Paracoccidioidomycosis in Patients Infected with and Not Infected with Human Immunodeficiency Virus: A Case-Control Study

Abstract

Epidemiologic and clinical data for 53 patients with paracoccidioidomycosis and co-infected with human immunodeficiency virus (HIV) (cases) were compared with those for 106 patients with endemic paracoccidioidomycosis (controls). The prevalence of Paracoccidioides brasiliensis co-infection was estimated in 1.4% in cases of acquired immunodeficiency syndrome (AIDS). Patients co-infected with HIV were younger, less involved in agricultural occupations; 83.7% had CD4+ cell count < 200 cells/microL. Paracoccidioidomycosis in co-infected patients usually showed a rapid progression, with more fever, frequent involvement of the lungs, and multiple extrapulmonary lesions. The response to antifungal therapy and deaths caused by paracoccidioidomycosis were similar in the two patient groups, but late relapses were more common in co-infected cases. Paracoccidioidomycosis in HIV-infected patients shows epidemiologic and clinical characteristics differing from those of the endemic disease and should be considered an AIDS-defining opportunistic infection in Latin America.

Serological diagnosis of paracoccidioidomycosis in HIV-coinfected patients

“…Surprisingly, some patients with severe cell immunodeficiency respond with high antibody titres, as observed in the present study and in previous reports (Tobon et al 1998). There may be other causes contributing to a lower level of anti-P. brasiliensis antibodies, such as the more rapid progression of paracoccidioidomycosis in patients infected with HIV (Morejón et al 2009). Moreover, in these patients, fungal disease may be the consequence of reactivation of residual foci of the primary infection that arose in the remote past, a condition in which there may be a reduced stimulus for antibody production.…”

“…105 (7): 904-907, November 2010 In a vast area of South America, paracoccidioidomycosis is the fourth most common systemic fungal infection among patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Opportunistic infection with Paracoccidioides brasiliensis is generally disseminated among patients with a low CD4 cell count, involving the lungs, tegument, lymph nodes, monocyte-macrophage system and other tissues (Silva-Vergara et al 2003, Morejón et al 2009). This clinical picture must be differentiated from other opportunistic infections, particularly those involving mycobacteria and histoplasmosis.…”

AIDS-associated paracoccidioidomycosis in a patient with a CD4+ T-cell count of 4 cells/mm³

“…2,4,6 In the present case, despite the extremely low CD4+ cell count (4 cells/mm 3 ), the patient was able to control pathogen load and to form granulomas. Granuloma formation was supported by epithelial cells, giant cells, plasma cells and CD8+ T cells and the absence of CD4+ T cells, as shown by the immunohistochemical analysis.…”

Pulmonary Paracoccidioidomycosis: Clinical, Immunological and Histopathological Aspects

“…The predominance of adult patients is reflected in higher mortality rates for those within this age group (Bittencourt et al, 2005;Coutinho et al, 2002;Prado et al, 2009;Santo, 2008). Although co-existence of the mycosis with HIV infection is relatively uncommon, 4%-5% according to data in the two largest series of cases published in Brazil (Belissimo- Rodrigues et al, 2011;Morejon et al, 2009), this dual infection has introduced a significant change in age distribution as these patients are younger (mean, 34 years of age) than the PCM non-AIDS cases (mean, 45 years of age).…”