Genomic diversity of the human pathogen Paracoccidioides across the South American continent.

Paracoccidioidomycosis (PCM) is a life-threatening systemic mycosis widely reported in the Gran Chaco ecosystem. The disease is caused by different species from the genus Paracoccidioides, which are all endemic to South and Central America. Here, we sequenced and analyzed 31 isolates of Paracoccidioides across South America, with particular focus on isolates from Argentina and Paraguay. The de novo sequenced isolates were compared with publicly available genomes. Phylogenetics and population genomics revealed that PCM in Argentina and Paraguay is caused by three distinct Paracoccidioides genotypes, P. brasiliensis (S1a and S1b) and P. restrepiensis (PS3). P. brasiliensis S1a isolates from Argentina are frequently associated with chronic forms of the disease. Our results suggest the existence of extensive molecular polymorphism among Paracoccidioides species, and provide a framework to begin to dissect the connection between genotypic differences in the pathogen and the clinical outcomes of the disease.

Paracoccidioidomicose (doença de Lutz-Splendore-Almeida): manifestações clínicas / Paracoccidioidomycosis disease (Lutz-Splendore-Almeida): clinical manifestations

A paracoccidioidomicose possui clínica polimórfica, com manifestações localizadas em pele e mucosas até comprometimento de vários órgãos e sistemas, potencialmente capaz de provocar sequelas graves e morte. Deve ser incluída no diagnóstico diferencial das doenças granulomatosas, em áreas endêmicas, como ocorre no Brasil, para que seja reconhecida com precocidade, tratada convenientemente e evitada sua evolução para sequelas e morte prematura.

Paracoccidioidomycosis has polymorphic clinical features with lesions located in the skin and mucous membranes, as well as involvement of various organs and systems, as is potentially capable of causing death and serious sequelae. It should be included in the differential diagnosis of granulomatous diseases in endemic areas, including Brazil, so that it is recognized early, for more convenient treatment as to prevent progression with sequelae or premature death.

Paracoccidioidomicose (doença de Lutz-SPLENDORE-almeida): tratamento, duração do tratamento, recidiva, reação paradoxal, prognóstico, profilaxia / Paracoccidioidomycosis (Lutz-Splendore-Almeida disease): treatment, duration of treatment, recurrence, paradoxical reaction, prognosis, prophylaxis

A paracoccidioidomicose, apesar de ser a micose profunda mais importante da América Latina, ainda possui muitas lacunas quanto à sua abordagem, especialmente em relação à duração de seu tratamento, controle de cura e profilaxia. Na dependência da sua gravidade podem ser usadas em seu tratamento: sulfas, azólicos (itraconazol e o cetoconazol)e anfotericina. O prognóstico depende da sua gravidade, do tempo para estabelecer o diagnóstico e da terapêutica instituída. Nas formas leves é bom; e nas formas moderadas e graves, em que há risco do desenvolvimento de sequelas e de morte, é reservado.

Paracoccidioidomycosis, despite being the most important deep mycosis in Latin America, still has many blindspots in terms of its approach, especially in relation to duration of treatment, cure control and prophylaxis. Depending on severity, the following can be used in the treatment: sulfonamides, azoles (itraconazole and ketoconazole), and amphotericin. The prognosis depends on severity, time between onset and diagnosis, and therapy instituted. In mild forms, prognosis is good; in moderate and severe forms, for which there is risk of developing sequelae and death, it is guarded.

Infecciones micóticas sistémicas o profundas: paracoccidioidomicosis / Sistemic or Deeph fungal infections: paracoccidioidomycoses

La enfermedad de Bowen es una forma de carcinoma escamocelular de la piel y de la mucosa que afecta a pacientes adultos mayores de 60 años siendo raro los casos reportados antes de los 30 años. Se caracteriza por una placa escamosa de crecimiento lento y progresivo principalmente en áreas expuestas a radiación solar como cabeza, cuello y tronco. Se presenta el caso de un paciente de 20 años con lesión en palma de mano que se inicia hace 10 años, en quien se diagnostica Enfermedad de Bowen, recibe tratamiento con imiquimod con evolución favorable.

