Comparison of clinico-epidemiological and radiological features in paracoccidioidomycosis patients regarding serological classification using antigens from Paracoccidioides brasiliensis complex and Paracoccidioides lutzii

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.

Immunoproteomic Analysis Reveals Novel Candidate Antigens for the Diagnosis of Paracoccidioidomycosis Due to Paracoccidioides lutzii

“…We believe that a new generation of diagnostic tests with the expected high sensitivity and specificity should be composed of various linear B-cell epitopes, mapped in silico from the Paracoccidioides antigens identified in this study. The current clinical data on PCM have shown great overlap of clinical signs due to distinct Paracoccidioides species [ 12 , 14 , 180 ]. Therefore, the best strategy for the immunodiagnosis still involves differentiation between P. lutzii and members of the P. brasiliensis complex instead of stressing a multimarker diagnostic assay, which will likely pose a major challenge regarding specificity and sensitivity for successful implementation.…”

“…The temperature-induced switching of Paracoccidioides species from a saprophytic filamentous morphotype in the soil at 25 °C to a pathogenic budding yeast form in the human host is an essential morphological adaptation shared with other dimorphic pathogens in the Onygenales. While the disease is classically characterized by pulmonary involvement and systemic infections, lesions in the cutaneous and subcutaneous tissues with regional lymphocutaneous dissemination may also occur [ 12 , 13 , 14 ].…”

Molecular Tools for Detection and Identification of Paracoccidioides Species: Current Status and Future Perspectives

“…There is no scientific evidence of whether different species cause different clinical manifestations. Previous data have shown a remarkable overlap of clinical symptoms of patients infected with various members of the P. brasiliensis complex or even between the P. brasiliensis complex and P. lutzii [ 33 , 34 , 35 ]. On the other hand, there is strong evidence from a seroepidemiological investigation that the diagnosis can be impaired when using specific antigenic preparations derived from Paracoccidioides spp., suggesting the need for regional antigen formulations to overcome this gap [ 36 ].…”

Diagnosis of Breakthrough Fungal Infections in the Clinical Mycology Laboratory: An ECMM Consensus Statement

“…Still, in the right patient quantitative antigen methods with monitoring of Histoplasma antigen titers can allow for monitoring response during treatment [ 54 ]. In contrast, paracoccidioidomycosis serologies exhibit high sensitivity and specificity [ 108 , 109 , 110 ]. Sporotrichosis serologic testing is infrequently used due to the lack of a commercial assay, while the sensitivity of antibody testing for talaromycosis ranges from 30–80% likely due to the highly immunosuppressed state (e.g., advanced HIV disease) of most affected patients [ 111 , 112 ].…”