RESUMO
We report a case of unusual paracoccidioidomycosis reactivation after eyebrow micropigmentation in a Brazilian patient. The cutaneous lesion was the only clinical manifestation. Direct cutaneous inoculation in dermal tissues with Paracoccidioides sp. is extremely rare, explaining why paracoccidioidomycosis is not classically considered a cutaneous implantation mycosis.
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Paracoccidioidomycosis (PCM) is the main and most prevalent systemic mycosis in Latin America, that until recently, it was believed to be caused only by Paracoccidioides brasiliensis (P. brasiliensis). In 2006, researchers described three cryptic species: S1, PS2, PS3, and later, another one, PS4. In 2009, Paracoccidioides lutzii (Pb01-like) was described, and in 2017, a new nomenclature was proposed for the different agents: P. brasiliensis (S1), P. americana (PS2), P. restrepiensis (PS3), and P. venezuelensis (PS4). These species are not uniformly distributed throughout Latin America and, knowing that more than one cryptic species could coexist in some regions, we aimed to identify those species in patients' biopsy samples for a better understanding of the distribution and occurrence of these recently described species in Botucatu region. The Hospital of Medical School of Botucatu-UNESP, which is a PCM study pole, is located in São Paulo State mid-west region and is classified as a PCM endemic area. Genotyping analyses of clinical specimens from these patients that have been diagnosed and treated in our Hospital could favor a possible correlation between genetic groups and mycological and clinical characteristics. For this, molecular techniques to differentiate Paracoccidioides species in these biopsies, such as DNA extraction, PCR, and sequencing of three target genes (ITS, CHS2, and ARF) were conducted. All the sequences were analyzed at BLAST to testify the presence of P. brasiliensis. The phylogenetic trees were constructed using Mega 7.0 software and showed that 100% of our positive samples were from S1 cryptic species, therefore P. brasiliensis. This is important data, demonstrating the predominance of this species in the São Paulo State region.
RESUMO
BACKGROUND: Paracoccidioidomycosis is a systemic mycosis caused by the inhalation of conidia of the genus Paracoccidioides. During the infectious process, fungal cells use several carbon sources, leading to the production of propionyl-CoA. The latter is metabolized by the methylcitrate synthase, a key enzyme of the methylcitrate cycle. We identified an inhibitor compound (ZINC08964784) that showed antifungal activity against P. brasiliensis. METHODS: This work aimed to understand the fungal metabolic response of P. brasiliensis cells exposed to ZINC08964784 through a proteomics approach. We used a glucose-free medium supplemented with propionate in order to simulate the environment found by the pathogen during the infection. We performed pyruvate dosage, proteolytic assay, dosage of intracellular lipids and quantification of reactive oxygen species in order to validate the proteomic results. RESULTS: The proteomic analysis indicated that the fungal cells undergo a metabolic shift due to the inhibition of the methylcitrate cycle and the generation of reactive species. Proteolytic enzymes were induced, driving amino acids into degradation for energy production. In addition, glycolysis and the citric acid cycle were down-regulated while ß-oxidation was up-regulated. The accumulation of pyruvate and propionyl-CoA led the cells to a state of oxidative stress in the presence of ZINC08964784. CONCLUSIONS: The inhibition of methylcitrate synthase caused by the compound promoted a metabolic shift in P. brasiliensis damaging energy production and generating oxidative stress. Hence, the compound is a promising alternative for developing new strategies of therapies against paracoccidioidomycosis.
