Avaliação da bioquímica sanguínea de pacientes com paracoccidioidomicose, tratados com cotrimoxazol ou itraconazol

Pós-graduação em Doenças Tropicais - FMB

Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis

BackgroundThere are no published reports on studies comparing itraconazole (ITC), sulfamethoxazole-trimethoprim (cotrimoxazole, CMX), and ITC followed by CMX (ITC/CMX) in the treatment of paracoccidiodomycosis. This study aimed to compare the efficacy, effectiveness, safety and time to clinical and serologic cure in paracoccidioidomycosis patients treated with ITC or CMX, the antifungal agents most widely used.MethodologyA quasi-experimental study was performed in 177 patients with a confirmed or probable diagnosis of paracoccidioidomycosis. Treatment was divided into two stages: 1) initial, which was continued until clinical cure was achieved and the erythrocyte sedimentation rate decreased to normal values; 2) complementary, which was continued until serologic cure was achieved. Medians were compared via the Mann-Whitney test, and frequencies were compared via the chi-squared test. The assessment of variables as a function of time was performed using Kaplan-Meier curves and Cox regression. The significance level was established as p <= 0.05.Principal FindingsNo difference was found in the efficacy and effectiveness of the initial treatment of 47 individuals given ITC and 130 individuals given CMX; however, the time to clinical cure was shorter in the former compared with the latter group (105 vs. 159 days; p = 0.001), specifically in patients with the chronic form. Efficacy and effectiveness of the three regimens were similar in the complementary treatment; however, the time to serologic cure was shorter when ITC (161 days) or CMX (495 days) was used compared with ITC/CMX (881 days) [p = 0.02]. The independent predictors of a shorter time to serologic cure were treatment with ITC [risk ratio = 6.61 (2.01-21.75)] or with CMX [risk ratio = 5.11 (1.91-13.67)]). The prevalence of side effects was lower with ITC (6.4%) than with CMX (20.0%; p = 0.03).ConclusionsSince ITC induced earlier clinical cure and was better tolerated than CMX, such triazole should be considered the first-choice for PCM treatment.

Sporothrix schenckii sensu stricto Isolated from Soil in an Armadillo's Burrow

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Anticorpos naturais e infecção: anticorpos naturais na doença de Chagas e na paracoccidioidomicose

Using ELISA technique, natural antibodies against self and non self antigens were determined in 80 patients chronically intected by T. cruzi and 40 individuals suffering from a deep mycosis frequentely found in Latin Amarica (Paracoccidioidomycosis - PCM). Two forms of PCM were investigated: adult forms and juvenil type of disease. Eighty percent (80%) of the former group had significantly elevated anti-laminin antibody levels (M=4.7,SD±1.8) compared with healthy controls and different specificities of antibody were associated with anti-laminin in pathological sera. A notable binding to cytoskeletal proteins was observed, specially with band 3 and their peptides derivates, such as 62 kDa peptide. By means of Protein A chromatography we were able to show that natural anti-Gal antibodies may be bound by their Fab region to other immunoglobulins and/or to Protein A by alternative sites of binding. The finding of lgG anti-Gal antibodies in circulating immune complexes isolated from chagasic sera supported the first alternative. However, it is possible that some of lgG anti-Gal antibodies, belong to VH111 subgroup of immunoglobulins, that bind directly to Protein A. Among the 40 sera from PCM examined, the majority was considered as not exhibiting a signilicantly higher binding than normal sera to antigens tested. However thirty percent (30%) of the chronic patients had an increased levels of natural antibodies at least for one specificity such as actyn, myosin and Gala1,3Gal epitopes. ln juvenil type of PCM the mean value found for actyn was also increased 2,42 (range 1,0 to 5,3). Utilizing the polyethylene glicol precipitation the presence of circulating immune complexes was investigated in PCM sera. Specific antibodies for soluble antigens from P. brasiliensis and natural antibodies against myoglobin, myosin and Gala1,3 Gal epitopes were characterized

Paracoccidioides lutzii sp nov.: biological and clinical implications

Paracoccidioides lutzii, formerly known as 'Pb01-like' strains in the P. brasiliensis complex, is proposed as a new species based on phylogenetic and comparative genomics data, recombination analysis, and morphological characteristics. Conidia of P. lutzii are elongated, different from those of P. brasiliensis. P. lutzii occurs in the central and northern regions of Brazil. Studies comparing P. brasiliensis and P. lutzii may have significant clinical consequences for the diagnosis and treatment of paracoccidioidomycosis.

