Perfil sorológico dos pacientes com suspeita clínica de paracoccidiodomicose avaliados pelo Instituto Adolfo Lutz no ano de 2016 / Serological profile of patients with clinical suspicion of paracoccidiodomycosis evaluated by Instituto Adolfo Lutz in 2016

Oitenta porcento dos casos de paracoccidioidomicose (PMC) ocorrem no Brasil. As regiões brasileiras com maior número de casos são: sul, sudeste e centro-oeste, sendo emergente no norte e nordeste. A imunodifusão dupla em gel de agarose assume grande importância no diagnóstico, por permitir o monitoramento da doença e por oferecer subsídios para levantamentos soroepidemiológicos. O objetivo deste trabalho foi de avaliar e caracterizar os pacientes atendidos no Laboratório de Imunodiagnóstico das Micoses do Instituto Adolfo Lutz de São Paulo, em 2016. Trata-se de um estudo retrospectivo realizado utilizando-se dados secundários e avaliando-se as seguintes informações: idade, sexo, procedência do pedido médico, resultado e histórico sorológico dos pacientes. Dos 1.408 pacientes, 12,8% apresentaram reatividade sorológica para Paracoccidioides brasiliensis. Destes, 42,5% não possuiam histórico sorológico, sendo considerados como casos novos da doença. A classificação dos pacientes reagentes por gênero demonstrou que 83,4% eram do sexo masculino, com razão de masculinidade de 5:1. A faixa etária variou de um (1) a 92 anos, e aproximadamente 40% dos pacientes eram da faixa etária de 41 a 60 anos. Este estudo demonstra e reforça a importância da implementação dos estudos soroepidemiológicos como ferramenta auxiliar para nortear as ações de vigilância e políticas em saúde na PCM.

Eighty percent of paracoccidioidomycosis (PMC) cases occur in Brazil. The highest numbers occur in south, southeast and center-west region, being emergent in the north and northeast areas. The double immunodiffusion in agarose gel is valuable for its diagnosis, as it allows the monitoring of the disease and offers subsidies for the seroepidemiological surveys. This study evaluated and characterized the patients attended in 2016 at the Mycoses Immunodiagnosis Laboratory of Adolfo Lutz Institute of São Paulo. This retrospective study, based on the secondary data, evaluated the information: age, sex, medical request origin, result and serological history of the patients. Of 1,408 patients, 12.8% presented positive serological reactivity for Paracoccidioides brasiliensis. Of them, 42.5% had no serological history and they were considered as new cases. The classification of reactive patients by gender showed that 83.4% were males, being the masculinity ratio of 5:1. The age range was one (1) to 92 years old, and ±40% of the patients were of age ranging from 41-60 years old. This study reinforces the importance of the implementation of the seroepidemiological studies as to guide the surveillance actions and the public health politics in PCM.

Perfil sorológico dos pacientes com suspeita clínica de paracoccidiodomicose avaliados pelo Instituto Adolfo Lutz no ano de 2016 / Serological profile of patients with clinical suspicion of paracoccidiodomycosis evaluated by Instituto Adolfo Lutz in 2016

Oitenta porcento dos casos de paracoccidioidomicose (PMC) ocorrem no Brasil. As regiões brasileiras com maior número de casos são: sul, sudeste e centro-oeste, sendo emergente no norte e nordeste. A imunodifusão dupla em gel de agarose assume grande importância no diagnóstico, por permitir o monitoramento da doença e por oferecer subsídios para levantamentos soroepidemiológicos. O objetivo deste trabalho foi de avaliar e caracterizar os pacientes atendidos no Laboratório de Imunodiagnóstico das Micoses do Instituto Adolfo Lutz de São Paulo, em 2016. Trata-se de um estudo retrospectivo realizado utilizando-se dados secundários e avaliando-se as seguintes informações: idade, sexo, procedência do pedido médico, resultado e histórico sorológico dos pacientes. Dos 1.408 pacientes, 12,8% apresentaram reatividade sorológica para Paracoccidioides brasiliensis. Destes, 42,5% não possuiam histórico sorológico, sendo considerados como casos novos da doença. A classificação dos pacientes reagentes por gênero demonstrou que 83,4% eram do sexo masculino, com razão de masculinidade de 5:1. A faixa etária variou de um (1) a 92 anos, e aproximadamente 40% dos pacientes eram da faixa etária de 41 a 60 anos. Este estudo demonstra e reforça a importância da implementação dos estudos soroepidemiológicos como ferramenta auxiliar para nortear as ações de vigilância e políticas em saúde na PCM. (AU)

Eighty percent of paracoccidioidomycosis (PMC) cases occur in Brazil. The highest numbers occur in south, southeast and center-west region, being emergent in the north and northeast areas. The double immunodiffusion in agarose gel is valuable for its diagnosis, as it allows the monitoring of the disease and offers subsidies for the seroepidemiological surveys. This study evaluated and characterized the patients attended in 2016 at the Mycoses Immunodiagnosis Laboratory of Adolfo Lutz Institute of São Paulo. This retrospective study, based on the secondary data, evaluated the information: age, sex, medical request origin, result and serological history of the patients. Of 1,408 patients, 12.8% presented positive serological reactivity for Paracoccidioides brasiliensis. Of them, 42.5% had no serological history and they were considered as new cases. The classification of reactive patients by gender showed that 83.4% were males, being the masculinity ratio of 5:1. The age range was one (1) to 92 years old, and ±40% of the patients were of age ranging from 41-60 years old. This study reinforces the importance of the implementation of the seroepidemiological studies as to guide the surveillance actions and the public health politics in PCM.(AU)

