodies in Western-blot were 96%, 20.8% and 41.6%, respectively. Antigens with molecular weights varying from 16-78 kDa, from 21-76 kDa and from 27-78 kDa were reactive for IgG, IgA and IgM antibodies, respectively. The most frequently reactive antigenic components had molecular weights of 27, 33 and 43 kDa for IgG, and 70 for IgA and IgM antibodies. During the period of study, the patients responded well to treatment. The present data confirm the diversity and complexity of the humoral response in PCM, and the importance of utilizing different serological tests to detect IgG, IgA and IgM anti-P. brasiliensis antibodies.

Multinucleated giant cells (MGC) are characteristic cells in granulomatous disorders such as paracoccidioidomycosis (PCM) and also are formed in vitro from peripheral blood mononuclear cells by several stimuli. In this study, the authors investigated in vitro formation of MGC derived from monocytes of healthy individuals, stimulated with Paracoccidioides brasiliensis antigen (PbAg), compared with other stimuli such as IFN-gamma and supernatant of Con-A-stimulated peripheral blood mononuclear cells (CM-ConA). Besides, the fungicidal activity of monocytes and monocyte-derived MGC challenged with P. brasiliensis were compared, at a ratio of one fungus per 50 monocytes. Results demonstrated that PbAg, IFN-gamma, and CM-ConA stimuli were able to induce MGC generation, with fusion indices significantly higher than control cultures. Striking results were observed when MGC induced by PbAg and IFN-gamma presented higher fungicidal activity than monocytes, submitted to the same stimuli, showing a better capacity of these cells to kill P. brasiliensis. In summary, the results suggest that PbAg is able to induce MGC generation, and these cells presented higher fungicidal activity against P. brasiliensis than monocytes.

Interleukin (IL)-

after 4h of monocyte infection with the fungus. TNF-α production by these cells was determined in supernatant cultures by enzyme immunoassay (ELISA), and fungicidal activity of monocytes against Pb18 was assessed by viable fungi recovery from 4h co-culture in Blood Heart Infusion-Agar (BHI-Agar) and counting of colonyforming units after 10 days. The results showed that monocyte incubation with TGFβ 1 concentrations (31.2 pg/ml to 500 pg/ml) suppressed H 2 O 2 release in a dosedependent manner. The Pb18 infection of monocytes pretreated with TGF-β 1 maintained the inhibitory effect on the H 2 O 2 production by these cells stimulated with PMA, even in low doses of TGF-β 1 , suggesting that Pb18 may also interfere with H 2 O 2 production by monocytes. These cells challenged with Pb18 produced significantly higher levels of TNF-α in comparison to monocytes not infected. However this production was inhibited when these cells were previously cultured with high concentrations of TGF-β 1. On the other hand, pretreatment of monocytes with high doses of this cytokine enhanced their fungicidal activity against P. brasiliensis. Together the results suggest that exogenous TGF-β 1 can exert a dual modulatory effect on monocytes infected with P.brasiliensis, when used in high concentrations. The effects are stimulatory on fungicidal activity and inhibitory on H 2 O 2 release and TNF-α production.