Adesão de Paracoccidioides brasiliensis e outros fungos anemófilos a teias de aranhas: implicações para a identificação de nichos microbianos no ambiente

The dimorphic pathogenic fungus, Paracoccidioides brasiliensis (Pb), is the etiological agent of paracoccidioidomycosis (PCM), the most important systemic mycosis in Latin America. While the yeast phase can be isolated from patients affected by paracoccidioidomycosis, dogs and naturally infected armadillos; several elements related to the ecology of the saprophytic phase of the pathogen, which is responsible for the production of infective propagules, are poorly understood, hampering the adoption of preventive measures. The demonstration of the high incidence of Pb infection in the 9- banded armadillo, Dasypus novemcinctus, has opened new perspectives for the identification of the pathogen’s habitat. At the opening of the armadillos’ burrows, spider webs are commonly found. The objective of this study was to evaluate the presence of Pb in spider webs samples related to the habitat of armadillos. Spider web samples were collected at Lageado Farm, Botucatu/SP and prepared for microscopic, molecular and mycological analyses. Microscopic analysis showed that different fungi were closely attached to spider web samples. Nested-PCR reaction showed positive amplification for Pb in 4 samples, with identity confirmed by amplicon sequencing. Fungal colonies also included members of Aspergillus, Blastobotrys, Penicillium, Candida, and Sporothrix genera, which are related to opportunistic disease and primary infections of great medical importance. In vitro adhesion tests of mycelia and yeast form of Pb to the spider webs were also performed, in order to analyze the possible physical attraction between fungal cells and the spider web protein network. The results showed a clear adherence of fungal particles to spider webs. In the current literature, there are no studies reporting adhesive properties of microorganisms to spider webs... (Complete abstract click electronic access below)

Análise funcional da proteína 14-3-3 de Paracoccidioides brasiliensis e prospecção de alvos terapêuticos inibidores da interação de P. brasiliensis à pneumócitos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Caracterização e identificação de moléculas de superfície presentes em Paracoccidioides spp

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudo da migração de células peritoneais na paracoccidioidomicose experimental murina: avalaição do efeito da estimulaçao de células peritoneais por lectina sobra a evolução da lesão paracoccidióidica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Síntese de aminochalconas e análogos arílicos como agentes antivirais, antifúngicos e inibidores de mieloperoxidase

Pós-graduação em Química - IBILCE

Paracoccidioides brasiliensis interferes on dendritic cells maturation by inhibiting PGE(2) production

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Importance of adhesins in virulence of Paracoccidioides spp.

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Alterations of protein expression in conditions of copper-deprivation for Paracoccidioides lutzii in the presence of extracellular matrix components

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The multifaceted roles of metabolic enzymes in the Paracoccidioides species complex

Paracoccidioides species are dimorphic fungi and are the etiologic agents of paracoccidioidomycosis, which is a serious disease that involves multiple organs. The many tissues colonized by this fungus suggest a variety of surface molecules involved in adhesion. A surprising finding is that most enzymes in the glycolytic pathway, tricarboxylic acid (TCA) cycle and glyoxylate cycle in Paracoccidioides spp. have adhesive properties that aid in interacting with the host extracellular matrix and thus act as 'moonlighting'proteins. Moonlighting proteins have multiple functions, which adds a dimension to cellular complexity and benefit cells in several ways. This phenomenon occurs in both eukaryotes and prokaryotes. For example, moonlighting proteins from the glycolytic pathway or TCA cycle can play a role in bacterial pathogenesis by either acting as proteins secreted in a conventional pathway and/or as cell surface components that facilitate adhesion or adherence. This review outlines the multifunctionality exhibited by many Paracoccidioides spp. enzymes, including aconitase, aldolase, glyceraldehyde-3-phosphate dehydrogenase, isocitratelyase, malatesynthase, triose phosphate isomerase, fumarase, and enolase. We discuss the roles that moonlighting activities play in the virulence characteristics of this fungus and several other human pathogens during their interactions with the host.

The use of a mixture of somatic and culture filtrate antigens in the evaluation of the immune response to Paracoccidioides brasiliensis

Three Paracoccidioides brasiliensis antigens, namely a culture filtrate preparation, a somatic antigen and a mixture of equal parts of the two, were tested by two serological techniques against sera from patients with paracoccidioidomycosis, and in an in vivo delayed hypersensitivity model in mice. The antigen mixture was more sensitive than the two individual antigens for the evaluation of humoral and cellular immune response to P. brasiliensis, both in man and in experimental animals.