Evaluation of the "shelf life" of nitrocellulose membranes immobilized with Paracoccidioides brasiliensis antigen for performing the immunodiagnosis of paracoccidioidomycosis / Avaliação do "tempo de prateleira" de membranas de nitrocelulose imobilizadas com antígeno de Paracoccidioides brasiliensis para o imunodiagnóstico da paracoccidioidomicose

The immunoblotting reaction for performing the paracoccidioidomycosis (PCM) immunodiagnosis is an in-house methodology; and being a laborious task involving two previous steps, SDS-PAGE and Western blot, we evaluated the shelf life of nitrocellulose membranes containing the immobilized P. brasiliensis antigens, stored at -20 o C for 7, 15, 30, 45, 60 and 90 days. Twenty-eight serum samples were analyzed on two nitrocellulose membranes groups: (a) membranes previously blocked with PBS-5 % non-fat dry milk and (b) the priory non-blocked membranes. No difference was detected in the reactivity pattern in serum samples evaluated in the both membrane groups, especially for those stored for 7, 15, 30, 45 and 60 days. It might be emphasized that a good stability of P. brasiliensis antigens, immobilized on the nitrocellulose membranes, enable them to be stored up to 60 days at -20 o C. This finding contributes to the rapid diagnosis of PCM, and for sending them to other laboratories without adequate infrastructure for carrying out the steps that precede the immunodetection as the antigen production, SDS-PAGE and Western blot techniques. This scheme contributes substantially to improve the quality of PCM serodiagnosis, as it provides reproducible results in the units of the Laboratory Network.(AU)

Considerando-se que o immunoblotting para o imunodiagnóstico da paracoccidioidomicose (PCM) é uma metodologia in house e laboriosa envolvendo duas etapas iniciais, SDS-PAGE e Western blot, neste estudo foi avaliado o tempo de prateleira das membranas de nitrocelulose sensibilizadas com antígeno de P. brasiliensis, armazenadas a -20 o C durante 7, 15, 30, 45, 60 e 90 dias. Vinte e oito amostras de soro foram analisadas em dois grupos de membranas de nitrocelulose (membranas previamente bloqueadas com PBS-leite 5 % e as não-bloqueadas). Não houve diferença no padrão de reatividade quando os soros foram avaliados frente a ambos os grupos, especialmente para membranas armazenadas por 7, 15, 30, 45 e 60 dias. A boa estabilidade do antígeno utilizado para sensibilizar as membranas fez com que estas pudessem ser armazenadas a -20 C até 60 dias. Estas características contribuem para efetuar o diagnóstico rápido da PCM, bem como as perspectivas dessas membranas sensibilizadas serem encaminhadas para os laboratórios, que não possuam infraestrutura necessária para executar as etapas que antecedem a realização de immunoblotting, como a produção de antígeno, as técnicas de SDS PAGE e Western blot. Este procedimento contribui substancialmente para melhorar o diagnóstico sorológico da PCM, pois poderá fornecer resultados reprodutíveis nas unidades componentes da Rede de Laboratórios.(AU)

Standardization and validation of Dot-ELISA assay for Paracoccidioides brasiliensis antibody detection

Background Paracoccidioidomycosis (PCM) is a neglected systemic mycosis caused by a dimorphic fungus of the Paracoccidioides genus. The standard diagnosis is based on isolation of the fungi in culture, and by microscopic visualization of characteristic multiple budding yeast cells in biological samples. However, in some situations, access to the site of injury prevents the collection of biological material. A variety of immuno-serological techniques has proven useful for allowing inferring diagnosis with a certain degree of certainty, thus optimizing time. The aim of this study was to standardize and validate the Dot-ELISA (DE) assay, comparing it with the serological standard, double immunodiffusion (DI). Methods In order to standardize the DE assay, 143 serum samples were used. Out of those, 23 were from apparently healthy patients, 77 were from patients with confirmed PCM and 43 were from patients with other lung infections (tuberculosis, aspergillosis and histoplasmosis). To validate the DE technique, 300 serum samples from patients with PCM clinical suspicion (probable and possible cases) were employed, and these results were compared with those of DI. Results The DE assay showed sensitivity of 91%, specificity of 95.4%, positive predictive value of 96%, negative predictive value of 98.2%, accuracy of 93%, and great precision (k = 0.93). In addition, the nitrocellulose membranes have proved to be viable for using at least 90 days after P. brasiliensis B-339 antigen sensitization. Conclusion Dot-ELISA method was found to be an extremely promising tool as serologic screening technique, because of its high sensitivity. Furthermore, Dot-ELISA shows the prospect of being transferred to laboratories of mycoserology including those with fewer resources or even to be used directly in the field. It has an excellent shelf life - membranes coated with antigen can be used for testing without changes in the pattern of reactivity among laboratories - and presents reliable values of sensitivity, specificity, predictive values, accuracy and a high correlation with the serological standard methodology. Based on the present findings, it possible to state that this technique constitutes a remarkable option to be used in routine diagnosis for public health centers.(AU)