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Neuroparacoccidiodimycosis (NPDM) is an uncommon granulomatous disease, which more frequently affects immunocompromised male patients over 30 years of age in the course of chronic lung disease. Paracoccidioides brasiliensis (PB) is an endemic fungus in Brazil, and grows as thick-walled yeast (with round to oval bodies) measuring 10 µm to 60 µm in diameter. Neuroparacoccidiodimycosi may develop many years after transmission and/or primary lung involvement. The authors describe a case of NPDM affecting a male patient, 52 years of age, farmer, heavy smoker, with clinical complaint of headache, asthenia, seizures, and prostration in the previous nine months. Upon physical examination, the patient presented regular general condition, without other relevant physical alterations. Computed tomography (CT) showed multiple bilateral pulmonary nodules associated to enlargement of the mediastinal lymph node. Magnetic resonance imaging (MRI) and CTscans of the central nervous system showed six heterogeneous nodular lesions compromising the frontal and parietal lobes, the largest one measuring 3.8 3.2 3.2 cm. The hypothesis of a neoplastic process compromising the lung and brain was considered. A biopsy of the mediastinal lymph node showed epithelioid granulomas, which exhibited round, thin-walled fungal structures in Grocott silver stain. The stereotactic biopsy of the frontal lesion was constituted by necrotic tissue admixed with some round to oval, thin-walled fungi measuring 10 µm to 60 µm, compatible with PB (identified on Grocott silver stain/confirmed in culture). The diagnosis of NPDM was then established. The employed therapeutic regimen was intravenous amphotericin B, itraconazole, and sulfamethoxazole-trimetropin. After ninety days of clinical follow-up, no episodes of seizures/neurological deficits were identified, and a marked decrease in the number and size of the lung and brain lesions were found.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/terapia , Hospedeiro Imunocomprometido , Infecções Fúngicas do Sistema Nervoso Central/cirurgia , Antifúngicos/uso terapêutico , Paracoccidioides , Paracoccidioidomicose/diagnóstico por imagem , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico por imagemRESUMO
In agreement with other fungal infections, immunoprotection in pulmonary paracoccidioidomycosis (PCM) is mediated by Th1/Th17 cells whereas disease progression by prevalent Th2/Th9 immunity. Treg cells play a dual role, suppressing immunity but also controlling excessive tissue inflammation. Our recent studies have demonstrated that the enzyme indoleamine 2,3 dioxygenase (IDO) and the transcription factor aryl hydrocarbon receptor (AhR) play an important role in the immunoregulation of PCM. To further evaluate the immunomodulatory activity of AhR in this fungal infection, Paracoccidioides brasiliensis infected mice were treated with two different AhR agonists, L-Kynurenin (L-Kyn) or 6-formylindole [3,2-b] carbazole (FICZ), and one AhR specific antagonist (CH223191). The disease severity and immune response of treated and untreated mice were assessed 96 hours and 2 weeks after infection. Some similar effects on host response were shared by FICZ and L-Kyn, such as the reduced fungal loads, decreased numbers of CD11c+ lung myeloid cells expressing activation markers (IA, CD40, CD80, CD86), and early increased expression of IDO and AhR. In contrast, the AhR antagonist CH223191 induced increased fungal loads, increased number of pulmonary CD11c+ leukocytes expressing activation markers, and a reduction in AhR and IDO production. While FICZ treatment promoted large increases in ILC3, L-Kyn and CH223191 significantly reduced this cell population. Each of these AhR ligands induced a characteristic adaptive immunity. The large expansion of FICZ-induced myeloid, lymphoid, and plasmacytoid dendritic cells (DCs) led to the increased expansion of all CD4+ T cell subpopulations (Th1, Th2, Th17, Th22, and Treg), but with a clear predominance of Th17 and Th22 subsets. On the other hand, L-Kyn, that preferentially activated plasmacytoid DCs, reduced Th1/Th22 development but caused a robust expansion of Treg cells. The AhR antagonist CH223191 induced a preferential expansion of myeloid DCs, reduced the number of Th1, Th22, and Treg cells, but increased Th17 differentiation. In conclusion, the present study showed that the pathogen loads and the immune response in pulmonary PCM can be modulated by AhR ligands. However, further studies are needed to define the possible use of these compounds as adjuvant therapy for this fungal infection.
Assuntos
Diferenciação Celular/imunologia , Ligantes , Linfócitos/fisiologia , Paracoccidioidomicose/imunologia , Receptores de Hidrocarboneto Arílico/genética , Receptores de Hidrocarboneto Arílico/imunologia , Índice de Gravidade de Doença , Animais , Diferenciação Celular/genética , Imunidade Inata , Imunomodulação , Pulmão/imunologia , Pneumopatias Fúngicas/imunologia , Linfócitos/imunologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Células Th1/imunologia , Células Th17/imunologiaRESUMO
Paracoccidiodomycosis s is an endemic infection in Latin America. It can affect several organs, but systemic involvement is rare, especially when the adrenal glands and the central nervous system are affected. We describe two cases of paracoccidiodomycosis presenting with Addison's disease, one of which also presented with a pseudotumor cerebri. The diagnosis of paracoccidiodomycosis was confirmed in both cases with histopathological studies. Antifungal management and hormone supplementation were given, achieving complete resolution of symptoms. 2012 Elsevier Ltd. All rights reserved.
