Paracoccidiodomicosis oral en mujer inmunocompetente: a propósito de un caso y revisión de la literatura / Oral paracoccidiodomycosis in an immunocompetent woman: a case report and literature review

La paracoccidioidomicosis es una enfermedad crónica, sistémica y progresiva, identificada como la segunda micosis más común en Suramérica. Aproximadamente 10millones de habitantes latinoamericanos están infectados. Se encuentra con mayor frecuencia el compromiso pulmonar en hombres adultos agricultores. La paracoccidioidomicosis oral es la segunda forma más frecuente de evolución crónica. Presentamos el caso atípico de una paciente de mediana edad, inmunocompetente, con compromiso de la mucosa oral por infección con paracoccidio y una revisión breve acerca de la infección por paracoccidio en la cavidad oral.(AU)

Paracoccidioidomycosis is a progressive, chronic, systemic disease which is the second most common form of mycosis in South America, affecting approximately 10million people in this region. It occurs most commonly in adult male farmers and mainly affects the lungs. Oral paracoccidioidomycosis is the second most frequent chronic presentation. We report the case of an immunocompetent female patient whose oral mucosae was infected with paracoccidium and discuss oral paracoccidium.(AU)

Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 associated with acquired immunodeficiency syndrome: A case report / Paracoccidioidomicosis por Paracoccidioides brasiliensis S1 asociado al síndrome de inmunodeficiencia adquirida: A propósito de un caso

BACKGROUND: Paracoccidioidomycosis (PCM) is an endemic disease in Latin America. In immunocompetent hosts, PCM occurs in two main clinical forms: acute and chronic. However, in HIV-infected patients PCM may show up simultaneous manifestations of acute and chronic forms. CASE REPORT: We present the case of a patient diagnosed with HIV who had disseminated skin lesions and generalized lymphadenopathy, as well as respiratory and central nervous system involvement. The PCM diagnosis was confirmed by direct KOH examination, double immunodiffusion and the isolation of the fungus in samples of an abscess in the subcostal region. The isolate was identified as Paracoccidioides brasiliensis S1 by species-specific PCR using primers for protein-coding gene GP43 (exon 2) followed by PCR-RFLP of the alpha-tubulin gene. CONCLUSIONS: There are few data in literature reporting species-specific molecular identification of Paracoccidioides in HIV/PCM patients. Therefore, this case report may contribute to improve the knowledge about this severe disease, its causative cryptic species, and its consequences to patients

ANTECEDENTES: La paracoccidioidomicosis (PCM) es una enfermedad endémica en Latinoamérica. En los pacientes inmunocompetentes, la PCM cursa con dos principales formas: aguda y crónica. Sin embargo, los pacientes infectados por el VIH pueden presentar manifestaciones simultáneas de las dos formas clínicas. CASO CLÍNICO: Se presenta el caso de un paciente VIH-positivo, con lesiones cutáneas diseminadas, linfadenopatía generalizada y afectación del sistema nervioso central y respiratorio. El diagnóstico de PCM se confirmó mediante un examen directo con KOH, doble inmunodifusión y el aislamiento del hongo en cultivo, a partir de muestras de un absceso en la región subcostal. La cepa aislada se identificó como Paracoccidioides brasiliensis S1 mediante PCR especie-específica del gen codificador de la proteína GP43 (exón 2), seguida de PCR-RFLP del gen de la alfa-tubulina. CONCLUSIONES: Existen pocos datos en la literatura que describan la identificación molecular especie-específica de Paracoccidioides en pacientes con VIH/PCM. Por lo tanto, la presentación de este caso clínico puede contribuir a mejorar el conocimiento sobre esta enfermedad grave, la especie críptica implicada y sus consecuencias para los pacientes

Unraveling the susceptibility of paracoccidioidomycosis: Insights towards the pathogen-immune interplay and immunogenetics.