Standardization and validation of Dot-ELISA assay for Paracoccidioides brasiliensis antibody detection

Background Paracoccidioidomycosis (PCM) is a neglected systemic mycosis caused by a dimorphic fungus of the Paracoccidioides genus. The standard diagnosis is based on isolation of the fungi in culture, and by microscopic visualization of characteristic multiple budding yeast cells in biological samples. However, in some situations, access to the site of injury prevents the collection of biological material. A variety of immuno-serological techniques has proven useful for allowing inferring diagnosis with a certain degree of certainty, thus optimizing time. The aim of this study was to standardize and validate the Dot-ELISA (DE) assay, comparing it with the serological standard, double immunodiffusion (DI). Methods In order to standardize the DE assay, 143 serum samples were used. Out of those, 23 were from apparently healthy patients, 77 were from patients with confirmed PCM and 43 were from patients with other lung infections (tuberculosis, aspergillosis and histoplasmosis). To validate the DE technique, 300 serum samples from patients with PCM clinical suspicion (probable and possible cases) were employed, and these results were compared with those of DI. Results The DE assay showed sensitivity of 91%, specificity of 95.4%, positive predictive value of 96%, negative predictive value of 98.2%, accuracy of 93%, and great precision (k = 0.93). In addition, the nitrocellulose membranes have proved to be viable for using at least 90 days after P. brasiliensis B-339 antigen sensitization. Conclusion Dot-ELISA method was found to be an extremely promising tool as serologic screening technique, because of its high sensitivity. Furthermore, Dot-ELISA shows the prospect of being transferred to laboratories of mycoserology including those with fewer resources or even to be used directly in the field. It has an excellent shelf life - membranes coated with antigen can be used for testing without changes in the pattern of reactivity among laboratories - and presents reliable values of sensitivity, specificity, predictive values, accuracy and a high correlation with the serological standard methodology. Based on the present findings, it possible to state that this technique constitutes a remarkable option to be used in routine diagnosis for public health centers.(AU)

Standardization and validation of Dot-ELISA assay for Paracoccidioides brasiliensis antibody detection

Abstract Background Paracoccidioidomycosis (PCM) is a neglected systemic mycosis caused by a dimorphic fungus of the Paracoccidioides genus. The standard diagnosis is based on isolation of the fungi in culture, and by microscopic visualization of characteristic multiple budding yeast cells in biological samples. However, in some situations, access to the site of injury prevents the collection of biological material. A variety of immuno-serological techniques has proven useful for allowing inferring diagnosis with a certain degree of certainty, thus optimizing time. The aim of this study was to standardize and validate the Dot-ELISA (DE) assay, comparing it with the serological standard, double immunodiffusion (DI). Methods In order to standardize the DE assay, 143 serum samples were used. Out of those, 23 were from apparently healthy patients, 77 were from patients with confirmed PCM and 43 were from patients with other lung infections (tuberculosis, aspergillosis and histoplasmosis). To validate the DE technique, 300 serum samples from patients with PCM clinical suspicion (probable and possible cases) were employed, and these results were compared with those of DI. Results The DE assay showed sensitivity of 91%, specificity of 95.4%, positive predictive value of 96%, negative predictive value of 98.2%, accuracy of 93%, and great precision (k = 0.93). In addition, the nitrocellulose membranes have proved to be viable for using at least 90 days after P. brasiliensis B-339 antigen sensitization. Conclusion Dot-ELISA method was found to be an extremely promising tool as serologic screening technique, because of its high sensitivity. Furthermore, Dot-ELISA shows the prospect of being transferred to laboratories of mycoserology including those with fewer resources or even to be used directly in the field. It has an excellent shelf life membranes coated with antigen can be used for testing without changes in the pattern of reactivity among laboratories and presents reliable values of sensitivity, specificity, predictive values, accuracy and a high correlation with the serological standard methodology. Based on the present findings, it possible to state that this technique constitutes a remarkable option to be used in routine diagnosis for public health centers.

Paracoccidioidomycosis in southern Rio Grande do Sul: a retrospective study of histopathologically diagnosed cases

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis and is endemic to Brazil. The aim of this study was to perform a retrospective analysis of the PCM cases in the countryside south of Rio Grande do Sul, Brazil. The files from four histopathology laboratories located in the city of Pelotas were obtained, and all of the epidemiological and clinical data from the PCM diagnosed cases were collected for analysis. A total of 123 PCM cases diagnosed between 1966 and 2009 were selected. Of these patients, 104 (84.5%) were male, and 17 were female. The patients ranged from 02 to 92 years of age. Fifty-two cases (41.9%) were obtained from the oral pathology laboratory, and the remaining 71 cases (58.1%) were obtained from the three general pathology laboratories. Of all of the patients studied, 65.2% lived in rural zones and worked in agriculture or other related fields. Data on the evolution of this disease was available for 43 cases, and the time frame ranged from 20 to 2920 days (mean = 572.3 days). An accurate diagnosis performed in less than 30 days only occurred in 21% of the cases. PCM is endemic to the countryside of Rio Grande do Sul. Therefore, it is recommended that PCM be included as a differential diagnosis, mainly for individuals between 30 and 60 years of age, living in rural zones and who have respiratory signs and associated-oropharyngeal lesions.(AU)

