Mycological diagnosis of paracoccidioidomycosis in a hospital from a nonendemic area: classical and molecular methods
Abstract
Introduction. Paracoccidioidomycosis is a systemic mycosis endemic in Latin America. Climate change and host migration emphasize the need to optimize this infection diagnosis.
Objective. To evaluate the implementation of Paracoccidioides spp. DNA detection in the mycological diagnosis of patients with suspected paracoccidioidomycosis.
Materials and methods. It is a retrospective study with laboratory data from patients with clinical suspicion of paracoccidioidomycosis, who consulted a university hospital from a non-endemic area.
Results. We analyzed the laboratory results of samples from 19 patients with suspected paracoccidioidomycosis. Seventeen out of 19 patients were born in or had visited an endemic area in Latin America. Fourteen adult male patients were confirmed to have paracoccidioidomycosis by conventional diagnosis: the direct examination was positive in 12 samples while fungal growth was found only in 4. Anti-Paracoccidioides spp. antibodies were detected in 10 patients, 8 of them with proven paracoccidioidomycosis. Nested PCR for Paracoccidioides spp. detection was performed on clinical samples from 14 patients, and positive results were obtained for 9 out of 10 patients with the conventional diagnosis of paracoccidioidomycosis.
Conclusions. The incorporation of molecular techniques to detect Paracoccidioides spp. DNA complements the conventional diagnosis of paracoccidioidomycosis. This tool allows the prescription of antifungal treatment in those cases where the fungus is not observed in the clinical samples.
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References
Canteros CE. Paracoccidioidomicosis: crónica de una enfermedad olvidada. Medicina. 2018;78:180-4.
Queiroz-Telles F, Hassan Fahal A, Falci D, Cáceres DH, Chiller T, Pasqualotto A. Neglected endemic mycoses. Lancet Infect Dis. 2017;17. https://doi.org/10.1016/S1473-3099(17)30306-7
Fernández NB, Davel G. Micosis de declaración obligatoria: utopía o realidad. Una cuestión olvidada por resolver. Rev Arg Microbiol. 2019;51:101-2. https://doi.org/10.1016/j.ram.2019.04.001
World Health Organization. WHO fungal priority pathogens list to guide research development and public health action. Geneva: World Health Organization; 2022. Fecha de consulta: 8 de enero de 2023. Disponible en https://www.who.int/publications/i/item/9789240060241
Zancope-Oliveira RM, Pizzini CV, de Medeiros MM, Valle ACDF, AlmeidaPaes R. Diagnostic aspects of paracoccidioidomycosis. Curr Trop Med Rep. 2014;1:111-8. https://doi.org/10.1007/s40475-014-0022-y
Montalvo R, Díaz A, Montalvo J, Pomazongo M, Montalvo M, Tunque E. Disseminated paracoccidioidomycosis associated with lymph node tuberculosis in a nonimmunocompromised child. IDCases. 2022;29:e01507. https://doi.org/10.1016/j.idcr.2022.e01507
Peçanha PM, Batista ME, Massaroni MA, Schmidt EB, Lamas M, Zanotti RL, et al. Paracoccidioidomycosis: Epidemiological and clinical aspects in 546 cases studied in the State of Espírito Santo, Brazil. Am J Trop Med Hyg. 2017;97:836-44. https://doi.org/10.4269/ajtmh.16-0790
Gómez BL. Molecular diagnosis of endemic and invasive mycoses: Advances and challenges. Rev Iberoam Micol. 2014;31:35-41. https://doi.org/10.1016/j.riam.2013.09.009
Martínez R. Epidemiology of paracoccidioidomicosis. Rev Inst Med Trop Sao Paulo. 2015;57 (Suppl. 19):S11-20. https://doi.org/10.1590/S0036-46652015000700004
Olivero R, Domínguez A, Sánchez C, Di-Liberti D. Diagnóstico de paracoccidioidomicosis en el Laboratorio de Micología de la Universidad de Carabobo durante 14 años (1992-2005). Rev Soc Ven Microbiol. 2007;27:349-63.
López-Martínez R, Hernandéz-Hernandéz F, Mendez-Toiar LJ, Manzano-Gayosso P, Bonifaz A, Arenas R, et al. Paracoccidioidomycosis in Mexico: Clinical and epidemiological data from 93 new cases (1972-2012). Mycoses. 2014;57:525-30. https://doi.org/10.1111/myc.12190
Torrado E, Castañeda E, de la Hoz F, Restrepo A. Paracoccidioidomicocis: definición de las áreas endémicas de Colombia. Biomédica. 2000;20:327-34. https://doi.org/10.7705/biomedica.v20i4.1076
Arenas Guzmán R, Torres Guerrero E. Paracoccidioidomicosis. En: Micología médica ilustrada. 6 edición. McGraw Hill; 2020. Fecha de consulta: 8 de enero de 2023. Disponible en: https://accessmedicina.mhmedical.com/content.aspx?bookid=2791§ionid=234860916.