Paracoccidioidomycosis (PCM) is a life-threatening systemic mycosis caused by Paracoccidioides spp. This disease comprises three clinical forms: symptomatic acute and chronic forms (PCM disease) and PCM infection, a latent form without clinical symptoms. PCM disease differs markedly according to severity, clinical manifestations, and host immune response. Fungal virulence factors and adhesion molecules are determinants for entry, latency, immune escape and invasion, and dissemination in the host. Neutrophils and macrophages play a paramount role in first-line defense against the fungus through the recognition of antigens by pattern recognition receptors (PRRs), activating their microbicidal machinery. Furthermore, the clinical outcome of the PCM is strongly associated with the variability of cytokines and immunoglobulins produced by T and B cells. While the mechanisms that mediate susceptibility or resistance to infection are dictated by the immune system, some genetic factors may alter gene expression and its final products and, hence, modulate how the organism responds to infection and injury. This review outlines the main findings relative to this topic, addressing the complexity of the immune response triggered by Paracoccidioides spp. infection from preclinical investigations to studies in humans. Here, we focus on mechanisms of fungal pathogenesis, the patterns of innate and adaptive immunity, and the genetic and molecular basis related to immune response and susceptibility to the development of the PCM and its clinical forms. Immunogenetic features such as HLA system, cytokines/cytokines receptors genes and other immune-related genes, and miRNAs are likewise discussed. Finally, we point out the occurrence of PCM in patients with primary immunodeficiencies and call attention to the research gaps and challenges faced by the PCM field.

Paracoccidioidomycosis in a child: exuberant presentation due to the inadvertent use of systemic corticosteroids.

Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.

Paracoccidioidomycosis in a child: exuberant presentation due to the inadvertent use of systemic corticosteroids

Abstract: Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.

Neuroparacoccidioidomicosis: para tener presente / Neuroparacoccidiodomycosis to keep in mind:

La paracoccidioidomicosis (PCM) es una micosis endémica de zonas tropicales y subtropicales, con mayor prevalencia en América Latina, producida por especies del género Para-coccidioides. Es una micosis profunda sistémica que en su forma crónica afecta principalmente a varones adultos. La afectación del sistema nervioso central (SNC) está descrita en un 10-27%. Nosotros presentamos dos casos con mani-festación neurológica al ingreso

Paracoccidioidomycosis (PCM) is an endemic mycosis, from tropical and subtropical zones, with a higher prevalence in Latin America, produced by species of the genus Paracoccidioides. It is a deep chronic systemic my-cosis, which mainly affects adult males. The involvement of the central nervous system (CNS) is described in 10-27%. We present two cases with neurological manifestation upon admission.

Manifestaciones orales de Paracoccidioidomicosis: informe de un caso / Oral manifestations of Paracoccidioidomycosis: report of a case

Objetivo: un caso clínico de paracoccidioidomicosis restringida a cavidad oral, contribuyendo con el conocimiento de esta patología al odontólogo general. Caso clínico: paciente masculino de 57 años de edad proveniente de la ciudad de Tartagal, Salta, derivado a la Unidad de Estomatología del Hospital Señor del Milagro, por presentar lesiones orales de tres meses de evolución. Clínicamente se observaron lesiones granulomatosas, indoloras, moriformes, en encía vestibulary palatina del sector antero superior derecho con ausencia de lesiones pulmonares. Se realizaron estudios microbiológicos y anatomopatológicos. Posteriormente, el paciente fue derivado al Servicio de infectología, donde recibió tratamiento con itraconasol (200 mg), con repuesta clínica favorable. Conclusión: el conocimiento de las manifestaciones orales puede llevar al diagnóstico clínico de la paracoccidioidomicosis por parte del odontólogo. El diagnóstico precoz es la mejor manera de salvar al paciente de las complicaciones de esta enfermedad.

Objective: a clinical case of paracoccidioidomicosis restricted to oral cavity, contributing to the knowledge of this disease to the general dentist. Case report: male patient of 57 years old from Tartagal, Salta referred to the Stomatology Center of Hospital Señor Del Milagro, presenting oral lesions with an evolution of three months. He had painless granulomatory lesions in the buccal and palatal gingiva of the upper right sector and without lungs injury. It performed microbiological and pathological studies. Subsequently, the patient referred to the Service of Infectious Diseases where he was treated with 200mg Itraconasol with a favorable clinical response. Conclusion: knowledge of oral manifestations can lead to clinical diagnosis of paracoccidioidomicosis by general dentist. Early diagnosis is the best way to save the patient from complications of this disease.

