Case of recurrent Paracoccidioidomycosis: 25 years after initial treatment

Araújo, Stanley de Almeida; Prado, Laura de Godoy Rousseff; Veloso, Juliana Márcia; Pedroso, Ênio Roberto Pietra

doi:10.1590/s1413-86702009000500017

Cited by 11 publications

(10 citation statements)

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“…In both cases, patients moved to the urban area of large cities, outside the endemic zones, which suggests that those were real relapses instead of reinfections. 42,43 The unpublished statistics in our service show that 75% of all relapses occur up to 3 years after the initial treatment and are correlated with the sustained alcohol intake abuse, as well as irregular or incomplete treatments.…”

Section: Clinical Presentationmentioning

confidence: 94%

“…42,43 Both were treated with the association of sulfamethoxazole plus trimethoprim (patient a) with added sulphadiazine and ketoconazole (patient b), however dosage or length of treatment were not informed, thus letting the possibility of insufficient or incomplete treatment, the main causes of relapse, unanswered. In both cases, patients moved to the urban area of large cities, outside the endemic zones, which suggests that those were real relapses instead of reinfections.…”

Section: Clinical Presentationmentioning

confidence: 99%

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Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating

Marques¹

2013

An. Bras. Dermatol.

119

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Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by fungi of the genus Paracoccidioides. Due to its frequent tegument clinical expression, paracoccidioidomycosis is an important disease for dermatologists, who must be up-to-date about it. This article focuses on recent epidemiological data and discusses the new insights coming from molecular studies, as well as those related to clinical, diagnostic and therapeutic aspects. In the latter section, we give particular attention to the guideline on paracoccidioidomycosis organized by specialists in this subject.

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Section: Clinical Presentationmentioning

confidence: 94%

Section: Clinical Presentationmentioning

confidence: 99%

Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating

Marques¹

2013

An. Bras. Dermatol.

119

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“…The relapses of acute‐subacute PCM observed in some patients of this cohort are rare, but usually predictable events. Poor adherence to the treatment leads to the survival of quiescent yeasts in the organism that may proliferate as soon as the environment becomes favourable …”

Section: Discussionmentioning

confidence: 99%

“…The explanation for the maintained results is probably related to the pattern of the patient's immune response to the disease, a variable that could not be changed between the two groups. Some laboratorial and in vitro studies have been used to infer the importance of in vivo immune response to PCM, but such an issue certainly requires more studies, including clinical prospective trials, in order to better clarify that information …”

Section: Discussionmentioning

confidence: 99%

Acute‐subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non‐survival predictor

Romaneli

Tardelli

Tresoldi

et al. 2019

Mycoses

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Summary The acute‐subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute‐subacute PCM, to determine a mortality risk factor and to propose a test for non‐survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15 years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P < .05). Through a period of 38 years, 141 children and adolescents were diagnosed with acute‐subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole‐trimethoprim (SMX‐TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut‐off for serum albumin was 2.18 g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute‐subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage ≤ 2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard.

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“…Virulent P. brasiliensis human isolate was obtained from a patient with active PCM, whose case was reported by Araujo and coworkers [25], maintained in YPD agar medium [0.5% yeast extract, 0.5% peptone, 1.5% D-glucose, 1.5% agar, pH 7.0] (Sigma, St. Louis, MO, USA) at 36°C and collected on the seventh day of culture. The viability of fungal suspensions determined by staining with Janus Green B vital dye method [26] (Merck.…”

Section: Methodsmentioning

confidence: 99%

Additive Effect of rPb27 Immunization and Chemotherapy in Experimental Paracoccidioidomycosis

et al. 2011

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Paracoccidioidomycosis, PCM, the major systemic mycosis in Latin America, is caused by the termally dimorphic fungus Paracoccidioides brasiliensis and requires extended periods of chemotherapy with a significant frequency of relapsing disease. The search for new alternatives of treatment is necessary. rPb27 is an antigenic protein from P. brasiliensis that already showed a significant protective activity as a vaccine for PCM in experimental models. The cDNA of rPb27 was subcloned into a pET-DEST 42 plasmid, expressed in E. coli with a his-tag and purified by affinity chromatography. Immunization with this recombinant protein and chemotherapy were used together in an attempt to improve treatment of PCM. For this, BALB/c mice were challenged with pathogenic P. brasiliensis strain and after immunized with rPb27, in the presence of Corynebacterium parvum and Al(OH)3, some groups were also treated with fluconazole. After 40 days of treatment, the combined drug/rPb27 administration controlled PCM in the liver and spleen, with long lasting protection, and largely preserved tissues structures of these organs. Additionally, in the lungs after 40 days of treatment there was a significant reduction in the fungal load and size of lesions. At the same time, the levels of TNF-α were higher than infected-only mice. Moreover, significant levels of anti-rPb27 specific IgG1, IgG2a and IgG2b isotypes were detected in the sera of mice immunized with rPb27 fluconazole treated or not. These results showed an additive protective effect of rPb27 immunization and chemotherapy, suggesting that an rPb27-based vaccine can be used to enhance PCM antifungal treatment.

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Case of recurrent Paracoccidioidomycosis: 25 years after initial treatment

Cited by 11 publications

References 0 publications

Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating

Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating

Acute‐subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non‐survival predictor

Additive Effect of rPb27 Immunization and Chemotherapy in Experimental Paracoccidioidomycosis

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