Retrospective seroepidemiological analysis of patients with suspicion of paracoccidioidomycosis in São Paulo State, Brazil

The geographic distribution of paracoccidioidomycosis (PCM) in the Brazilian state of São Paulo was evaluated in a retrospective study using secondary data from serological analyses, carried out by double immunodiffusion assay of patients with PCM suspicion, from January 1999 to May 2010. Sixty percent of 10,176 patients, from 239 cities, were serologically reactive to P. brasiliensis. The cities that showed the most serological reactivity among patients were São João da Boa Vista (85%), Piracicaba (75%), Sorocaba (73%), Campinas (72%) and São Paulo (62%). São Paulo state has an area of 248,209.4 km²; the climate is tropical and sub-tropical with annual temperatures between 18 and 24ºC, high rainfall (900 to 1800 mm/year), rainy summers and mild winters. It also features large areas composed of acidic soils, and is one of the greatest contributors to Brazilian agricultural production and, separately, the largest producer of orange juice and, the ninth greatest producer of soy and sugar cane and the fourth largest coffee producer. We suggest that the climatic characteristics associated with soil type and development of primary activities can contribute to the endemic potential of PCM in São Paulo state.(AU)

Paracoccidioides brasiliensis infection in dogs from Western Brazilian Amazon / Infecção por Paracoccidioides brasiliensis em cães da Amazônia Ocidental Brasileira

The objective of the study was to evaluate Paracoccidioides brasiliensis infection in urban dogs from the municipality of Monte Negro, Rondonia, Western Brazilian Amazon. The serum samples (n=126) were analyzed by indirect ELISA and the immunodiffusion test using P. brasiliensis gp43 and exoantigen as antigens, respectively. A positivity of 54.8% was observed only in the ELISA test and no statistical difference was observed in the seroprevalence in relation to age or sex. This is the first paracoccidioidomycosis survey carried out with dogs from the Western Brazilian Amazon. The higher positivity rates of P. brasiliensis infection observed in this study suggest that veterinarians must be alert to detect new cases of natural disease in dogs living in paracoccidioidomycosis endemic areas.(AU)

O objetivo deste estudo foi avaliar a infecção por Paracoccidioides brasiliensis em cães urbanos do município de Monte Negro, Rondônia, Amazônia Ocidental Brasileira. As amostras de soro (n=126) foram analisadas por meio dos testes de ELISA indireto e imunodifusão utilizando gp43 de P. brasiliensis e exoantígeno como antígenos, respectivamente. Uma positividade de 54,8% foi observada apé isso mesmoenas no teste de ELISA e nenhuma diferença estatística foi observada na soroprevalência em relação ao sexo ou à idade. Este é o primeiro estudo epidemiológico de paracoccidioidomicose realizado com cães da Amazônia Ocidental Brasileira. A alta positividade de infecção por P. brasiliensis observada neste estudo sugere que os veterinários devem estar atentos para detectar a doença natural em cães de áreas endêmicas para paracoccidioidomicose.(AU)

Research and characterization of selected pathogens of cutaneous and mucocutaneous lesions in cetaceans from the Brazilian coast

