Immunodiagnosis of Paracoccidioidomycosis due to Paracoccidioides brasiliensis Using a Latex Test: Detection of Specific Antibody Anti-gp43 and Specific Antigen gp43

BackgroundParacoccidioidomycosis (PCM) is a life-threatening systemic disease and is a neglected public health problem in many endemic regions of Latin America. Though several diagnostic methods are available, almost all of them present with some limitations.Method/Principle FindingsA latex immunoassay using sensitized latex particles (SLPs) with gp43 antigen, the immunodominant antigen of Paracoccidioides brasiliensis, or the monoclonal antibody mAb17c (anti-gp43) was evaluated for antibody or antigen detection in sera, cerebrospinal fluid (CSF), and bronchoalveolar lavage (BAL) from patients with PCM due to P. brasiliensis. the gp43-SLPs performed optimally to detect specific antibodies with high levels of sensitivity (98.46%, 95% CI 91.7-100.0), specificity (93.94%, 95% CI 87.3-97.7), and positive (91.4%) and negative (98.9%) predictive values. in addition, we propose the use of mAb17c-SLPs to detect circulating gp43, which would be particularly important in patients with immune deficiencies who fail to produce normal levels of immunoglobulins, achieving good levels of sensitivity (96.92%, 95% CI 89.3-99.6), specificity (88.89%, 95% CI 81.0-94.3), and positive (85.1%) and negative (97.8%) predictive values. Very good agreement between latex tests and double immune diffusion was observed for gp43-SLPs (k = 0.924) and mAb17c-SLPs (k = 0.850), which reinforces the usefulness of our tests for the rapid diagnosis of PCM in less than 10 minutes. Minor cross-reactivity occurred with sera from patients with other fungal infections. We successfully detected antigens and antibodies from CSF and BAL samples. in addition, the latex test was useful for monitoring PCM patients receiving therapy.Conclusions/SignificanceThe high diagnostic accuracy, low cost, reduced assay time, and simplicity of this new latex test offer the potential to be commercialized and makes it an attractive diagnostic assay for use not only in clinics and medical mycology laboratories, but mainly in remote locations with limited laboratory infrastructure and/or minimally trained community health workers.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Dept Microbiol Immunol & Parasitol, Div Cell Biol, São Paulo, BrazilEvandro Chagas Inst, Bacteriol & Mycol Div, Ananindeua, Para, BrazilUniv Fed Alfenas, Inst Biomed Sci, Alfenas, MG, BrazilUniversidade Federal de São Paulo, Dept Microbiol Immunol & Parasitol, Div Cell Biol, São Paulo, BrazilFAPESP: FAPESP 2011/07350-1FAPESP: 2011/01628-8FAPESP: 2009/54181-0FAPESP: 2009/54024-2Web of Scienc

Characteristics of 151 Brazilian Sporothrix schenckii Isolates from 5 Different Geographic Regions of Brazil: A Forgotten and Re-Emergent Pathogen

Abstract: We used RAPD (random amplification of polymorphic DNA) to analyze the phenotypic and genotypic characteristics of Sporothrix schenckii isolated from five geographic regions of Brazil, from clinical, animal, and environmental sources. Our results yielded a significant difference (P<0.01) in the mean conidial area of S. schenckii animal isolates (2.96 ± 1.07) compared with those of clinical isolates (fixed form, 2.33 ± 0.53; lymphocutaneous form, 2.37 ± 0.43). There was no association among S. schenckii clinical isolates and geographic region. Isolates from the Northeast region exhibited the lowest thermotolerance (% growth inhibition) at 35ºC ( x = 49.23% ± 17.25) and at 37ºC (70.43% ± 10.93%). Northern isolates exhibited the highest thermotolerance at 35ºC (12.82% ± 5.73%) and at 37ºC (23.81% ± 8.27%). RAPD with a 10-mer primer OPD-18 generated 67 PCR fingerprint patterns. The 151 S. schenckii isolates fell into seven major clusters with such great genetic diversity that an association of isolates with clinical forms or geographic areas could not be determined, even with investigations focused on more restricted geographic areas. The main physiological characteristics of Brazilian S. schenckii isolates were also characterized, including osmophilia, halophilia, pH tolerance, urease activity, casein hydrolysis, and gelatinase, proteinase, and DNAase production

O impacto da ultrassonografia no atendimento multidisciplinar na UTI

Introduction: The introduction of ultrasound in the Intensive Care Unit (ICU) represents a significant milestone, fostering substantial advancements in multidisciplinary practice and positively influencing the management of various critical conditions. The application of pulmonary ultrasound, in particular, emerges as a versatile and essential tool, directly impacting the quality of care provided. Methodology: A bibliographic search was conducted on the PUBMED platform, utilizing specific Mesh descriptors: Ultrasonography, Intensive Care Units, Patient Care Team. The search period spanned from 2013 to 2021, encompassing a total of 33 articles. Results: The application of ultrasound in the ICU has proven to be an extremely relevant tool for multidisciplinary care. Pulmonary ultrasound, when employed by intensivists, not only provides a precise assessment of the mentioned conditions but also plays a fundamental role in rapid decision-making and treatment optimization. Conclusion: Ultrasound emerges as a transformative tool in the ICU, shaping multidisciplinary practice and ushering in an era of more advanced and patient-centered intensive care. Its crucial role in swift decision-making and treatment optimization reinforces its position as an indispensable element in the toolkit of healthcare professionals in both the present and future ICU settings.Introdução: A introdução da ultrassonografia na Unidade de Terapia Intensiva (UTI) representa um marco significativo, promovendo avanços substanciais na prática multidisciplinar e influenciando positivamente o manejo de diversas condições críticas. A aplicação da ultrassonografia pulmonar, em particular, surge como uma ferramenta versátil e essencial, impactando diretamente a qualidade do atendimento prestado. Metodologia: A pesquisa bibliográfica foi conduzida na plataforma PUBMED, utilizando descritores Mesh específicos: Ultrasonography, Intensive Care Units, Patient Care Team. O período de busca abrangeu os anos de 2013 a 2021, totalizando 33 artigos. Resultado: Aplicação da ultrassonografia na UTI tem se mostrado uma ferramenta de extrema relevância para o atendimento multidisciplinar. A ultrassonografia pulmonar, quando utilizada pelos intensivistas, não apenas oferece uma avaliação precisa das condições mencionadas, mas também desempenha um papel fundamental na rápida tomada de decisões e na otimização do tratamento. Conclusão: A ultrassonografia emerge como uma ferramenta transformadora na UTI, moldando a prática multidisciplinar e promovendo uma era de cuidados intensivos mais avançados e centrados no paciente. Seu papel crucial na rápida tomada de decisões e na otimização do tratamento reforça sua posição como um elemento indispensável na caixa de ferramentas dos profissionais de saúde nas UTIs do presente e do futuro