Abstract
Paracoccidioidomycosis (PCM) is the most important systemic mycoses in Latin America. We describe a severe case of paracoccidioidomycosis in a 14-year-old boy, with a rapid disease progression. The fungal strain was isolated and inoculated into a T and/or B cell immunocompromised mice, which revealed a highly virulent strain. The case report presented herein emphasizes the importance of considering PCM in the differential diagnosis of patients with other infectious diseases in endemic areas and highlights a novel isolate.
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References
Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: an update. Clin Microbiol Rev. 1993;6:89–117.
Coutinho ZF, Silva Dd, Lazéra M, et al. Paracoccidioidomycosis mortality in Brazil (1980–1995). Cadernos de Saúde Pública. 2002;18:1441–54.
Shikanai-Yasuda MA, Telles-Filho Q, Mendes RP, Colombo AL, Moretti ML. Guidelines in Paracoccidioidomycosis. Revista da Sociedade Brasilieira de Medicina Tropical. 2006;39:297–310.
Teixeira MM, Theodoro RC, de Carvalho MJA, et al. Phylogenetic analysis reveals a high level of speciation in the Paracoccidioides genus. Mol Phylogenet Evol. 2009;52:273–83.
Restrepo-Moreno A. Paracoccidioidomycosis. In: Murphy JW, Friedman H, Bendinelli M, editors. Fungal infections and immune responses. Springer: Berlin; 1993. p. 251–76.
San-Blas G, Niño-Vega G, Iturriaga T. Paracoccidioides brasiliensis and paracoccidioidomycosis: molecular approaches to morphogenesis, diagnosis, epidemiology, taxonomy and genetics. Med Mycol. 2002;40:225–42.
de Castro LF, Ferreira MC, da Silva RM, Blotta MH, Longhi LNA, Mamoni RL. Characterization of the immune response in human paracoccidioidomycosis. J Infect. 2013;67:470–85.
Franco M, Montenegro MR, Mendes RP, Marques SA, Dillon NL, Mota NGS. Paracoccidioidomycosis: a recently proposed classification of its clinical forms. Rev Soc Bras Med Trop. 1987;20:129–32.
Benard G, Hong MA, Del Negro GMB, Batista L, Shikanai-Yasuda MA, Duarte AJS. Antigen-specific immunosuppression in paracoccidioidomycosis. Am J Trop Med Hyg. 1996;54:7–12.
Benard G, Mendes-Giannini MJ, Juvenale M, Miranda ET, Duarte AJS. Immunosuppression in paracoccidioidomycosis: T cell hyporesponsiveness to two Paracoccidioides brasiliensis glycoproteins that elicit strong humoral immune response. J Infect Dis. 1997;175:1263–7.
Calich VLG, Vaz CAC, Burger E. Immunity to Paracoccidioides brasiliensis infection. Res Immunol. 1998;149:407–17.
Cano LE, Kashino SS, Arruda C, et al. Protective role of gamma interferon in experimental pulmonary paracoccidioidomycosis. Infect Immun. 1998;66:800–6.
Souto JT, Figueiredo F, Furlanetto AB, Pfeffer K, Rossi MA, Silva JS. Interferon-g and Tumor Necrosis Factor-a determine resistance to Paracoccidioides brasiliensis infection in mice. Am J Pathol. 2000;156:1811–20.
Benard G, Romano CC, Cacere CR, Juvenale M, Mendes-Giannini MJ, Duarte AJS. Imbalance of IL-2, IFN-gamma and IL-10 secretion in the immunosuppression associated with human paracoccidioidomycosis. Cytokine. 2001;13:248–52.
Oliveira SJ, Mamoni RL, Musatti CC, Papaiordanou PMO, Blotta MHSL. Cytokines and lymphocyte proliferation in juvenile and adult forms of paracoccidioidomycosis: comparison with infected and non-infected controls. Microbes Infect. 2002;4:139–44.
Casadevall A, Pirofski L. Host-pathogen interactions: the attributes of virulence. J Infect Dis. 2001;184:337–44.
Romani L. Cell mediated immunity to fungi: a reassessment. Med Mycol. 2008;46:515–29.
Klebanoff SJ. Oxygen metabolism and the toxic properties of phagocytes. Ann Intern Med. 1980;93:480–9.
Chang C-I, Liao JC, Kuo L. Arginase modulates nitric oxide production in activated macrophages. Am J Physiol. 1998;274:H342–H8.
Morejón KML, Machado AA, Martinez R. Paracoccidioidomycosis in patients infected with and not infected with human immunodeficiency virus: a case–control study. Am J Trop Med Hyg. 2009;80:359–66.
Mocroft A, Furrer HJ, Miro JM, et al. The Incidence of AIDS-defining illnesses at a current CD4 count ≥ 200 cells/µL in the post-combination antiretroviral therapy era. Clin Infect Dis. 2013;57:1038–47.
Rygaard J. Thymus and self: immunobiology of the mouse mutant nude. Wiley: New Jersey; 1975.
Holub M. The nude mouse. ILAR J. 1992;34:1–3.
Robledo MA, Graybill JR, Ahrens J, Restrepo A, Drutz DJ, Robledo M. Host defense against experimental paracoccidioidomycosis. Am Rev Respir Dis. 1982;125:563–7.
