Consenso em paracoccidioidomicose Guideliness in paracoccidioidomycosis

Universidade de São Paulo Faculdade de Medicina Departamento de Moléstias Infecciosas e ParasitáriasUniversidade Federal do Paraná Departamento de Saúde ComunitáriaUniversidade Estadual de São Paulo Faculdade de Medicina Botucatu Departamento de Doenças Tropicais e Diagnóstico por ImagemEscola Paulista de Medicina Departamento de MedicinaUniversidade Estadual de Campinas Faculdade Ciências Médicas Departamento de Clínica MédicaUNIFESP, EPM, Depto. de MedicinaSciEL

Paracoccidioides brasiliensis isolated from armadillos is virulent to Syrian hamsters

Isolates of Paracoccidioides brasiliensis may vary in virulence according to time of in vitro subcultivation. The present study compared the morphology and pathogenicity to hamsters of two P. brasiliensis isolates: one obtained from human lesions and maintained in the laboratory for several years (Pb-18) and the other isolate recovered from hamsters inoculated with organ homogenates from armadillos (Pb-T). The microscopic morphology of Pb-18 and Pb-T showed yeast cells with similar diameter. However, Pb-T produced a significantly higher number of buds per mother cell than Pb-18. Besides, the mycelial form of Pb-T developed abundant sporulation during 8 weeks of culture which was absent in the Pb-18 isolate. Virulence studies demonstrated that mortality rates, antibody levels, fungal load and extent of lesions in the organs were significantly higher in animals infected with Pb-T. The results demonstrated that Pb-T recently isolated from an animal was more virulent than Pb-18. These differences between the two P. brasillensis isolates may be indicators of virulence attenuation in this fungal species

Antibody Titer Prediction from Serum Immunodiffusion Test of Patients with Paracoccidioidomycosis Using Infrared Spectroscopy and Chemometrics

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by fungi of the genus Paracoccidioides. Serological tests are auxiliary in the diagnosis of PCM. However, the lack of standardization is a central problem in serodiagnosis and antibody titration. The objective of this study was to propose a methodology based on Fourier transform infrared spectroscopy (FTIR) for predicting antibody titers in patients with PCM. A total of 118 serum samples from patients with PCM were included, for which antibody titration using double immunodiffusion (DID) was previously performed. Serum samples were analyzed by attenuated total reflection (ATR)-FTIR and a supervised analysis with partial least squares regression (PLS) was used to predict the antibody titers. The PLS model with two latent variables and with the use of one orthogonal signal correction (OSC) showed a determination coefficient (R2) higher than 0.9999 for both the calibration and prediction set. The model was able to predict the antibody titers from patients with PCM with a minimal error. Therefore, modeling with FTIR/ATR and multivariate calibration proved to be a fast and highly accurate method for antibody titration, replacing the need for antigen production and performance of traditional serological tests

Rapid Classification of Serum from Patients with Paracoccidioidomycosis Using Infrared Spectroscopy, Univariate Statistics, and Linear Discriminant Analysis (LDA)

Paracoccidioidomycosis (PCM) is a systemic mycosis that is diagnosed by visualizing the fungus in clinical samples or by other methods, like serological techniques. However, all PCM diagnostic methods have limitations. The aim of this study was to develop a diagnostic tool for PCM based on Fourier transform infrared (FTIR) spectroscopy. A total of 224 serum samples were included: 132 from PCM patients and 92 constituting the control group (50 from healthy blood donors and 42 from patients with other systemic mycoses). Samples were analyzed by attenuated total reflection (ATR) and a t-test was performed to find differences in the spectra of the two groups. The wavenumbers that had p p value was used for variable selection through principal component analysis (PCA). The selected variables were used in a linear discriminant analysis (LDA). In univariate analysis, the ROC curves with the best performance were obtained in the region 1551–1095 cm−1. The wavenumber that had the highest AUC value was 1264 cm−1, achieving a sensitivity of 97.73%, specificity of 76.01%, and accuracy of 94.22%. The total separation of groups was obtained in the PCA performed with a spectral range of 1551–1095 cm−1. LDA performed with the eight wavenumbers with the greatest weight from the group discrimination in the PCA obtained 100% accuracy. The methodology proposed here is simple, fast, and highly accurate, proving its potential to be applied in the diagnosis of PCM. The proposed method is more accurate than the currently known diagnostic methods, which is particularly relevant for a neglected tropical mycosis such as paracoccidioidomycosis

DECREASING PREVALENCE OF THE ACUTE/SUBACUTE CLINICAL FORM OF PARACOCCIDIOIDOMYCOSIS IN MATO GROSSO DO SUL STATE, BRAZIL

Com o objetivo de avaliar o comportamento da paracoccidioidomicose nas últimas três décadas, dados clínicos e epidemiológicos de 595 pacientes atendidos dentre 1980 a 2009 no Hospital da Universidade Federal de Mato Grosso do Sul foram estudados. Sexo, faixa etária, forma clínica, associação com tuberculose ou AIDS e mortalidade foram comparados por década em que a doença foi diagnosticada. Observou-se, nas três décadas do estudo, uma redução do percentual de mulheres, de pacientes do grupo de 20 a 39 anos, assim como de casos com a forma aguda/subaguda. Estas alterações estão intimamente relacionadas e podem ser analisadas simultaneamente. Houve aumento de casos de coinfecção com AIDS da primeira para segunda década, coincidindo com o surgimento da epidemia, e manteve-se estável durante a década seguinte. Não houve alteração da taxa de coinfecção com tuberculose, que no geral foi de 6,9% o que reforça a importância desta comorbidade. A taxa geral de mortalidade foi de 6,7% e também não variou entre as décadas estudadas. A manutenção da taxa de óbitos chama a atenção para a relevância dessa doença negligenciada.With the objective to evaluate the behavior of paracoccidioidomycosis in the last three decades, clinical and epidemiological data of 595 patients admitted to clinical services of the Federal University of Mato Grosso do Sul from 1980 to 2009 were investigated. Gender, age distribution, clinical form, comorbidity with tuberculosis or AIDS, and mortality were compared by decades of clinical admission. It was shown that during the three decades there was a decrease in women percentage, and the same manner occurred a reduction in participants in the age group of 20 to 39 years. Moreover, the acute/subacute forms have been diminished in the period. These fluctuations are closely related and can be simultaneously analyzed. Increased AIDS co-infection prevalence from the first to the second decade was also revealed, coinciding with the appearance of the retroviral epidemic and stabilizing during the third decade. No change in the tuberculosis co-infection rate was observed (overall = 6.9%). It reinforces the importance of this co-morbidity. The overall mortality rate remained steady at 6.7%, not varying significantly from one decade to another. The persistent mortality rate calls attention to the importance of this neglected disease