Paracoccidioidomycosis: Current Status and Future Trends

Autor(es)

Hahn, Rosane Christine ; Hagen, Ferry ; Mendes, Rinaldo Poncio ; Burger, Eva ; Nery, Andreia Ferreira ; Siqueira, Nathan Pereira ; Guevara, Armando ; Rodrigues, Anderson Messias ; de Camargo, Zoilo Pires

• Tipo de documento: Artigo Científico
• Fonte: CLINICAL MICROBIOLOGY REVIEWS; v. 35, n. 4, p. 65-pg., 2022-09-08.

Resumo

Paracoccidioidomycosis (PCM), initially reported in 1908 in the city of Sao Paulo, Brazil, by Adolpho Lutz, is primarily a systemic and neglected tropical mycosis that may affect individuals with certain risk factors around Latin America, especially Brazil. Paracoccidioides brasiliensis sensu stricto, a classical thermodimorphic fungus associated with PCM, was long considered to represent a monotypic taxon. However, advances in molecular taxonomy revealed several cryptic species, including Paracoccidioides americana, P. restrepiensis, P. venezuelensis, and P. lutzii, that show a preference for skin and mucous membranes, lymph nodes, and respiratory organs but can also affect many other organs. Paracoccidioidomycosis (PCM), initially reported in 1908 in the city of Sao Paulo, Brazil, by Adolpho Lutz, is primarily a systemic and neglected tropical mycosis that may affect individuals with certain risk factors around Latin America, especially Brazil. Paracoccidioides brasiliensis sensu stricto, a classical thermodimorphic fungus associated with PCM, was long considered to represent a monotypic taxon. However, advances in molecular taxonomy revealed several cryptic species, including Paracoccidioides americana, P. restrepiensis, P. venezuelensis, and P. lutzii, that show a preference for skin and mucous membranes, lymph nodes, and respiratory organs but can also affect many other organs. The classical diagnosis of PCM benefits from direct microscopy culture-based, biochemical, and immunological assays in a general microbiology laboratory practice providing a generic identification of the agents. However, molecular assays should be employed to identify Paracoccidioides isolates to the species level, data that would be complemented by epidemiological investigations. From a clinical perspective, all probable and confirmed cases should be treated. The choice of treatment and its duration must be considered, along with the affected organs, process severity, history of previous treatment failure, possibility of administering oral medication, associated diseases, pregnancy, and patient compliance with the proposed treatment regimen. Nevertheless, even after appropriate treatment, there may be relapses, which generally occur 5 years after the apparent cure following treatment, and also, the mycosis may be confused with other diseases. This review provides a comprehensive and critical overview of the immunopathology, laboratory diagnosis, clinical aspects, and current treatment of PCM, highlighting current issues in the identification, treatment, and patient follow-up in light of recent Paracoccidioides species taxonomic developments. (AU)

• Processo FAPESP: 17/27265-5 - Epidemiologia molecular e perspectivas genômicas na evolução e propagação de patógenos fúngicos emergentes
• Beneficiário: Anderson Messias Rodrigues
• Modalidade de apoio: Auxílio à Pesquisa - Jovens Pesquisadores
• Processo FAPESP: 18/21460-3 - Estudo de diferentes preparações antigênicas de Paracoccidioides lutzii para a padronização do teste de ELISA como auxílio no diagnóstico da paracoccidioidomicose por P. lutzii
• Beneficiário: Zoilo Pires de Camargo
• Modalidade de apoio: Auxílio à Pesquisa - Regular