Serological diagnosis of paracoccidioidomycosis in HIV-coinfected patients

Abstract

Paracoccidioidomycosis should be differentiated from other opportunistic diseases in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients who live in Latin America. Laboratory investigation can begin with serological tests, which are rapid and efficient. In the present study, double immunodiffusion (DID), counterimmunoelectrophoresis (CIEP) and an enzyme linked immunosorbent assay (ELISA) tests were assessed for the detection of anti-Paracoccidioides brasiliensis antibodies in 40 patients coinfected with HIV. The results were compared to those obtained for 75 non-HIV-infected patients with endemic paracoccidioidomycosis. Anti-P. brasiliensis antibodies were detected in 65% (DID), 79% (CIEP) and 95% (ELISA) of the patients with HIV/AIDS, significantly lower rates than those detected in cases of endemic paracoccidioidomycosis, which were 89%, 99% and 100%, respectively. The reactive sera of HIV-infected patients also showed lower anti-P. brasiliensis antibody titres than those of non-HIV-infected patients. Despite the lower intensity of the specific humoral response, serological tests are useful for the diagnosis of opportunistic paracoccidioidomycosis in the HIV/AIDS population. We suggest optimization of the laboratory diagnosis by combining the ELISA test with CIEP or DID

Occurrence of Paracoccidioides lutzii in the Amazon Region: Description of Two Cases

“…Lower levels of antibodies against fungal antigens in PCM have been reported in patients with immune deficiencies such as HIV 23,24 or in patients receiving antifungal therapy. 25,26,27 However, neither of these conditions were noted in our patients.…”

Important aspects of oral paracoccidioidomycosis–a literature review

“…Patients coinfected with P. brasiliensis and HIV show lower titres of specific antibodies when compared to patients with only paracoccidioidomycosis. This finding points out the lower specific humoral response intensity, which can be explained by the B cell dysfunction associated with HIV and possibly by the rapid progression of paracoccidioidomycosis in these cases 54 . Severe immunosuppression with low levels of CD4 favours the establishment of paracoccidioidomycosis, 11,54 which can be the first sign of HIV immunosuppression 11 .…”

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

“…This same department also published data regarding the serologic anti- P.brasiliensis response in patients coinfected with HIV. 15 The authors used 3 methods (double-agar gel immunodiffusion -IDD; counter immunoelectrophoresis - CIEF and ELISA) to study a group of 40 co-infected patients and another of 75 patients diagnosed only with paracoccidioidomycosis. They observed a marked reduction in the detection of anti P.brasiliensis in the co-infection group by all methods: IDD (65% x 89%), CIEF (79% x 99%) and ELISA (95% x 100%).…”

“…Also, the titles obtained were significantly lower than those observed in the non co-infected group. 15 …”