Bowen's disease is a form of squamous cell carcinoma of the skin and mucosa that affects patients older than 60 years reported cases is rare before age 30. It is characterized by a plaque squamous mainly slow and progressive growth in areas exposed to solar radiation as the head, neck and trunk. We report the case of a patient of 20 years with palm of hand injury that begins 10 years ago, who was diagnosed in Bowen's disease, treated with imiquimod with favorable outcome.

Kinetics of cytokines and chemokines gene expression distinguishes Paracoccidioides brasiliensis infection from disease.

The human infection with Paracoccidioides brasiliensis may result in three major outcomes: the paracoccidioidomycosis-infection (PI), the adult form (AF) and the juvenile form (JF) of the disease. The aim of this study was to compare the immunological response among these groups. The gene expression of multiple cytokines, including IL-4, IL-5, IL-6, IL-10, IFN-gamma, TNF-alpha and TGF-beta1, and chemokines, CXCL8, CXCL9 and CXCL10 was evaluated by RT-PCR in peripheral blood mononuclear cells unstimulated or following phytohemagglutinin stimulation for 3, 6, 12, 24 and 48 h. PI individuals expressed earlier and higher levels of mRNA of IFN-gamma, TNF-alpha, CXCL9 and CXCL10 when compared to JF patients. In relation to AF patients, the PI group presented similar levels of CXCL10 and IFN-gamma and higher levels of CXCL9. On the other hand, mRNA expression of Th2 cytokines (IL-4, IL-10, IL-5 and TGF-beta1) was higher and earlier in JF and AF groups, when compared to PI individuals. At some time intervals it was possible to differentiate JF from AF, mainly in relation to IL-4 and TGF-beta1 mRNA, expressed in higher levels in the JF patients. The distinct patterns of cytokines and chemokines expression support their important role in determining the different outcomes observed in this disease.

Paracoccidioidomycosis of the mouth: an emerging deep mycosis.

Oral fungal infections (mycoses) have come into particular prominence since the advent of infection with Human Immunodeficiency Virus (HIV), and recognition of the Acquired Immune Deficiency Syndrome (AIDS), as well as the phenomenal increase in world travel with increased exposure to infections endemic in the tropics. Paracoccidioidomycosis is a rare mycosis worldwide but common in Brazil and some other areas in Latin America. It can be life-threatening and can manifest with a spectrum of clinical presentations, including frequent oral lesions. This paper reviews the more recent information on Paracoccidioidomycosis, emphasizing those areas most relevant in dental science.

Lacazia loboi gen. nov., comb. nov., the etiologic agent of lobomycosis.

The new genus Lacazia P. Taborda, V. Taborda, et McGinnis is proposed to accommodate Lacazia loboi (O. M. Fonseca et Lacaz) P. Taborda, V. Taborda, et McGinnis, the obligate pathogen that causes lobomycosis in mammals. The continued placement of that fungus in the genus Paracoccidioides Almeida as Paracoccidioides loboi is taxonomically inappropriate. Loboa loboi Ciferri et al. is a synonym of Paracoccidioides brasiliensis.

La infección pulmonar y sistémica causada por el Paracoccidioides brasiliensis. Avances recientes y perspectivas terapéuticas / Pulmonary and systemic infection caused by Paracoccidioides brasiliensis. Recent advances and therapeutic perspectives

La paracoccidioidomicosis es una infección fúngica subaguda o crónica adquirida por la inhalación del Paracoccidioides brasiliensis, caracterizada por la presencia de infiltados pulmonares "en mancha", y/o lesiones ulcesosa de la mucosa oronasal y la piel. La linfadenopatía es frecuente. En los casos diseminados, todas las vísceras pueden ser afectadas, pero las glándulas suprarrenales son especialmente susceptibles. El diagnóstico se confirma con el examen microscópico directo de los productos patológicos, la histopatología o el cultivo del agente infeccioso. Las técnicas de seroinmunología pueden ser de utilidad en el diagnóstico. Es endémica en las regiones tropicales y subtropicales de Sudamérica, Centroamérica y México. Los trabajadores con mayor riesgo son aquellos en contacto con el suelo, principalmente los campesinos, agricultores y obreros de la construcción; la incidencia más alta se ha registrado entre los adultos de 30 a 50 años de edad, siendo mucho más prevalente en los hombres que en las mujeres. El reservorio probablemente sea el suelo o la tierra cargada con las esporas del hongo. El medicamento de elección es el itraconazol. La anfotericina B seguida de una terapia prolongada con sulfas, resulta ser más barata pero menos efectiva. Sin embargo, los casos diseminados más graves, y la insuficiencia respiratoria residual representan un reto significativo a la terapéutica disponible.

