Association of IgG immunoglobulin and subclasses level with the severity of chromoblastomycosis due to Fonsecaea pedrosoi and therapeutic response to itraconazole

Abstract

Chromoblastomycosis (CBM) is a chronic, suppurative, granulomatous mycosis of the skin and subcutaneous tissues. The aim of this study was to evaluate the association between IgG antibody levels and the severity of CBM and therapeutic response of patients to itraconazole. A longitudinal study was conducted in patients with CBM due to Fonsecaea pedrosoi and in healthy subjects with chromomycin skin test (CST)+. The dosage of anti-F. pedrosoi IgG antibody performed in 47 healthy individuals with CST+ showed positivity in 97.5 %, with an average titer of 2,109 [standard deviation (SD) + 3,676)] and a mean optical density (OD) of 1.174 (SD + 0.456), showing positive correlation with the induration area of the CST (mm(2)). The level of antibodies in 55 patients with CBM expressed in OD and titration showed that, before treatment, patients with severe disease had higher levels of IgG, IgG1, IgG2, and IgG3 when compared with moderate or mild disease (p < 0.05). According to the time of treatment, the mean antibody titers of IgG, IgG1, and IgG2 were reduced after treatment (p < 0.05). In the assessment of therapeutic response, there was reduction of IgG3 and IgG titers in patients with rapid response (p < 0.05) and IgG2 on rapid and intermediate response (p < 0.05). There was clear evidence of what are the risk factors for exposure to F. pedrosoi in the daily lives of these subjects, with prospects of preventive measures for the target population. The immunological analysis shows that the antibody anti-F. pedrosoi did not exhibit a protective role against infection caused by this agent.

The global burden of chromoblastomycosis

“…Secondary recurrent bacterial infection exacerbates the involvement of lymphatic vessels, resembling elephantiasis. Severe forms of CBM disable and disfigure patients much more frequently than they kill, and are multifactorial [ 243 , 244 ]. Affected people live decades with disability, stigma and social withdrawal.…”

Unique case report of a chromomycosis and Listeria in soft tissue and cerebellar abscesses after kidney transplantation

“…Because of its facultative intracellular life, L. monocytogenes is also favoured by cellular immunity deficiency [23]. The role of the humoral anti-fungal response is unknown, although high titters of anti-fungal antibodies have been reported in the course of severe fungal disease, followed by a decrease after effective treatment [24]. …”

Mycetoma and Chromoblastomycosis: Perspective for Diagnosis Improvement Using Biomarkers

“…Furthermore, a reduction in IgG3 and IgG titers was observed in patients with a rapid response (p < 0.05) and a reduction in IgG2 in patients with rapid and intermediate responses (p < 0.05) [13]. Interestingly, the immunological analysis showed that the antibody anti-F. pedrosoi did not provide protection against infection [13]. The detection of anti-F. pedrosoi IgG may provide a specific diagnostic biomarker of chromoblastomycosis caused by F. pedrosoi.…”

“…In patients with severe chromoblastomycosis, the level of anti-F. pedrosoi IgG (IgG1, IgG2, and IgG3) was higher compared to patients with moderate or mild disease (p < 0.05) [13]. After treatment, the mean antibody titers of IgG, IgG1, and IgG2 were reduced (p < 0.05) [14].…”

“…After treatment, the mean antibody titers of IgG, IgG1, and IgG2 were reduced (p < 0.05) [14]. Furthermore, a reduction in IgG3 and IgG titers was observed in patients with a rapid response (p < 0.05) and a reduction in IgG2 in patients with rapid and intermediate responses (p < 0.05) [13]. Interestingly, the immunological analysis showed that the antibody anti-F. pedrosoi did not provide protection against infection [13].…”