Paracoccidioides brasiliensis-associated dermatitis and lymphadenitis in a dog.

Paracoccidioidomycosis (PCM) is an endemic disease of humans from Latin America that is caused by Paracoccidioides brasiliensis and P. lutzii, with most cases of PCM in domestic animals being associated with P. brasiliensis. This study presents the clinical, cytological, mycological, serological, and molecular findings associated with P. brasiliensis in a dog from Southern Brazil. Fine needle biopsies were collected from the skin and several lymph nodes of a 5-year-old female Labrador dog that had enlargement of most superficial lymph nodes. Cytology of the skin and lymph nodes revealed pyogranulomatous dermatitis and lymphadenitis associated with fine-necked, budding fungal structures consistent with the Paracoccidioides genus of organisms; mycological culture derived from the lymph node aspirate demonstrated similar budding structures. Serological assays using exoantigens obtained from the fungal culture demonstrated that the fungal organisms derived from the lymph node were antigenically similar to P. brasiliensis by immunodiffusion and Western blot. A PCR assay, using the fungal culture as input, amplified a partial segment of the internal transcribed spacer 1 and 2 regions of P. brasiliensis; direct sequencing and phylogenetic analyses confirmed the PCR product as P. brasiliensis. The combined cytological, mycological, serological, and molecular findings confirmed a diagnosis of fungal dermatitis and lymphadenitis due to P. brasiliensis in this dog. This case represents the third description of clinical PCM in dogs and the first confirmation of mycotic dermatitis associated with P. brasiliensis in this species. The participation of dogs in the possible dissemination of PCM is reviewed, and it is proposed that dogs are probable accidental hosts in the epidemiological cycle associated with P. brasiliensis.

Paracoccidiodomicosis cutánea. Comunicación de un caso / Cutaneous paracoccidioidomycosis. Case report

La paracoccidioidomicosis es una micosis profunda, causada por el Paracoccidioides brasiliensis, hongo dimórfico que se localiza en el suelo de áreas endémicas. Se caracteriza por presentar lesiones cutáneomucosas y fundamentalmente de las vías respiratorias. El diagnóstico se realiza por examen directo, cultivo y la histopatología. El tratamiento de elección es el itraconazol. Se comunica el caso de un paciente de sexo masculino, de 43 años de edad, con diagnóstico de paracoccidiodomicosis cutánea crónica del adulto que tuvo buena respuesta al tratamiento con itraconazol (AU)

Paracoccidioidomycosis is a deep mycosis caused by Paracoccidioides brasiliensis, a dimorphic fungus located on the soil of endemic areas. It is characterized by skin lesions and mainly by the respiratory tract. Diagnosis is made by direct examination, culture and histopathology. Chosen treatment is itraconazole. A 43-year-old male patient with adult chronic cutaneous paracoccidiodomycosis diagnosis and good response to treatment with itraconazole is reported (AU)

Lipoxin Inhibits Fungal Uptake by Macrophages and Reduces the Severity of Acute Pulmonary Infection Caused by Paracoccidioides brasiliensis.

Cysteinyl leukotrienes (CysLTs) and lipoxins (LXs) are lipid mediators that control inflammation, with the former inducing and the latter inhibiting this process. Because the role played by these mediators in paracoccidioidomycosis was not investigated, we aimed to characterize the role of CysLT in the pulmonary infection developed by resistant (A/J) and susceptible (B10.A) mice. 48 h after infection, elevated levels of pulmonary LTC4 and LXA4 were produced by both mouse strains, but higher levels were found in the lungs of susceptible mice. Blocking the CysLTs receptor by MTL reduced fungal loads in B10.A, but not in A/J mice. In susceptible mice, MLT treatment led to reduced influx of PMN leukocytes, increased recruitment of monocytes, predominant synthesis of anti-inflammatory cytokines, and augmented expression of 5- and 15-lipoxygenase mRNA, suggesting a prevalent LXA4 activity. In agreement, MTL-treated macrophages showed reduced fungal burdens associated with decreased ingestion of fungal cells. Furthermore, the addition of exogenous LX reduced, and the specific blockade of the LX receptor increased the fungal loads of B10.A macrophages. This study showed for the first time that inhibition of CysLTs signaling results in less severe pulmonary paracoccidioidomycosis that occurs in parallel with elevated LX activity and reduced infection of macrophages.

