Mycology and epidemiology of paracoccidioidomycosis
- Marcio Nucci, MD
Marcio Nucci, MD
- Associate Professor, Department of Internal Medicine Federal University of Rio de Janeiro
- Head, Mycology Laboratory
- Hospital Universitario Clementino Fraga Filho
- Arnaldo L Colombo, MD
Arnaldo L Colombo, MD
- Professor of Medicine, Division of Infectious Diseases
- Head, Special Mycology Laboratory
- Federal University of São Paulo
Paracoccidioidomycosis is a systemic endemic mycotic disease caused by thermally dimorphic fungi of the genus Paracoccidioides. Two species are recognized to cause paracoccidioidomycosis: Paracoccidioides brasiliensis and Paracoccidioides lutzii. The fungus has a geographic distribution limited to Central and South America, and paracoccidioidomycosis is the most frequent systemic endemic mycosis in this region.
Basic aspects of the fungal pathogen and the epidemiology of paracoccidioidomycosis will be reviewed here. Clinical manifestations, diagnosis, and treatment of paracoccidioidomycosis are discussed separately. (See "Clinical manifestations and diagnosis of chronic paracoccidioidomycosis" and "Clinical manifestations and diagnosis of acute/subacute paracoccidioidomycosis" and "Treatment of paracoccidioidomycosis".)
P. brasiliensis and P. lutzii are thermally dimorphic fungi that are found as a mycelium at 22 to 26ºC and as a yeast at 37ºC. This species lack a sexual stage (teleomorph).
In its mycelial form, Paracoccidioides spp appear as thin septated hyphae with occasional chlamydospores and conidia . In the yeast form, Paracoccidioides spp are characterized by oval or round budding yeast cells of varying sizes (4 to 40 microns). The typical appearance is that of a large mother cell surrounded by multiple budding daughter cells (blastoconidia), often called a "pilot's wheel" (picture 1). When the mother cell has only two budding cells, it may resemble a "Mickey mouse head." (See "Clinical manifestations and diagnosis of chronic paracoccidioidomycosis", section on 'Microscopy'.).
The use of multilocus sequence typing has differentiated P. brasiliensis from P. lutzii, and has identified three cryptic species of P. brasiliensis: species 1 (S1), the most widely distributed species, which is present in Brazil, Argentina, Uruguay, Paraguay, Peru, and Venezuela; phylogenetic species 2 (PS2), which is present in Brazil and Venezuela; and PS3, which is restricted to Colombia . P. lutzii occurs predominantly in the western-central region of Brazil, as well as in southern and northern Brazil, and Ecuador . Although the clinical impact of this genotypic diversity is not completely understood, data suggest that patients infected with P. lutzii may be negative for the immunodiffusion test that detects antibodies against the gp43 antigen . (See "Clinical manifestations and diagnosis of chronic paracoccidioidomycosis", section on 'Serologic tests'.)
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