Miyaji M, Nishimura K. Granuloma formation and killing functions of granuloma in congenitally athymic nude mice infected with Blastomyces dermatitidis and Paracoccidioides brasiliensis. Mycopathologia. 1983;82:129–41.
Lenzi HL, Calich VL, Miyaji M, Sano A, Nishimura K, Burger E. Fibrosis patterns of lesions developed by athymic and euthymic mice infected with Paracoccidioides brasiliensis. Braz J Med Biol Res. 1994;27:2301–8.
Burger E, Miyaji M, Sano A, Calich VLG, Nishimura K, Lenzi HL. Histopathology of paracoccidioidomycotic infection in athymic and euthymic mice: a sequential study. Am J Trop Med Hyg. 1996;55:235–42.
Mombaerts P, Iacomini J, Johnson RS, Herrup K, Tonegawa S, Papaioannou VE. RAG-1-deficient mice have no mature B and T lymphocytes. Cell. 1992;68:869–77.
Shinkai Y, Rathbun G, Lam K-P, et al. RAG-2-deficient mice lack mature lymphocytes owing to inability to initiate V(D)J rearrangement. Cell. 1992;68:855–67.
Zacharias D, Ueda A, Moscardi-Bacchi M, Franco M, San-Blas G. A comparative histopathological, immunological, and biochemical study of experimental intravenous paracoccidioidomycosis induced in mice by three Paracoccidioides brasiliensis isolates. J Med Vet Mycol. 1986;24:445–54.
Singer-Vermes LM, Burger E, Franco M, Di-Bacchi MM. Mendes Giannini MJS, Calich VLG. Evaluation of the pathogenicity and immunogenicity of seven Paracoccidioides brasiliensis isolates in susceptible inbred mice. J Med Vet Mycol. 1989;27:71–82.
Sardi JdCO, Pitangui NdS, Voltan AR, et al. In vitro Paracoccidioides brasiliensis biofilm and gene expression of adhesins and hydrolytic enzymes. Virulence. 2015;6:642–51.
Hanna SA, Monteiro Da Silva JL, Mendes-Giannini MJ. Adherence and intracellular parasitism of Paracoccidioides brasiliensis in Vero cells. Microbes Infect. 2000;2:877–84.
Mendes-Giannini MJS, Andreotti PF, Vicenzi LR, et al. Binding of extracellular matrix proteins to Paracoccidioides brasiliensis. Microbes Infect. 2006;8:1550–9.
Andreotti PF, Monteiro da Silva JL, Bailão AM, et al. Isolation and partial characterization of a 30 kDa adhesin from Paracoccidioides brasiliensis. Microbes Infect. 2005;7:875–81.
Marcos CM, de Fátima da Silva J, de Oliveira HC, Moraes da Silva RA, Mendes-Giannini MJS, Fusco-Almeida AM. Surface-expressed enolase contributes to the adhesion of Paracoccidioides brasiliensis to host cells 2012.
Barbosa MS, Báo SN, Andreotti PF, et al. Glyceraldehyde-3-phosphate dehydrogenase of Paracoccidioides brasiliensis is a cell surface protein involved in fungal adhesion to extracellular matrix proteins and interaction with cells. Infect Immun. 2006;74:382–9.
Bonfim CV, Mamoni RL, Blotta MHSL. TLR-2, TLR-4 and dectin-1 expression in humans monocytes and neutrophils stimulated by Paracoccidioides brasiliensis. Med Mycol. 2009;47:722–33.
Balderramas HA, Penitenti M, Rodrigues DR, et al. Human neutrophils produce IL-12, IL-10, PGE2 and LTB4 in response to Paracoccidioides brasiliensis. Involvement of TLR2, mannose receptor and dectin-1. Cytokine. 2014;67:36–43.
Tristão FSM, Rocha FA, Moreira AP, Cunha FQ, Rossi MA, Silva JS. 5-lipoxygenase activity increases susceptibility to experimental Paracoccidioides brasiliensis infection. Infect Immun. 2013;81:1256–66.
Michelin MA, Figueiredo F, Cunha FQ. Involvement of prostaglandins in the immunosuppression occurring during experimental infection by Paracoccidioides brasiliensis. Exp Parasitol. 2002;102:170–7.
Soares AMVC, Calvi SA, Peraçoli MTS, Fernandez AC, Diaz LA, Anjos AR. Modulatory effect of prostaglandins on human monocyte activation for killing of high- and low-virulence strains of Paracoccidioides brasiliensis. Immunology. 2001;102:480–5.
Biondo G, Dias-Melicio L, Bordon-Graciani A, Acorci-Valério M, Soares A. Paracoccidioides brasiliensis uses endogenous and exogenous arachidonic acid for PGEx production. Mycopathologia. 2010;170:123–30.
Biondo GA, Dias-Melicio LA, Bordon-Graciani AP, Kurokawa CS, de Campos Soares AMV. Production of leukotriene B4 by Paracoccidioides brasiliensis. Yeast. 2012;29:201–8.
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Ruas, L.P., Pereira, R.M., Braga, F.G. et al. Severe Paracoccidioidomycosis in a 14-Year-Old Boy. Mycopathologia 181, 915–920 (2016). https://doi.org/10.1007/s11046-016-0035-2
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DOI: https://doi.org/10.1007/s11046-016-0035-2