RESUMO
The cell wall has a critical role in the host immune response to fungal pathogens. In this study, we investigated the influence of two cell wall fractions of the dimorphic fungi Paracoccidioides brasiliensis (Pb) in the in vitro generation of monocyte-derived dendritic cells (MoDCs). Monocytes were purified from the peripheral blood of healthy donors and cultivated for 7 days in medium supplemented with IL-4 and GM-CSF in the presence of Pb cell wall fractions: the alkali-insoluble F1, constituted by ß-1,3-glucans, chitin and proteins, and the alkali-soluble F2, mainly constituted by α-glucan. MoDCs phenotypes were evaluated regarding cell surface expression of CD1a, DC-SIGN, HLA-DR, CD80, and CD83 and production of cytokines. The α-glucan-rich cell wall fraction downregulated the differentiation of CD1a+ MoDCs, a dendritic cell subset that stimulate Th1 responses. The presence of both cell fractions inhibited DC-SIGN and HLA-DR expression, while the expression of maturation markers was differentially induced in CD1a- MoDCs. Differentiation upon F1 and F2 stimulation induced mixed profile of inflammatory cytokines. Altogether, these data demonstrate that Pb cell wall fractions differentially induce a dysregulation in DCs differentiation. Moreover, our results suggest that cell wall α-glucan promote the differentiation of CD1a- DCs, potentially favoring Th2 polarization and contributing to pathogen persistence.
RESUMO
Trata-se de apresentação da Análise da Imagem de lesões cutâneas e intracranianas reveladas pelo exame clínico direto e radiológico, em que características clínico-epidemiológicas e de exames complementares permitem a identificação de agente etiológico mais provável, e revela gravidade extrema de nosologia eminentemente brasileira, que requer alerta para seu diagnóstico precoce e tratamento adequado para impedir sequelas e morte precoce. (AU)
This is a presentation of the Image Analysis of cutaneous and intracranial lesions revealed by direct clinical and radiological examination, in which clinical-epidemiological and complementary features allow the identification of the most probable etiological agent, and reveals extreme severity of nosology in Brazil, which requires alertness for its early diagnosis and appropriate treatment to prevent sequelae and early death. (Au)
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Humanos , Masculino , Adulto , Paracoccidioidomicose , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/tratamento farmacológico , Cérebro/lesões , Paracoccidioidomicose/diagnóstico por imagem , Gânglios da Base/lesões , Lesões dos Tecidos Moles , Extremidade Inferior , Linfonodos/anormalidadesRESUMO
La paracoccidioidomicosis (PCM) es una enfermedad crónica, sistémica, granulomatosa, endémica en nuestro país, producida por un hongo dimorfo denominado Paracoccidioides brasiliensis. Existen numerosas técnicas para realizar el diagnóstico de esta entidad. Nos planteamos la posibilidad de realizar un estudio para determinar la concordancia que pudiese existir entre las diferentes técnicas que se utilizan para el diagnóstico de la PCM. Se realizó un registro de historias clínicas. Se evaluaron 251 historias clínicas de pacientes con diagnóstico de PCM, de la consulta externa de la Sección de Micología Médica Dr. Dante Borelli del IMT-UCV, entre los años 2000 y 2010. Se determinó la concordancia entre los métodos diagnósticos por medio del análisis de concordancia de atributos para datos binarios. Entre el examen directo y el cultivo, no hubo acuerdo. Entre la serología y el examen directo, se encontró que hubo equivalencia, así como entre el cultivo y la serología. No se pudo calcular correlación alguna con la histopatología, ya que no hubo datos negativos, en vista de que todas las muestras procesadas fueron positivas. El diagnóstico de la PCM se basa en la identificación y el aislamiento del hongo. Es obligatoria la realización del examen directo en fresco de toda muestra clínica. Nuestro estudio de muestra que deben realizarse todos los métodos que estén al alcance (examen directo en fresco, cultivo, serología, histopatología) a fin de aumentar la probabilidad de llegar a un diagnóstico certero de esta patología
Paracoccidioidomycosis (PCM) is a chronic, granulomatous disease, endemic in our country, produced by a dimorphic fungus, Paracoccidioides brasiliensis. Several techniques are used for the diagnosis. A study was performed to determine the agreement that could exist between the different techniques, used for the diagnosis of PCM. Clinical records of patients with diagnosis of PCM was made. 251 clinical records were reviewed, from the Sección de Micología Médica Dr. Dante Borelli, IMT- UCV, between 2000 and 2010. The agreement between the methods was determined by means of the analysis of agreement of attributes for binary data. Between direct examination and culture, there was no agreement. Between serology and direct examination, there was equivalence, as well as between culture and serology. Correlation could not be calculated with histopathology, since there were no negative data, due to the fact that all the processed samples were positive. The diagnosis of the PCM is based on the identification and isolation of the fungus. Direct examination is mandatory in all clinical samples. Our study demonstrates that all the methods must be performed (direct examination, culture, serology, histopathology) in order to increase the probability of reaching an accurate diagnosis
Assuntos
Humanos , Técnicas e Procedimentos Diagnósticos , Exames Médicos/métodos , Micologia/métodos , Paracoccidioidomicose/diagnóstico , Sorologia/métodos , InfectologiaRESUMO
Se presenta el caso de un paciente alcoholista con una ulceración perianal y manifestaciones cutáneas de enfermedad de Hansen. La biopsia de la lesión perianal y otros estudios arribaron al diagnóstico de una forma diseminada de paracoccidioidomicosis, así como también las biopsias cutáneas y los estudios baciloscópicos fueron diagnósticos de lepra lepromatosa. La respuesta a la terapéutica fue satisfactoria con desaparición de las lesiones cutáneas. La disminución de la respuesta inmunológica celular genera un terreno propicio para la infección de estos gérmenes y al compartir área endémica la asociación entre ambas patologías puede ocurrir.
