Fatal septic shock caused by Paracoccidioides brasiliensis phylogenetic species S1 in a young immunocompetent patient: a case report

Abstract

The authors report the first case of fatal septic shock, a rare clinical presentation of paracoccidioidomycosis (PCM) caused by Paracoccidioides brasiliensis S1. We also provide an immunological evaluation of the patient. Severe clinical signs such as organ dysfunction and digital gangrene occurred in this case. The patient presented a remarkable cell activation profile and diminished percentage of peripheral blood T regulatory cells. A decrease in anti-inflammatory IL-1RA plasma level showed the potential for endothelium damage, probably contributing to a vasculitis process. Together with P. lutzii, P. brasiliensis appears to be involved in severe cases of PCM.

Clinical features and genetic background of the sympatric species Paracoccidioides brasiliensis and Paracoccidioides americana

“…It is well described that P . brasiliensis [8, 21, 23, 25] and P . lutzii [45] can be related to severe PCM cases.…”

“…brasiliensis was responsible for many complications in the patients included in this study, severe cases including acute lymph abdominal forms and a fatal septic shock similar to a previous case report of PCM associated with P . lutzii [25, 45].…”

“…brasiliensis and one as P . americana [8, 21–25]. These species are potentially sympatric since they seem to inhabit the same geographical area, i.e.…”

Paracoccidioidomycosis due to P lutzii: The importance of neutrophil/lymphocyte ratio in the symptomatic and asymptomatic phases in severe cases

“…12 Specific regulation patterns of T-lymphocytes mediated immunity have been associated with different clinical manifestations of the disease spectrum 13 and patients with the most severe forms-such as the acute/subacute form (AF), the chronic form (CF), or the mixed form 5 -evolve with a predominance of Th2 and Th9 response, affecting the formation of compact granulomas, 14 and consequently with a more serious/disseminated disease and a higher fungal load. 15,16 A late diagnosis of PCM induces serious complications, including death, as already reported by Macedo et al (2018). 17 It is important to note that, as was described by Hahn et al (2019), 18 the confirmation of diagnosis by fungal culture allows molecular identification, although the sole positive result of the direct mycological examination is sufficient to start the therapeutic regimen.…”

Paracoccidioidomicosis en caninos y felinos: hallazgos clínicos, diagnóstico y tratamiento

“…Cuando la respuesta inmunitaria es inadecuada o deficiente, es posible que la enfermedad progrese hasta la diseminación y, además, pueda causar enfermedad pulmonar grave (Morgan et al, 2004; Thompson, 2008. Se ha reportado un caso de shock séptico fatal en una persona a causa de P. brasiliensis S1, mientras que en animales no se han reportado casos similares (Macedo et al, 2018).…”