Cetáceos são sentinelas do ambiente marinho, atualmente ameaçados por diversos fatores, principalmente antropogênicos. Os processos de pele e mucosas externas são os mais facilmente identificados, bons indicadores do estado de saúde em cetáceos. Lesões cutâneas e mucocutâneas já foram amplamente relatadas em cetáceos de vida livre e de cativeiro, mas pouco se sabe a respeito dos fatores etiológicos envolvidos, evolução das lesões dermatológicas e suas consequências sistêmicas. Vírus são os agentes mais comumente envolvidos em lesões cutâneas e mucocutâneas, especialmente os herpesvírus (HV), associados a lesões de morfologias variáveis em mucosas, e poxvírus dos cetáceos (Cetacean Poxvirus CePV), principalmente associados a lesões de pele tatuagem ou anel características. Agentes fúngicos também podem causar doenças dermatológicas em cetáceos, como por exemplo a paracoccidioidomicose ceti, caracterizada por lesões esbranquiçadas elevadas e proliferativas, causada por leveduras nãocultiváveis de Paracoccidioides brasiliensis (ordem Onygenales). Apesar de mundialmente reportados, a ocorrência desses agentes etiológicos em cetáceos do Atlântico Sul ainda é pouco compreendida. O objetivo desse estudo foi identificar e caracterizar patógenos cutâneos e mucocutâneos selecionados (HV, CePV e P. brasiliensis) de cetáceos brasileiros de vida livre e desenhar métodos diagnósticos mais sensíveis para sua detecção. Todos os animais estudados encalharam ao longo da costa brasileira, entre 2005 e 2015, exceto por três botos-cor-de-rosa que foram fisicamente imobilizados e liberados após a coleta de amostras. Para atingir tais objetivos, empregamos técnicas moleculares e histológicas, e ocasionalmente de imunohistoquímica e microscopia eletrônica. A presença de HV e CePV foi avaliada, respectivamente, em amostras cutâneas e de mucosa oral e genital de 115 espécimes, e amostras de pele de 113 indivíduos; enquanto a presença de membros da ordem Onygenales foi avaliada em quatro espécimes que apresentavam lesões macroscópicas compatíveis. Amostras de pele ou de mucosa oral de quatro animais foram positivas para a PCR de HV: uma lesão ulcerada de pele de coloração esbranquiçada de um boto-cinza (Sotalia guianensis), uma amostra de tecido lingual de um golfinho-pintado-do-Atlântico (Stenella frontalis), lesões ulcerativas e amostras de pele saudável de um cachalote-anão (Kogia sima), e uma lesão proliferativa de pele em boto-vermelho-boliviano (Inia boliviensis). Os primeiros três animais estavam infectados com alphaherpesvirus. Uma sequência mais similar com gammaherpesvírus foi obtida da lesão proliferativa de pele do boto-vermelhoboliviano. A sequência do boto-vermelho-boliviano possivelmente pertence a um novo gênero de gammaherpesvírus. Ademais, todas as outras amostras de tecidos disponíveis dos espécimes HV-positivos, à parte de pele e mucosa oral, também foram avaliadas por técnicas de PCR e histológicas. Uma sequência diferente de alphaherpesvírus foi encontrada no estômago e em um linfonodo mesentérico do cachalote-anão. Achados microscópicos em dois animais HV-positivos (dermatites proliferativas em boto-vermelho-boliviano e boto-cinza) eram compatíveis com HV. CePV foi identificado em lesões de pele do tipo tattoo de um golfinho-nariz-degarrafa (Tursiops truncatus) e de um boto-cinza por meio de técnicas moleculares estabelecidas, e observação de partículas de poxvírus por microscopia eletrônica. Animais CePV-positivos apresentavam degeneração balonosa epidérmica e ocasionais inclusões intracitoplasmáticas anfofílicas ou eosinofílicas compatíveis com CePV. Motivos aminoácidos específicos para todos os CePVs também foram identificados, reforçando a sugestão de um novo gênero, chamado Cetaceanpoxvirus. Nesse estudo também foram desenvolvidas novas técnicas de PCR convencional e real-time com SYBR® Green, significativamente mais sensíveis do que os métodos atualmente disponíveis em literatura. Um boto-cinza, inicialmente negativo segundo os métodos de PCR previamente conhecidos foi diagnosticado positivo para CePV por meio das novas técnicas aqui descritas. Leveduras refratáveis (49 m de diâmetro) foram observadas á microscopia sob a forma de lesões de pele granulomatosas moderadas e necróticas em quatro golfinhos-narizde- garrafa, e pela primeira vez, em um abscesso muscular (esse último um indício do potencial invasivo desse agente). Leveduras de Onygenales sp. foram identificadas em lesões de pele por meio de imunohistoquímica e uma sequência de P. brasiliensis mais semelhante (100% de identidade de nucleotídeos) áquela descrita em um gofinho-nariz-de-garrafa de Cuba do que a casos de humanos e mamíferos descritos no Brasil, foi encontrada em lesões de pele de um dos espécimes. Esse estudo relata a primeira identificação molecular de HV em cetáceos da América do Sul e em golfinhos de rio no mundo. Além disso, descrevemos a primeira amplificação de CePV e P. brasiliensis em odontocetes da América do Sul, confirmando a etiologia desse tipo de lesões. Quatro das cinco novas sequências de HV identificadas são possivelmente novas espécies, provisoriamente chamadas Delphinid HV-10, Kogiid HV-2, Kogiid HV-3 e Iniid HV-1.