Restrepo A, Mc Ewen JG, Castañeda E. The habitat of Paracoccidioides brasiliensis: How far from solving the riddle? Med Mycol. 2001;39:233-41. https://doi.org/10.1080/mmy.39.3.233.241
Colombo AL, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol. 2011;49:785-98. https://doi.org/10.3109/13693786.2011.577821
Shikanai-Yasuda MA, Mendes RP, Colombo AL, de Queiroz-Telles F, Kono AS, Paniago AM, et al. Brazilian guidelines for the clinical management of paracoccidioidomycosis. Rev Soc Brasil Med Trop. 2017;50:715-40. https://doi.org/10.1590/0037-8682-0230-2017
de Almeida JN Jr, Peçanha-Pietrobom PM, Colombo AL. Paracoccidioidomycosis in immunocompromised patients: a literature review. J Fungi (Basel). 2018;5:2. https://doi.org/10.3390/jof5010002
Lockhart SR, Toda M, Benedict K, Caceres DH, Litvintseva AP. Endemic and other dimorphic mycoses in the Americas. J Fungi. 2021;7:151. https://doi.org/10.3390/jof7020151
Hahn RC, Hagen F, Mendes RP, Burger E, Nery AF, Siqueira NP, et al. Paracoccidioidomycosis: Current and future trends. Clin Microbiol Rev. 2022;35:e0023321. https://doi.org/10.1128/cmr.00233-21
Krakhecke-Teixeira AG, Yamauchi DH, Rossi A, de Sousa HR, Graces HG, Júnior JL, et al. Clinical and eco-epidemiological aspects of a novel hyperendemic area of Paracoccidioidomycosis in the Tocantins-Araguaia Basin (Northern Brazil), caused by Paracoccidioides ssp. J Fungi (Basel). 2022;8:502. https://doi.org/10.3390/jof8050502
Giusiano G, Aguirre C, Vratnica C, Rojas F, Corallo T, Cattana ME, et al. Emergence of acute/subacute infant-juvenile paracoccidioidomycosis in Northeast Argentina: Effect of climatic and anthropogenic changes? Med Mycol. 2019;57:30-7. https://doi.org/10.1093/mmy/myx153
Buitrago MJ, Cuenca-Estrella M. Epidemiologia actual y diagnóstico de laboratorio de las micosis endémicas en España. Enferm Infecc Microbiol Clin. 2012:30:407-13. https://doi.org/10.1016/j.eimc.2011.09.014
Matute DR, Sepúlveda VE, Quesada LM, Goldman GH, Taylor JW, Restrepo A, et al. Microsatellite analysis of three phylogenetic species of Paracoccidioides brasiliensis. J Clin Microbiol. 2006;44:2153-7. https://doi.org/10.1128/JCM.02540-05
Turissini DA, Gómez OM, Teixeira MM, McEwen JG, Matute DR. Species boundaries in the human pathogen Paracoccidioides. Fungal Genet Biol. 2017;106:925. https://doi.org/10.1016/j.fgb.2017.05.007
Rodríguez AM, Hagen F, Puccia R, Hahn RC, Pires de Camargo Z. Paracoccidioides and paracoccidioidomicosis in the 21st century. Mycopathologia. 2023;188:129-33. https://doi.org/10.1007/s11046-022-00704-y
Mavengere H, Mattox K, Teixeira MM, Sepúlveda VE, Gómez OM, Hernández O, et al. Paracoccidioides genomes reflect high levels of species divergence and little interspecific gene flow. mBio. 2020;11:e019920. https://10.1128/mBio.01999-20
Restrepo A, Cano LE, Gonzalez Á. The power of the small: The example of Paracoccidioides brasiliensis conidia. Rev Inst Med Trop Sao Paulo. 2015;57 (Suppl. 19):S5-10. https://doi.org/10.1590/S0036-46652015000700003
Pinheiro BG, Possa AP, Della PP, de Carvalho JA, Ricci G, Nishikaku, AS, et al. A new duplex PCR-assay for the detection and identification of Paracoccidioides species. J Fungi. 2021;7:169. https://doi.org/10.3390/jof7030169
Griffiths J, Lopes Colombo A, Denning D.W. The case for paracoccidioidomycosis to be accepted as a neglected tropical (fungal) disease. PLoS Negl Trop Dis. 2019;13. https://doi.org/10.1371/journal.pntd.0007195
Peçanha PM, Peçanha-Pietrobom PM, Grão-Velloso TR, Rosa M, Falqueto A, Gonçalves SS. Paracoccidioidomycosis: What we know and what is new in epidemiology, diagnosis, and treatment. J Fungi. 2022;8:1098. https://doi.org/10.3390/jof8101098