Lepra and Paracoccidioidomycosis are endemic diseases in Argentina. We report a case of a patient with an unusual perianal ulceration and cutaneous manifestations of Hansen's disease. The biopsy of perianal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, as well as skin biopsy and baciloscopic finding diagnostic of Lepromatous Leprosy. The main portal of entry of paracoccidioides is the lung. Hematogenous dissemination of the fungus may occur at this time, with the establishment of metastatic foci in any organ. Anal and perianal lesions are present only in 1.3 to 2.4% of the patients. The pathogenesis of anal lesions remains unclear, it may be secondary from a systemic or a local disease. The patient response to the therapeutic was notable, with disappearance of lesions up to the third month of started itraconazole orally 400 mg/day leading just atrophy scars in perianal areas. The treatment of Hansen's disease was made according to OMS guidelines for multibacillary disease.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hanseníase Virchowiana/diagnóstico , Paracoccidioidomicose/diagnóstico , Doenças Endêmicas , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/patologia , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/patologiaRESUMO
A paracoccidioidomicose é a micose sistêmica mais prevalente na América Latina, principalmente no Brasil. Apesar de existirem vários estudos sobre o diagnóstico e patologia dessa micose, pouco se conhece sobre a ecologia do agente etiológico Paracoccidioides brasiliensis. Seu habitat ainda não foi determinado, mas provavelmente o fungo vive saprofiticamente no solo. Há também pouca informação quanto a participação de outras espécies de animais na eco-epidemiologia do fungo e os isolamentos obtidos de animais como morcego e pingüim não foram reprodutíveis. Até o presente, o fungo tem sido isolado com maior freqüência do tatu, Dasypus novencinctus. Estudos soroepidemiológicos demonstraram que a infecção é freqüente em cães, principalmente da área rural e recentemente foi relatado o primeiro caso de paracoccidiodomicose natural em cão. O papel de outras espécies de animais na eco-epidemiologia do fungo ainda não está esclarecido.
Assuntos
Micoses , Animais Domésticos , Animais Selvagens , ParacoccidioidomicoseRESUMO
Paracoccidiodomycosis is the most prevalent systemic mycosis in Latin América, mainly in Brazil. Although many studies have been done about the pathology and diagnosis of this mycosis little is known about the eco-epidemiology of the etiological agent Paracoccidioides brasiliensis. The fungus habitat also is unknown although is thought that the fungus lives as a saprobe in soil. The participation of other animal species in P. brasiliensis ecology is poorly understood and fungus isolation from animals as bat and penguin were not reproducible. The armadillos Dasypus novencinctus probably play a role in the fungus eco-epidemiology taking into account that several isolates were obtained from these animals. Seroepidemiologic studies have shown that dogs are infected by P. brasiliensis mainly in rural areas and recently was reported the first case o natural paracoccidioidomycosis in dogs. The role of other animal species in the eco-epidemiology of P. brasiliensis remains doubtful.
A paracoccidioidomicose é a micose sistêmica mais prevalente na América Latina, principalmente no Brasil. Apesar de existirem vários estudos sobre o diagnóstico e patologia dessa micose, pouco se conhece sobre a ecologia do agente etiológico Paracoccidioides brasiliensis. Seu habitat ainda não foi determinado, mas provavelmente o fungo vive saprofiticamente no solo. Há também pouca informação quanto a participação de outras espécies de animais na eco-epidemiologia do fungo e os isolamentos obtidos de animais como morcego e pingüim não foram reprodutíveis. Até o presente, o fungo tem sido isolado com maior freqüência do tatu, Dasypus novencinctus. Estudos soroepidemiológicos demonstraram que a infecção é freqüente em cães, principalmente da área rural e recentemente foi relatado o primeiro caso de paracoccidiodomicose natural em cão. O papel de outras espécies de animais na eco-epidemiologia do fungo ainda não está esclarecido.