Cetaceans are sentinels of the marine environment, currently threatened by many factors, mainly anthropogenic. The most easily identified compromising conditions are those affecting the skin and external mucosae - good indicators of the cetaceans health status. Cutaneous and mucocutaneous lesions have been extensively reported in wild and captive cetaceans, but little is known about the involved etiological factors, evolution of the dermatological lesions and their systemic consequences. Viruses are the most commonly involved agents in cutaneous and mucocutaneous lesions, especially herpesviruses (HV) and, associated with skin and mucosal lesions with varying morphologies, and cetacean poxviruses (CePV), mainly associated with characteristic tattoo or ring skin lesions. In addition, fungal agents are also recognized as causative agents of dermatological disease in cetaceans, especially in the process known as paracoccidioidomycosis ceti, observed as raised proliferative whitish lesions, caused by non cultivable yeast of Paracoccidioides brasiliensis (order Onygenales). Despite being reported worldwide, the occurrence of these etiological agents in southern Atlantic cetaceans is still poorly understood. The goal of this study was to identify and characterize selected cutaneous and mucocutaneous pathogens (HV, CePV and P. brasiliensis) of free-ranging cetaceans from Brazil, and to design more sensitive diagnostic methods for their detection. All the studied cetaceans stranded along the coast of Brazil, between 2005 and 2015, except three wild riverine dolphins that were physically contained and released after sample collection. In order to achieve our goals, we employed molecular, histopathological, and occasionally immunohistochemical and electron microscopy techniques. The presence of HV and CePV was evaluated in cutaneous, and oral and genital mucosal samples from 115 specimens and skin samples from 113 individuals, respectively; whereas the presence of members of the genus Onygenales sp. was evaluated in four specimens presenting macroscopic compatible lesions. Skin or oral mucosal samples from four animals were HV PCR-positive: a whitish ulcerated skin lesion from a Guiana dolphin (Sotalia guianensis), a lingual sample from an Atlantic spotted dolphin (Stenella frontalis), ulcerative lesions and healthy skin samples from a dwarf sperm whale (Kogia sima), and a proliferative skin lesion from a Bolivian river dolphin (Inia boliviensis). The tree first animals were infected with alphaherpesvirus. A sequence more similar to gammaherpesvirus was obtained from the Bolivian river dolphins proliferative skin lesion. The Bolivian river dolphin sequence could possibly be a member of a new gammaherpesvirus genus. Additionally, all other available tissue samples from HV-positive specimens, aside from skin and oral mucosa, were also tested by PCR and histologically evaluated. A different alphaherpesvirus sequence was found in the stomach and in a mesenteric lymph node of the dwarf sperm whale. Microscopic findings in two HV-positive animals (chronic proliferative dermatitis in Bolivian river dolphin and Guiana dolphin) were compatible with HV. CePV was identified in tattoo skin lesions of an Atlantic bottlenose dolphin and a Guiana dolphin by established molecular methods, and poxviral particles were observed by electron microscopy. CePV-positive animals presented epidermal ballooning degeneration and occasionally small, pale eosinophilic or amphophilic intracytoplasmic inclusions, compatible with CePV. Specific amino acid motifs for all CePV were also identified, reinforcing the suggestion of the new Cetaceanpoxvirus genus. We also designed novel SYBR® Green real-time and conventional CePV PCR methods significantly more sensitive than those currently available in the literature. An additional Guiana dolphin, previously negative based in established PCR methods was diagnosed positive for CePV through these new techniques. Refractile yeasts (49 m in diameter) were observed under light microscopy in mild granulomatous and necrotic skin lesions of four Atlantic bottlenose dolphin, and for the first time, in a skeletal muscle abscess (the former possibly indicating the invasive potential of the agent).Onygenales sp. yeasts were identified in skin lesions by immunohistochemistry and a sequence of P. brasiliensis, more similar (100% nucleotide identity) to the one described in an Atlantic bottlenose dolphin from Cuba than to human or any other terrestrial mammals cases in Brazil, was obtained from the skin lesion of one of the specimens, confirming the etiological agent of these type of lesions. Herein we report the first molecular identification of HV in South American cetaceans and in riverine dolphins worldwide. This study also describes the first amplification of CePV and P. brasiliensis in odontocetes from South America. Four of the five novel herpesvirus sequences herein identified are possibly novel species, tentatively named Delphinid HV-10, Kogiid HV-2, Kogiid HV-3 and Iniid HV-1.

Cell-free antigens from precocious Paracoccidioides brasiliensis culture induce a typical delayed-type hypersensitivity reaction

Cell-free antigens (CFAg) derived from Paracoccidioides brasiliensis have typically been used in immunodiffusion reactions for serodiagnosis or therapeutic follow-up of paracoccidioidomycosis patients. Thus, we investigated the usefulness of CFAg obtained from cultures at different ages, to evaluate cellular immunity by the footpad test, in experimental murine paracoccidioidomycosis. Male mice infected with P. brasiliensis 265 strain were challenged in the footpad with CFAg obtained from four- (4d CFAg) or 11-day-old cultures (11d CFAg). The increase in footpad swelling provoked by 4d CFAg and 11d CFAg was similar and showed significant difference in relation to control groups. However, the infiltrate pattern was strikingly different: 4d CFAg induced a predominant mononuclear infiltrate whereas 11d CFAg provoked a predominant polymophonuclear infiltrate. These different inflammatory patterns were associated with distinct electrophoretic characteristics. By comparison with 11d CFAg, 4d CFAg showed more numerous and intense bands, including a strong one of 43 kDa (gp43). These results suggest that CFAg derived from Pb 265 isolate can be used as a reagent to evaluate cellular immunity; however, the culture's age is critical because only young cultures are able to induce a typical mononuclear infiltrate. The efficacy of this new paracoccidioidin to assay the cellular immunity in infections caused by other P. brasiliensis isolates is under investigation.(AU)

An unusual case of paracoccidioidomycosis in Brazil

This paper reports an unusual case of paracoccidioidomycosis with ulcerations in the head and nose in a Brazilian man. For diagnosis, direct microscopic examination of ulcer secretion and skin samples treated with potassium hydroxide was performed. The isolation of Paracoccidioides brasiliensis occurred at 28ºC and 37ºC on Sabouraud agar with chloranphenicol. Diagnosis was established by the presence of isolated and multiple budding yeast-like cells and typical fungus growth of P. brasiliensis.