Almeida-Paes R, Bernardes-Engemann AR, da Silva Motta B, Pizzini CV, de Abreu Almeida M, de Medeiros Muñiz M, et al. Immunologic diagnosis of endemic mycoses. J Fungi. 2022;8:993. https://doi.org/10.3390/jof8100993
Bialek R, Ibricevic A, Aepinus C, Najvar L, Fothergill A, Knobloch J, et al. Detection of Paracoccidioides brasiliensis in tissue samples by a Nested PCR assay. J Clin Microbiol. 2000;8:2940-2. https://doi.org/10.1128/JCM.38.8.2940-2942.2000
Ricci G, Campanini EB, Nishikaku AS, Puccia R, Marques M, Bialek R, et al. PbGP43 genotyping using paraffin-embedded biopsies of human paracoccidioidomycosis reveals a genetically distinct lineage in the Paracoccidioides brasiliensis complex. Mycopathologia. 2022;187:157-68. https://doi.org/10.1007/s11046-021-00608-3
Gaviria M, Rivera V, Muñoz-Cadavid C, Cano LE, Naranjo TW. Validation and clinical application of a nested PCR for paracoccidioidomycosis diagnosis in clinical samples from Colombian patients. Braz J Infect Dis. 2015;19:376-83. https://doi.org/10.1016/j.bjid.2015.04.008
Restrepo A. Morphological aspects of Paracoccidioides brasiliensis in lymph nodes: Implications for the prolonged latency of paracoccidioidomycosis? Med Mycol. 2000;38:317-22. https://doi.org/ 10.1080/mmy.38.4.317.322
Messina F, Romero M, Benchetrit A, Marin E, Arechavala A, Depardo R, et al. Clinical and microbiological characteristics of paracoccidioidomycosis in patients with AIDS in Buenos Aires, Argentina. Med Mycol. 2020;58:22-9. https://doi.org/0.1093/mmy/myz021
Taicz M, Rosanova MT, Bes D, Lisdero ML, Iglesias V, Santos P, et al. Paracoccidioidomicosis en pediatría: descripción de 4 casos. Rev Iberoam Micol. 2014;31:141-4. https://doi.org/10.1016/j.riam.2013.05.013
Falci DR, Pasqualotto AC. Clinical mycology in Latin America and the Caribbean: A snapshot of diagnostic and therapeutic capabilities. Mycoses. 2019;62:368-73. https://doi.org/10.1111/myc.12890
Moreto TC, Marques ME, de Oliveira ML, Moris DV, de Carvalho LR, Mendes RP. Accuracy of routine diagnostic tests used in paracoccidioidomycosis patients at a university hospital. Trans R Soc Trop Med Hyg. 2011;105:473-8. https://doi.org/10.1016/j.trstmh.2011.03.001
Buitrago MJ, Merino P, Puente S, Gómez-López A, Arribi A, ZancopeOliveira RM, et al. Utility of real-time PCR for the detection of Paracoccidioides brasiliensis DNA in the diagnosis of imported paracoccidioidomycosis. Med Mycol. 2009;47:879-882. https://doi.org/10.3109/13693780802713208
Rocha-Silva F, Gomes LI, Gracielle-Melo C, Goes AM, Caligiorne RB. Real time polymerase chain reaction (rt-PCR): a new patent to diagnostic purposes for paracoccidioidomycosis. Recent Pat Endocr Metab Immune Drug Discov. 2017;10:1439. https://doi.org/10.2174/1872214810666160905150958
Endo S, Komori T, Ricci G, Sano A, Yokoyama K, Ohori A, et al. Detection of gp43 of Paracoccidioides brasiliensis by the loop-mediated isothermal amplification (LAMP) method. FEMS Microbiol Lett. 2004;234:93-7. https://doi.org/10.1016/J.FEMSLE.2004.03.01546
Tatibana BT, Sano A, Uno J, Kamei K, Igarashi T, Mikami Y, et al. Detection of Paracoccidioides brasiliensis gp43 gene in sputa by loop-mediated isothermal amplification. J Clin Lab Anal. 2009;23:139-43. https://doi.org/10.1002/jcla.20304
Hahn RC, Rodrigues AM, Della Terra PP, Nery AF, Hoffmann-Santos HD, Gois HM, et al. Clinical and epidemiological features of paracoccidioidomycosis due to Paracoccidioides lutzii. PLoS Negl Trop Dis. 2019;13. https://doi.org/10.1371/journal.pntd.0007437
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