Paracoccidioidomycosis: Eco-Epidemiology, Taxonomy and Clinical and Therapeutic Issues

Abstract

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.

Antifungal and antioxidant activity of fatty acid methyl esters from vegetable oils

“…PCM is a disease limited to Latin America and is a common cause of deaths from fungal diseases. PCM is the eighth most important cause of mortality from chronic infectious diseases reaching rates of 1.65 deaths per 10 6 habitants (Bocca et al 2013, Coutinho et al 2002, Prado et al 2009). There are some drugs available to treat PCM; itraconazole therapy is the first choice to control the mild to moderate clinical forms but this therapy is not easily available in most of the endemic regions.…”

Decreased expression of 14-3-3 inParacoccidioides brasiliensisconfirms its involvement in fungal pathogenesis

“…Infection occurs mainly by inhalation of airborne propagules released by the mycelial form; once in the lungs and in contact with the host body temperature, it transforms to its yeast form, which is responsible for the symptoms and clinical manifestations during disease. 5,6 The development and the course of the microbial infection can be considered a multifactorial process that results from the interaction between the virulence factors of pathogen, leading to the pathogen's establishment in the host and causing disease, and the host's ability to prevent and resist microbial colonization or invasion. [7][8][9][10] The pathogen uses a large repertoire of surface molecules, specifically adhesins, that can bind to the extracellular matrix (ECM) of various cell types in the host, inducing endocytosis in normally non-phagocytic cells (epithelial and endothelial cells) during the invasion process.…”

Paracoccidioidomycosis in a liver transplant recipient

“…Treatment should continue until all cure criteria are achieved. These criteria include the following: symptom resolution, stabilization or regression of radiologic findings, and negative/stabilized immunodiffusion titers (to less than 1:2) 11,13 . In conclusion, paracoccidioidomycosis is extremely rare in organ transplant recipients.…”