Este trabalho relata um caso incomum de paracocci-dioidomicose com ulcerações na cabeça e nariz em homem brasileiro. Para o diagnóstico, realizou-se exame microscópico direto de secreção de úlcera e amostras de pele, tratados com hidróxido de potássio. O isolamento de Paracoccidioides brasiliensis ocorreu a 28ºC e 37ºC em Sabouraud ágar com cloranfenicol. O diagnóstico foi estabelecido pela presença de células leveduriformes isoladas e com brotações múltiplas e o crescimento típico do fungo P. brasiliensis.

Natural antibodies in paracoccidioidomycosis

Recent attention has been focused on the natural antibodies as a component of natural immunity and as integral part of the idiotypic network. However, their functional role in different infections has rarely been studied. This work was undertaken to investigate the presence of natural antibodies in paracoccidioidomycosis (PCM). In addition, we analyzed anti-P. brasiliensis antibodies and their distribution in IgG subclasses in order to acquire better knowledge about the humoral immune response in this mycosis. Our findings show that the natural antibody response is not very much increased in PCM when compared with other parasite infections and this response is restricted to a few specificities, suggesting that P. brasiliensis moderately triggers CD5+ B cells. The anti-actin antibody was the main antibody specificity found in PCM. Specific antibodies to P. brasiliensis were mainly found in the IgG1 subclass in chronic patients of PCM.

Recente atenção tem sido dada aos anticorpos naturais como componentes da imunidade natural e como parte integrante da rede idiotípica. Todavia, seu papel funcional em diferentes infecções tem, raramente, sido estudado. O objetivo deste trabalho foi investigar a presença de anticorpos naturais na paracoccidioidomicose (PCM). Em adição, analisamos os anticorpos específicos anti-P. brasiliensis e sua distribuição em subclasses a fim de adquirir mais conhecimento sobre a resposta imune humoral nesta micose. Nossos achados mostram que a resposta de anticorpos naturais não é acentuada na PCM quando comparada com outras infecções por parasitas e, é restrita a poucas especificidades, sugerindo que o P. brasiliensis estimula moderadamente as células B CD5+. O anticorpo anti-actina foi a principal especificidade encontrada na PCM. Os anticorpos especificos para P. brasiliensis, nos pacientes crônicos, eram, principalmente, da subclasse IgG1.

Natural antibodies in paracoccidioidomycosis

Recent attention has been focused on the natural antibodies as a component of natural immunity and as integral part of the idiotypic network. However, their functional role in different infections has rarely been studied. This work was undertaken to investigate the presence of natural antibodies in paracoccidioidomycosis (PCM). In addition, we analyzed anti-P. brasiliensis antibodies and their distribution in IgG subclasses in order to acquire better knowledge about the humoral immune response in this mycosis. Our findings show that the natural antibody response is not very much increased in PCM when compared with other parasite infections and this response is restricted to a few specificities, suggesting that P. brasiliensis moderately triggers CD5+ B cells. The anti-actin antibody was the main antibody specificity found in PCM. Specific antibodies to P. brasiliensis were mainly found in the IgG1 subclass in chronic patients of PCM.

Recente atenção tem sido dada aos anticorpos naturais como componentes da imunidade natural e como parte integrante da rede idiotípica. Todavia, seu papel funcional em diferentes infecções tem, raramente, sido estudado. O objetivo deste trabalho foi investigar a presença de anticorpos naturais na paracoccidioidomicose (PCM). Em adição, analisamos os anticorpos específicos anti-P. brasiliensis e sua distribuição em subclasses a fim de adquirir mais conhecimento sobre a resposta imune humoral nesta micose. Nossos achados mostram que a resposta de anticorpos naturais não é acentuada na PCM quando comparada com outras infecções por parasitas e, é restrita a poucas especificidades, sugerindo que o P. brasiliensis estimula moderadamente as células B CD5+. O anticorpo anti-actina foi a principal especificidade encontrada na PCM. Os anticorpos especificos para P. brasiliensis, nos pacientes crônicos, eram, principalmente, da subclasse IgG1.

Detection of antibodies to Paracoccidioides brasiliensis in horses from northern Region of Paraná State / Detecção de anticorpos para Paracoccidioides brasiliensis em cavalos da região norte do Estado do Paraná

Paracoccidioidomycosis, caused by the dimorphic fungus Paracoccidioides brasiliensis, is the most prevalent human systemic mycosis in Latin America. Paracoccidioidomycosis affects mainly male rural workers, causing granulomatous lesions in organs such as lungs, liver and spleen. The participation of other animal species in the fungus eco-epidemiology in not well understood. The aim of this study was to evaluate the infection by P. brasiliensis in horses from the Northern Region of Paraná State. The serum samples from 100 horses were assayed by ELISA and Immunodiffusion test, using gp43 and exoantigen as antigens, respectively. A seropositivity of 30% was observed by ELISA test, although all samples were negative by immunodiffusion test. These results suggest that horses can be indicator of fungus presence in the ambient.

