Molecular epidemiology of Paracoccidiodes spp. recovered from patients with paracoccidioidomycosis in a teaching hospital from Minas Gerais State of Brazil.

INTRODUCTION: Paracoccidioidomycosis (PCM) is caused by several species of the Paracoccidioides genus which can be differentiated by interspecific genetic variations, morphology and geographic distribution. Intraspecific variability correlation with clinical and epidemiological aspects of these species still remains unclear. This study aimed to sequence the loci GP43, exon 2 and ARF of 23 clinical isolates of Paracoccidioides spp. from patients in the Southeast Region of Brazil. METHODOLOGY AND MAIN FINDINGS: GenBank was used to compare the present (23) with previous described sequences (151) that included ARF and GP43. It was identified a high polymorphism rate among the 23 isolates in comparison to the other 151. Among the isolates, 22 (95.66%) were S1/P. brasiliensis and 1 (4.34%) was identified as PS2/P. americana. A total of 45 haplotypes were found as follows: 19 from S1/P. brasiliensis (13 from the present study), 15 from P. lutzii, 6 from PS2/P. americana (1 from the present study), 3 from PS3/P. restrepiensis and 2 from PS4/P. venezuelensis. Moreover, exclusive haplotypes according to clinical origin and geographical area were found. S1/P. brasiliensis (HD = 0.655 and K = 4.613) and P. lutzii (HD = 0.649 and K = 2.906) presented the highest rate of polymorphism among all species, from which 12 isolates of the present study were clustered within S1b/P. brasiliensis. The GP43 locus showed a higher variability and was found to be the main reason for the species differentiation. CONCLUSIONS: The results herein decribed show a high intraspecific genetic variability among S1/P. brasiliensis isolates and confirm the predominance of this species in the Southeast region of Brazil. The finding of exclusive haplotypes according to clinical origin and geographical area would suggest correlation between the molecular profile with the clinical form and geographic origin of patients with PCM.

Choroiditis in a HIV-infected patient with disseminated cryptococcal infection: A case report and literature review.

BACKGROUND: Ocular involvement in AIDS patients is a common event mainly caused by inflammation or infection. Despite the high prevalence rate of cryptococcosis in these individuals, ocular features have been occasionally described. CASE REPORT: A 20-year-old Brazilian female with HIV infection recently diagnosed was admitted with a respiratory profile presumptively diagnosed as Pneumocystis jirovecii pneumonia; an ophthalmologic exam suggested choroiditis by this agent as well. She was complaining of headaches and blurred vision which led to cryptococcal meningitis diagnosis by a CSF positive India ink stain and Cryptococcus neoformans positive culture. Despite therapy based on amphotericin B plus fluconazole, her clinical state progressively worsened and the patient died one week later. At necropsy, disseminated cryptococcal infection was evidenced in several organs including eyes, which presented bilateral chorioretinitis. CONCLUSIONS: Cryptococcal ocular involvement in AIDS patients has been occasionally proved among the cases already reported. Thus, the post mortem exam is still pivotal to improve the quality of the clinical diagnosis, especially in limited-resource settings.

Choroiditis in a HIV-infected patient with disseminated cryptococcal infection: a case report and literature review / Coroiditis en un paciente con VIH con criptococosis diseminada: caso clínico y revisión de la bibliografía

Background: Ocular involvement in AIDS patients is a common event mainly caused by inflammation or infection. Despite the high prevalence rate of cryptococcosis in these individuals, ocular features have been occasionally described. Case report: A 20-year-old Brazilian female with HIV infection recently diagnosed was admitted with a respiratory profile presumptively diagnosed as Pneumocystis jirovecii pneumonia; an ophthalmologic exam suggested choroiditis by this agent as well. She was complaining of headaches and blurred vision which led to cryptococcal meningitis diagnosis by a CSF positive India ink stain and Cryptococcus neoformans positive culture. Despite therapy based on amphotericin B plus fluconazole, her clinical state progressively worsened and the patient died one week later. At necropsy, disseminated cryptococcal infection was evidenced in several organs including eyes, which presented bilateral chorioretinitis. Conclusions: Cryptococcal ocular involvement in AIDS patients has been occasionally proved among the cases already reported. Thus, the post mortem exam is still pivotal to improve the quality of the clinical diagnosis, especially in limited-resource settingsl

Antecedentes: La afectación ocular en pacientes con sida es una circunstancia común provocada principalmente por procesos inflamatorios o infecciosos. A pesar de la alta prevalencia de criptococosis en estos individuos, los hallazgos oculares solo se describen ocasionalmente. Caso clínico: Una mujer brasileña de 20 años, diagnosticada poco tiempo antes de infección por el VIH, fue hospitalizada por dificultad respiratoria con el presunto diagnóstico de neumonía por Pneumocystis jirovecii; el examen oftalmológico sugirió también la existencia de coroiditis por el mismo agente etiológico. Las quejas de la paciente por cefalea y visión borrosa orientaron el diagnóstico hacia la criptococosis meníngea, confirmada por el examen directo y el crecimiento de Cryptococcus neoformans en el cultivo del líquido cefalorraquídeo. A pesar de haber comenzado un tratamiento con anfotericina B y fluconazol, el estado clínico empeoró progresivamente y la paciente falleció una semana después. La necropsia mostró criptococosis diseminada en varios órganos, incluidos los ojos, que presentaban coriorretinitis bilateral. Conclusiones: La criptococosis ocular en pacientes con VIH se ha descrito ocasionalmente en los casos publicados. Por este motivo, la necropsia todavía es fundamental para mejorar la calidad del diagnóstico clínico de esa enfermedad, especialmente en regiones con recursos limitados