Paracoccidioidomicose (doença de Lutz-Splendore-Almeida): etiologia, epidemiologia e patogênese / Paracoccidioidomycosis disease (Lutz-Splendore-Almeida): etiology, epidemiology, and pathogenesis

A paracoccidioidomicose (PCM) é uma micose granulomatosa sistêmica, polimórfica, determinada pelos Paracoccidioides brasiliensis e P. lutzii e constitui-se em uma das 10 causas de morbimortalidade entre as doenças endêmicas parasitárias no Brasil. A atualização do conhecimento sobre sua etiologia, epidemiologia e patogênese constitui estímulo para que seja incluída no espectro do diagnóstico diferencial da prática médicarotineira, reconhecida com precocidade e tratada convenientemente, evitando-se que evolua com sequelas e morte.

Paracoccidioidomycosis (PCM) is a polymorphic systemic granulomatous mycosis determined by Paracoccidioides brasiliensis and P. lutzii and constitutes one of the 10 leading causes of morbidity and mortality by the parasitic diseases endemic in Brazil. The need for updates on the etiology, epidemiology, and pathogenesis is a for routinely including this disease in the differential diagnosis of current medical practice, recognizing it early and treating it properly, so as to avoid progression with sequelae and death.

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.

Paracoccidioidal infection in HIV patients at an endemic area of paracoccidioidomycosis in Brazil.

The association between paracoccidioidomycosis (PCM) and AIDS is relatively rare in contrast to the higher incidence of other systemic mycosis. The explanation may be that AIDS is still predominantly an urban disease, and the PCM is endemic in Latin American rural areas. The aim of this study was to detect the prevalence of Paracoccidioides brasiliensis infection in HIV-positive patients at an endemic area of paracoccidioidomycosis in Brazil. Skin test with purified 43 kD glycoprotein (gp43) was performed in 90 HIV/AIDS patients. The prevalence found was 12.2% and it may be even greater, considering that HIV/AIDS patients may not respond to the intradermal test, which depends on cellular immunity for its positivity.

Análise das alterações radiográficas pulmonares durante a terapêutica da paracoccidioidomicose / Review of lung radiographic findings during treatment of patients with chronic paracoccidioidomycosis

OBJETIVO: Foram analisadas as alterações radiográficas pulmonares em pacientes com paracoccidioidomicose crônica de modo evolutivo, verificando-se as diferenças entre os tratados com um novo agente antifúngico triazólico, o voriconazol, em relação aos que utilizaram a atual droga de escolha para o tratamento, o itraconazol. MATERIAIS E MÉTODOS: Realizou-se estudo comparativo, randomizado, com avaliação das radiografias do tórax obtidas antes, durante e após o tratamento de 39 pacientes, divididos em dois grupos: um recebendo o voriconazol e o outro, itraconazol. A avaliação das radiografias teve como parâmetro uma adaptação do método já estabelecido para a análise de outra doença pulmonar difusa, o esquema ILO (International Labour Office) de classificação das pneumoconioses, classificando-se as lesões em pequenas ou grandes opacidades. RESULTADOS: Os resultados obtidos coincidiram com as descrições prévias existentes em relação à apresentação das alterações radiográficas pulmonares, e a evolução destas ao longo do tratamento foi semelhante nos dois grupos. As pequenas opacidades regrediram parcialmente, ao passo que as grandes opacidades mostraram tendência à regressão completa. CONCLUSÃO: O uso da adaptação do modelo ILO de classificação das pneumoconioses revelou-se útil para o acompanhamento dos pacientes com paracoccidioidomicose crônica ao longo do tratamento, do ponto de vista radiográfico.