Seguimiento post-terapia en pacientes con paracoccidioidomicosis tratados con itraconazol

De 80 pacientes con paracoccidioidomicosis (PCM) que, a partir de 1985, fueran diagnosticados en los laboratorios de la Corporación para Investigaciones Biológicas (CIB) y que recibieran tratamiento con itraconazol (ITZ), fue posible hacer un seguimiento post-terapia prolongado (promedio de 30 meses, rango 1-8 años) en 53 de ellos. Al momento del diagnóstico, 50 presentaban la forma crónica pulmonar del adulto y los 3 restantes, la forma juvenil. Cuatro de los enfermos estudiados habían recaído después de tratamiento con Ketoconazol. La mayoría de los pacientes (92.4 por ciento) recibieron 100 mgs diarios de ITZ, con una duración promedio de 6 meses de tratamiento en el 62 por ciento de los casos. Ninguno de los pacientes seguidos post-terapia presentó recaída durante el período de observación. Los sítomas más importantes a la terminación de la terapia fueron tos, expertoración y disnea, presentes al final de la terapia en 38.3 por ciento, 22.6 por ciento y 26.4 por ciento de los casos, respectivamente. Su frecuencia, sin embargo, disminuyó durante la observación post-terapia, persistiendo sólo la disnea en 35 por ciento de los casos. El seguimiento radiológico permitió observar la desaparición de los infiltrados retículo-nodulares presentes durante la terapia; sin embargo, la fibrosis fue permanente en 7 de los 11 pacientes que fueron seguidos por más de 4 años. En el 85 por ciento de los pacientes se notó un importante descenso en los títulos de anticuerpos contra el agente causal, P brasiliensis. Los anteriores hallazgos revelan la eficacia del ITZ en el tratamiento de la PCM; se comprueba que este triazol es superior a las drogas para administración oral o intravenosa anteriormente utilizadas ya que no se acompaña de recaídas.

Severe juvenile type paracoccidioidomycosis in an adult.

Paracoccidioidomycosis has recently been classified into juvenile (acute) and adult (chronic) forms. The latter affects middle-aged men and causes mucocutaneous lesions, while the more rare juvenile form affects the reticuloendothelial system of children and adults of both sexes under 30 years of age. It is not yet known, however, if the patient's age has a role in determining the immune response patterns to the fungus and the evolution to one form or the other. We present a 45-year-old man who presented with juvenile type disease characterized by intra-abdominal polyadenopathy forming a large epigastric mass. Immune evaluation showed high titres of anti-Paracoccidioides brasiliensis antibodies and an antigen-specific cellular immune defect. Treatment resulted in resolution of the clinical and immune abnormalities. His epidemiological background also suggested acute disease: he developed disease after moving from an urban to a rural endemic area. We suggest that acute or juvenile disease may occur in a previously healthy, susceptible individual when moving to an endemic area, at whatever age.

Paracoccidiodomicosis: coexistencia de lesiones extrapulmonares y patología pulmonar silente. Descripción de 64 pacientes

Se revisaron las historias clínicas y los resutados de los exámenes paramédicos correspondientes a 64 pacientes con paracoccidioidomicosis, que consultaron por lesiones extrapulmonares. A pesar de ello, en el momento de estabreser el diagnóstico, 57 (89 por ciento) presentaban patología pumonar demostrable en la radiografía de tórax y 36 (56.2 por ciento) tenían cultivo de esputos positivos para P. brasiliensis. puestos que estos pacientes no consutaron por síntomas que sugirieron afección respiratoria, los hallazgos anteriores revelan la frecuenciadel compromiso pulmonar silente en esta micosis. Iigualmente, estos datos señalan al pulmón como el órgano de afección primaria.