Paracoccidioidomycosis pathophysiology: Difference between revisions
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==Overview== | ==Overview== | ||
[[Spores]] of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' are commonly transmitted via the | [[Spores]] of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' are commonly transmitted via the respiratory route to the human host. Following transmission, ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' particles invade the terminal [[bronchioles]] and [[alveoli]] where [[granulomas]] are formed, but can be inactive for approximately 40 years. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref> On microscopic histopathological analysis, a "pilot's wheel" or a "Mickey mouse ears-like" appearance is a characteristic finding of [[Paracoccidioidomycosis|PCM]]. <ref>Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016</ref> <ref name="?">Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. ''CID''. 1996; 23: 1026-1032 </ref> <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | ||
==Pathogenesis== | ==Pathogenesis== | ||
| Line 10: | Line 10: | ||
*Rarely in can be transmitted via [[skin]] trauma, where the [[fungus]] attaches the skin and [[mucous membranes]]. Or via the [[digestive system]], after consuming contaminated food. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref> <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | *Rarely in can be transmitted via [[skin]] trauma, where the [[fungus]] attaches the skin and [[mucous membranes]]. Or via the [[digestive system]], after consuming contaminated food. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref> <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | ||
*Following transmission, ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' [[conidia]] and mycelial particles invade the terminal [[bronchioles]] and [[alveoli]] and convert into [[yeast]] cells. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref> | *Following transmission, ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' [[conidia]] and mycelial particles invade the terminal [[bronchioles]] and [[alveoli]] and convert into [[yeast]] cells. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref> | ||
*The organisms response to the primo-infection is: | *The organisms response to the primo-infection is: bronchoalveolitis, which is normally asymptomatic.<ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | ||
*After the primo-infection, the formation of [[granulomas]] start. [[Granulomas]] can be inactive for | *After the primo-infection, the formation of [[granulomas]] start. [[Granulomas]] can be inactive for several years. <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | ||
*If the [[infection]] is active or gets activated, it can spread through [[lymphatic]] and hematic routes to other [[tissues]]<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref> such as: | *If the [[infection]] is active or gets activated, it can spread through [[lymphatic]] and hematic routes to other [[tissues]]<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref> such as:, [[spleen]], [[kidneys]][[adrenal glands|, adrenal glands]], [[liver]], [[bone|bone,]] [[central nervous system]], and [[airways]]. <ref name="pmid22236894">{{cite journal| author=Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL et al.| title=Thoracic paracoccidioidomycosis: radiographic and CT findings. | journal=Radiographics | year= 2012 | volume= 32 | issue= 1 | pages= 71-84 | pmid=22236894 | doi=10.1148/rg.321115052 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22236894 }} </ref> | ||
* [[Paracoccidioides brasiliensis|Paracoccidioides spp]]. has developed different mechanisms which avoid getting caught inside [[mucus]] and therefore not being eradicated by mucigen [[cilliary cells]]. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue= | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779 }} </ref> | * [[Paracoccidioides brasiliensis|Paracoccidioides spp]]. has developed different mechanisms which avoid getting caught inside [[mucus]] and therefore not being eradicated by mucigen [[cilliary cells]]. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue= | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779 }} </ref> | ||