OBJECTIVE: Lung radiographic findings were reviewed to evaluate the differences in the progression of findings along the follow-up of patients with chronic paracoccidioidomycosis treated with a novel second-generation triazole antifungal agent (voriconazole) as compared with patients treated with the drug of choice for treatment of such disease (itraconazole). MATERIALS AND METHODS: A comparative, randomized study involved the review of chest radiographic images acquired before, during and after treatment of 39 patients divided into two groups: one receiving voriconazole and the other receiving itraconazole. The parameters adopted to describe and to measure lesions present on the radiographic images were based on an adaptation of the method used in cases of another diffuse pulmonary disease, the ILO (International Labour Office) classification of pneumoconioses, dividing the lesions into small and large opacities. RESULTS: The results coincided with previous descriptions regarding lung radiographic findings, and the progression of such findings along the treatment was similar for both groups. Partial regression was observed in the small opacities while large opacities showed a tendency towards complete regression. CONCLUSION: The adapted ILO classification demonstrated to be useful in the radiographic follow-up along treatment of patients with chronic paracoccidioidomycosis.

Manifestaciín bucal de paracoccidioidomicosis asociada a aspergilosis: presentación de caso / Manifestaciín oral paracoccidioidomycosis associated with aspergillosis: a case report

Paracoccidioidomicosis y Aspergilosis son micosis causadas respectivamente por los hongos Paracoccidioides brasiliensis y Aspergillus fumigatus, que afectan con mayor frecuencia los pulmones y posteriormente se propagan para otras regiones del cuerpo. La asociación de estas dos micosis en pacientes que no presentaban inmunosupresión es poco común. Descripción de caso clínico resaltadas: Paciente de sexo masculino de 49 años, presentó lesión en el paladar, orofaringe y región retromolar. Los exámenes histológicos, citopatológicos y microbiológicos confirmaron el diagnóstico de paracoccidioidomicosis asociada a aspergilosis. Históricamente los hongos se han considerado como la causa de infecciones de relativa significancia; sin embargo, en los últimos años se ha visto un aumento importante de las enfermedades que causan. El reconocimiento del agente etiológico en cultivos es importante para poder implementar el tratamiento adecuado, ya que éstos pueden producir daños irreversibles o llevar a la muerte del paciente. El objetivo de este trabajo fue mostrar por medio del caso clínico de un paciente que presentaba las dos mucosis asociadas em mucosa bucal y orofaringe la necesidad de exámenes complementares para el diagnóstico de las enfermedades bucales cuando los exámenes de laboratorio de rutina indican la presencia de enfermedades asociadas

Paracoccidioidomycosis and aspergillosis are, respectively, mycosis caused by Paracoccidioides brasiliensis and Aspergillus fumigatus fungi, which, most frequently, attack the lungs and later spread to other body regions. The association between both mycosis is rare in patients that do not present immunosuppression. A 49-year-old man presented with oral lesion, besides lesions on palatum, retromolar and oropharyngeal regions. Histopathological and microbiological exams confirmed the diagnosis of paracoccidioidomycosis associated to aspergillosis. Historically, fungi have been considered as the cause of relatively important infections, but, in the last years, a significant increase of diseases caused by fungi is evidenced. The recognition of the etiological agent in culture is important for the suitable treatment, once these fungi can cause irreversible damages or even death. The purpose of this study was to demonstrate, through the case of a patient who presented both mycosis associated, the need of complementary exams for the diagnosis of oral diseases, when routine laboratorial exams indicate the presence of another disease associated

Diagnóstico diferencial da paracoccidioidomicose com a doença periodontal em regiões endêmicas: relato de caso / Differential diagnosis of paracoccidioidomycosis and periodontal disease in endemic regions: case report

