Acquired by inhalation of the thermal dimorphic fungi Paracoccidioides spp. conidia, paracoccidioidomycosis ranges from symptomatic to severe and potentially fatal disseminated disease. The main focus of this review is to highlight clinical aspects of paracoccidioidomycosis and, its pathogens' diversity ecology and particularities. In addition, we present strategies for therapy, including DNA vaccines and nanostructured drugs. Molecular and morphological data supported the split of the Paracoccidioides genus into two species, Paracoccidioides brasiliensis and Paracoccidioides lutzii. An acute form of the disease affects approximately 5% of cases and involves the phagocytic mononuclear system, resulting in progressive lymphadenopathy. The chronic form affects adult men and frequently involves lungs, skin and mucous membranes, lymph nodes, and adrenal glands. The clinical manifestations depend on the ability of the host to control the fungal multiplication and dissemination. The long survival time of the fungus in the host tissues allows it to evade immune responses; therefore, successful treatment often requires long-time therapy. The consensus for treatment must consider the severity of the disease and includes sulfone derivatives, amphotericin B and azoles. Novel strategies for therapy, based on DNA vaccines and nanostructured drugs are also presented and discussed in this review.

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The increase in solid organ transplantations may soon create a rise in the occurrence of endemic fungal diseases, such as paracoccidioidomycosis, due to the lack of rigorous screening of donors from endemic areas. Here we present the first case of an immunocompetent and asymptomatic kidney donor who had Paracoccidioides brasiliensis infected-adrenal tissue but no glandular dysfunction.

Cellular immune responses are a significant defence mechanism in human paracoccidioidomycosis (PCM), an endemic mycosis in Latin America; however, little is known about the role of dendritic cells (DCs) in human PCM. We investigated monocyte‐derived DCs from patients with treated (TP) and active PCM (AP) compared with healthy non‐PCM donors (CO). DCs from the TP group showed higher expression of HLA‐DR, CD86 and DC‐SIGN compared with CO, whereas AP showed similar expression to CO. Production of IL‐10 was downregulated by TNF‐α in all groups and lower levels were observed in untreated DCs from AP compared with CO. Conversely, IL‐12p40 was significantly upregulated in the DCs of the TP group. TNF‐α‐activated DCs from the CO group produced significantly lower levels of IL‐12p40 when differentiated from magnetic‐sorted monocytes (MACS) compared with adhered monocyte‐derived DCs. This comparison in the TP group revealed similar levels of IL‐12p40, suggesting a T cell–independent increase in the production of IL‐12p40. Higher expression of surface molecules with increased IL‐12p40 may indicate a better activation of DCs after the treatment of PCM. Our findings suggest that DCs may be crucial in the protective response to Paracoccidioides brasiliensis and that in vitro‐generated DCs might be useful in enhancing antifungal immunity, especially during active PCM.