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'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Restrepo A, Tobon AM, Agudelo CA. Paracoccidioidomycosis. In: Diagnosis and Treatment of Human Mycoses, 1st edition, Hospenthal, DR, Rinaldi, MG (Eds), Humana Press, Totowa, NJ 2008. p.331.
- Theodoro RC, Bagagli E, Oliveira C. Phylogenetic analysis of PRP8 intein in Paracoccidioides brasiliensis species complex. Fungal Genet Biol 2008; 45:1284.
- Theodoro RC, Teixeira Mde M, Felipe MS, et al. Genus paracoccidioides: Species recognition and biogeographic aspects. PLoS One 2012; 7:e37694.
- Batista J Jr, de Camargo ZP, Fernandes GF, et al. Is the geographical origin of a Paracoccidioides brasiliensis isolate important for antigen production for regional diagnosis of paracoccidioidomycosis? Mycoses 2010; 53:176.
- Travassos LR, Taborda CP, Colombo AL. Treatment options for paracoccidioidomycosis and new strategies investigated. Expert Rev Anti Infect Ther 2008; 6:251.
- Bellissimo-Rodrigues F, Machado AA, Martinez R. Paracoccidioidomycosis epidemiological features of a 1,000-cases series from a hyperendemic area on the southeast of Brazil. Am J Trop Med Hyg 2011; 85:546.
- Silveira LH, Paes RC, Medeiros EV, et al. Occurrence of Antibodies to Paracoccidioides brasiliensis in dairy cattle from Mato Grosso do Sul, Brazil. Mycopathologia 2008; 165:367.
- Corte AC, Svoboda WK, Navarro IT, et al. Paracoccidioidomycosis in wild monkeys from Paraná State, Brazil. Mycopathologia 2007; 164:225.
- Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: an update. Clin Microbiol Rev 1993; 6:89.
- Restrepo A. The ecology of Paracoccidioides brasiliensis: a puzzle still unsolved. Sabouraudia 1985; 23:323.
- Martinez R. EPIDEMIOLOGY OF PARACOCCIDIOIDOMYCOSIS. Rev Inst Med Trop Sao Paulo 2015; 57 Suppl 19:11.
- Restrepo A, McEwen JG, Castañeda E. The habitat of Paracoccidioides brasiliensis: how far from solving the riddle? Med Mycol 2001; 39:233.
- Vieira Gde D, Alves Tda C, Lima SM, et al. Paracoccidioidomycosis in a western Brazilian Amazon State: clinical-epidemiologic profile and spatial distribution of the disease. Rev Soc Bras Med Trop 2014; 47:63.
- Coutinho ZF, Wanke B, Travassos C, et al. Hospital morbidity due to paracoccidioidomycosis in Brazil (1998-2006). Trop Med Int Health 2015; 20:673.
- Calle D, Rosero DS, Orozco LC, et al. Paracoccidioidomycosis in Colombia: an ecological study. Epidemiol Infect 2001; 126:309.
- Barrozo LV, Benard G, Silva ME, et al. First description of a cluster of acute/subacute paracoccidioidomycosis cases and its association with a climatic anomaly. PLoS Negl Trop Dis 2010; 4:e643.
- do Valle ACF, Marques de Macedo P, Almeida-Paes R, et al. Paracoccidioidomycosis after Highway Construction, Rio de Janeiro, Brazil. Emerg Infect Dis 2017; 23:1917.
- Bagagli E, Theodoro RC, Bosco SM, McEwen JG. Paracoccidioides brasiliensis: phylogenetic and ecological aspects. Mycopathologia 2008; 165:197.
- Franco M, Bagagli E, Scapolio S, da Silva Lacaz C. A critical analysis of isolation of Paracoccidioides brasiliensis from soil. Med Mycol 2000; 38:185.
- Blotta MH, Mamoni RL, Oliveira SJ, et al. Endemic regions of paracoccidioidomycosis in Brazil: a clinical and epidemiologic study of 584 cases in the southeast region. Am J Trop Med Hyg 1999; 61:390.
- Nucci M, Colombo AL, Queiroz-Telles F, et al. Paracoccidioidomycosis. Curr Fung Infect Rep 2009; 3:15.
- Queiroz-Telles, F. Influence of alternating coffee and sugar cane agriculture in the incidence of paracoccidioidomycosis in Brazil. Biomedica 2008; 28(Suppl 1):129.
- Mamoni RL, Blotta MH. Kinetics of cytokines and chemokines gene expression distinguishes Paracoccidioides brasiliensis infection from disease. Cytokine 2005; 32:20.
- Karhawi AS, Colombo AL, Salomão R. Production of IFN-gamma is impaired in patients with paracoccidioidomycosis during active disease and is restored after clinical remission. Med Mycol 2000; 38:225.
- Benard G, Romano CC, Cacere CR, et al. Imbalance of IL-2, IFN-gamma and IL-10 secretion in the immunosuppression associated with human paracoccidioidomycosis. Cytokine 2001; 13:248.
- Marques Mello L, Silva-Vergara ML, Rodrigues V Jr. Patients with active infection with Paracoccidioides brasiliensis present a Th2 immune response characterized by high Interleukin-4 and Interleukin-5 production. Hum Immunol 2002; 63:149.