A Paracoccidioidomicose é uma infecção fúngica causada pelo Paracoccidioides brasilienses, muito comum na população latino-americana. A via inalatória, atualmente, é considerada a principal porta de entrada da infecção, podendo ocorrer disseminação linfática ou hematogênica para diferentes regiões do organismo, inclusive a cavidade bucal. Desta forma, é importante que o cirurgião-dentista esteja familiarizado com o mecanismo de contágio, com os exames diagnósticos e com o tratamento adequado aos pacientes. O objetivo deste trabalho é apresentar um caso clínico de Paracoccidioidomicose com manifestação clínica bucal passível de ser confundida com Doença Periodontal, no intuito de auxiliar os cirurgiões-dentistas a procederem ao correto diagnóstico e encaminhamento para tratamento dessa doença.

Paracoccidioidomycosis is a fungi infection caused by Paracoccidioides brasilienses, much common in Latin American population. Inhalatory way is considered, nowadays, the principal entrance door of the infection, with possible lymphatic or blood dissemination to different parts of body, even the oral cavity. Thus, it is important for the clinician the knowledge about contamination ways, diagnosis exams and the adequate treatment for patients. The aim of this work is to present a clinical case of Paracoccidioidomycosis with clinical oral manifestation that can be confounded with periodontal disease, intending to help clinician to accomplish the correct diagnosis forward to the treatment of this illness.

Paracoccidioides brasiliensis enolase is a surface protein that binds plasminogen and mediates interaction of yeast forms with host cells.

Paracoccidioidomycosis (PCM), caused by the dimorphic fungus Paracoccidioides brasiliensis, is a disseminated, systemic disorder that involves the lungs and other organs. The ability of the pathogen to interact with host components, including extracellular matrix (ECM) proteins, is essential to further colonization, invasion, and growth. Previously, enolase (EC 4.2.1.11) was characterized as a fibronectin binding protein in P. brasiliensis. Interaction of surface-bound enolase with plasminogen has been incriminated in tissue invasion for pathogenesis in several pathogens. In this paper, enolase was expressed in Escherichia coli as a recombinant glutathione S-transferase (GST) fusion protein (recombinant P. brasiliensis enolase [rPbEno]). The P. brasiliensis native enolase (PbEno) was detected at the fungus surface and cytoplasm by immunofluorescence with an anti-rPbEno antibody. Immobilized purified rPbEno bound plasminogen in a specific, concentration-dependent fashion. Both native enolase and rPbEno activated conversion of plasminogen to plasmin through tissue plasminogen activator. The association between PbEno and plasminogen was lysine dependent. In competition experiments, purified rPbEno, in its soluble form, inhibited plasminogen binding to fixed P. brasiliensis, suggesting that this interaction required surface-localized PbEno. Plasminogen-coated P. brasiliensis yeast cells were capable of degrading purified fibronectin, providing in vitro evidence for the generation of active plasmin on the fungus surface. Exposure of epithelial cells and phagocytes to enolase was associated with an increased expression of surface sites of adhesion. In fact, the association of P. brasiliensis with epithelial cells and phagocytes was increased in the presence of rPbEno. The expression of PbEno was upregulated in yeast cells derived from mouse-infected tissues. These data indicate that surface-associated PbEno may contribute to the pathogenesis of P. brasiliensis.

Paracoccidioidomicose: histórico, etiologia, epidemiologia, patogênese, formas clínicas, diagnóstico laboratorial e antígenos / Paracoccidioidomycosis: historical, etiologic agent, epidemiology, pathogenesis, clinical forms, laboratory diagnosis and antigens

No centésimo aniversário da publicação do primeiro caso de paracoccidioidomicose, são apresentadas informações relacionadas ao histórico, agente etiológico, epidemiologia, patogênese, formas clínicas, diagnóstico laboratorial e antígenos. Apesar do expressivo avanço em diversas áreas do conhecimento, a micose descrita por Adolpho Lutz em 1908 ainda demonstra altas taxas de mortalidade e letalidade e baixa visibilidade, configurando-se como oitava causa de mortalidade por doença predominantemente crônica ou repetitiva entre as infecciosas e parasitárias, e a maior taxa de mortalidade entre as micoses sistêmicas.