A paracoccidioidomicose, causada pelo fungo dimórfico Paracoccidioides brasiliensis, é a micose sistêmica de maior prevalência em humanos na América Latina. A paracoccidioidomicose afeta principalmente trabalhadores rurais do sexo masculino, provocando lesões granulomatosas em órgãos como pulmões, fígado e baço. A participação de outras espécies de animais na eco-epidemiologia do fungo não é bem compreendida. Este trabalho teve como objetivo avaliar a infecção por P. brasiliensis em cavalos da Região Norte do Estado do Paraná. Foram analisadas 100 amostras de soros de cavalos por ELISA e por Imunodifusão em gel de agar, utilizando como antígenos a gp43 e o exoantígeno de P. brasiliensis, respectivamente. A soropositividade observada foi de 30% por ELISA enquanto que por imunodifusão todos os soros foram negativos. Os resultados obtidos sugerem que cavalos podem ser indicadores da presença do fungo no meio ambiente.

Detection of antibodies to Paracoccidioides brasiliensis in horses from northern Region of Paraná State / Detecção de anticorpos para Paracoccidioides brasiliensis em cavalos da região norte do Estado do Paraná

Paracoccidioidomycosis, caused by the dimorphic fungus Paracoccidioides brasiliensis, is the most prevalent human systemic mycosis in Latin America. Paracoccidioidomycosis affects mainly male rural workers, causing granulomatous lesions in organs such as lungs, liver and spleen. The participation of other animal species in the fungus eco-epidemiology in not well understood. The aim of this study was to evaluate the infection by P. brasiliensis in horses from the Northern Region of Paraná State. The serum samples from 100 horses were assayed by ELISA and Immunodiffusion test, using gp43 and exoantigen as antigens, respectively. A seropositivity of 30% was observed by ELISA test, although all samples were negative by immunodiffusion test. These results suggest that horses can be indicator of fungus presence in the ambient.

A paracoccidioidomicose, causada pelo fungo dimórfico Paracoccidioides brasiliensis, é a micose sistêmica de maior prevalência em humanos na América Latina. A paracoccidioidomicose afeta principalmente trabalhadores rurais do sexo masculino, provocando lesões granulomatosas em órgãos como pulmões, fígado e baço. A participação de outras espécies de animais na eco-epidemiologia do fungo não é bem compreendida. Este trabalho teve como objetivo avaliar a infecção por P. brasiliensis em cavalos da Região Norte do Estado do Paraná. Foram analisadas 100 amostras de soros de cavalos por ELISA e por Imunodifusão em gel de agar, utilizando como antígenos a gp43 e o exoantígeno de P. brasiliensis, respectivamente. A soropositividade observada foi de 30% por ELISA enquanto que por imunodifusão todos os soros foram negativos. Os resultados obtidos sugerem que cavalos podem ser indicadores da presença do fungo no meio ambiente.

Thymic atrophy and fungal virulence during experimental paracoccidioidomycosis

The immunosuppression observed in systemic mycosis can be related to primary lymphoid organs damage. Thus, our laboratory has studied the effects of the Paracoccidioides brasiliensis infection on the thymus of mice. Here, thymuses of susceptible and resistant mice were evaluated after inoculation with highly and slightly virulent isolates of the fungus. All groups presented thymic atrophy, loss of corticomedullary delimitation and increase of apoptotic index. However, mice inoculated with high virulent strain showed earlier and stronger alterations suggesting that thymic atrophy can be directly related to the fungal virulence and to the immunosuppression.

A imunossupressão observada em micoses sistêmicas pode estar relacionada a danos nos órgãos linfóides primários. Assim, nosso laboratório tem estudado uma possível ação do Paracoccidioides brasiliensis sobre o timo de camundongos. Neste estudo, analisamos o timo de camundongos susceptíveis e resistentes ao fungo utilizando cepas de alta e baixa virulência. Todos os grupos apresentaram atrofia tímica, perda de delimitação corticomedular e aumento da taxa de apoptose. Entretanto, as alterações foram mais precoces e pronunciadas em camundongos inoculados com a cepa virulenta do fungo, sugerindo que a virulência fúngica pode estar diretamente ligada à atrofia tímica e indução de imunossupressão.

Paracoccidioidomycosis in wild and domestic animals / Paracoccidiodomicose em animais silvestres e domésticos

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.

Thymic atrophy and fungal virulence during experimental paracoccidioidomycosis

The immunosuppression observed in systemic mycosis can be related to primary lymphoid organs damage. Thus, our laboratory has studied the effects of the Paracoccidioides brasiliensis infection on the thymus of mice. Here, thymuses of susceptible and resistant mice were evaluated after inoculation with highly and slightly virulent isolates of the fungus. All groups presented thymic atrophy, loss of corticomedullary delimitation and increase of apoptotic index. However, mice inoculated with high virulent strain showed earlier and stronger alterations suggesting that thymic atrophy can be directly related to the fungal virulence and to the immunosuppression.

A imunossupressão observada em micoses sistêmicas pode estar relacionada a danos nos órgãos linfóides primários. Assim, nosso laboratório tem estudado uma possível ação do Paracoccidioides brasiliensis sobre o timo de camundongos. Neste estudo, analisamos o timo de camundongos susceptíveis e resistentes ao fungo utilizando cepas de alta e baixa virulência. Todos os grupos apresentaram atrofia tímica, perda de delimitação corticomedular e aumento da taxa de apoptose. Entretanto, as alterações foram mais precoces e pronunciadas em camundongos inoculados com a cepa virulenta do fungo, sugerindo que a virulência fúngica pode estar diretamente ligada à atrofia tímica e indução de imunossupressão.