*The powerful adherence characteristic of the [[species]] provides a rapid takeover of host cells and consequently the avoidance of the [[immune system]]. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue= | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779 }} </ref> | *The powerful adherence characteristic of the [[species]] provides a rapid takeover of host cells and consequently the avoidance of the [[immune system]]. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue= | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779 }} </ref> | ||
==Genetics== | ==Genetics== | ||
*The majority of patients in countries such as Colombia and Brazil, with high prevalence of [[Paracoccidioidomycosis|PCM]], had | *The majority of patients in countries such as Colombia and Brazil, with high prevalence of [[Paracoccidioidomycosis|PCM]], had [[HLA-A9]], [[HLA-B13]], and HLA-B4 [[antigens]]. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> | ||
*Chronic [[Paracoccidioidomycosis|PCM]] is associated with patients that have | *Chronic [[Paracoccidioidomycosis|PCM]] is associated with patients that have C4B*-00 [[antigen]] of the [[Major histocompatibility complex|class III major histocompatibility complex]]. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> | ||
==Associated Conditions== | ==Associated Conditions== | ||
*Paracoccidiodomycosis has been associated with: | *''Paracoccidiodomycosis has been associated with:'' | ||
** | **'''Concomitant infections''' | ||
**[[Cancer]] | ***The most important infectious disease that can be found concomitant with [[Paracoccidioidomycosis|PCM]] is pulmonary [[tuberculosis]] ([[Tuberculosis|TB]]). [[Tuberculosis|TB]] can hold up the diagnosis of [[Paracoccidioidomycosis|PCM]], because they have similar clinical manifestations. Other [[infectious diseases]] associated with PCM because they have the same risk factors are: [[leishmaniasis]], [[leprosy]], [[Chagas disease|Chagas]] disease and [[strongyloidiasis]]. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> | ||
**[[Cancer|'''Cancer''']] | |||
***The majority of patients with [[carcinoma]] and [[Paracoccidioidomycosis|PCM]], have the same organ or adjacent tissues involved. A risk factor for [[carcinoma]] is [[chronic inflammation]] with [[squamous metaplasia]], which has been described in 33% cases of [[Paracoccidioidomycosis|PCM]] in a study. <ref name="ccc">Da Silva G, Bittencourt C, De Mattos F, Da Silva J, Prolla J Severo L. Association between paracoccidioidomycosis and cancer. ''J. bras. pneumol.'' 2010;36(3), 356-362 </ref> | |||
*Paracoccidioidomycosis is also considered an [[opportunistic infection]] in Latin America. Associated conditions are: | *''Paracoccidioidomycosis is also considered an [[opportunistic infection]] in Latin America. Associated conditions are:'' | ||
**[[HIV AIDS|HIV/AIDS]]: [[Endemic]] areas of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp]]''. in Brazil have the majority of [[HIV AIDS|HIV/AIDS]] patients.<ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;Vol 6(2):89-117''</ref> Nevertheless, the incidence of [[HIV AIDS|HIV/AIDS]] and paracoccidioidomycosis is minimum, this may be because the [[prophylaxis]] ([[Sulfamethoxazole- | **[[HIV AIDS|'''HIV/AIDS''']]: [[Endemic]] areas of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp]]''. in Brazil have the majority of [[HIV AIDS|HIV/AIDS]] patients.<ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;Vol 6(2):89-117''</ref> Nevertheless, the incidence of [[HIV AIDS|HIV/AIDS]] and paracoccidioidomycosis is minimum, this may be because the [[prophylaxis]] ([[Trimethoprim-Sulfamethoxazole|trimethoprim-sulfamethoxazole]]) used for ''[[Pneumocystis jiroveci]]'' is the one of the possible treatments for [[Paracoccidioidomycosis|PCM]]. <ref name="bbb">Amoroso A. A Man With Newly Diagnosed HIV/AIDS With Unusual Severe Opportunistic Infection and No AIDS-Defining Disease. ''CID''. 2014;58:1484-1485</ref> | ||
**[[Cancer]]: The majority of patients have been diagnosed at the same time (40%) or after the neoplasm diagnostic (60%). It is highly associated with solid organ and [[Hematological malignancies|hematologic neoplasias]]. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> | **[[Cancer|'''Cancer''']]: The majority of patients have been diagnosed at the same time (40%) or after the neoplasm diagnostic (60%). It is highly associated with solid organ and [[Hematological malignancies|hematologic neoplasias]]. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> | ||
** | **'''[[Transplantation|Organ Transplantation]]''': [[Paracoccidioidomycosis|PCM]] has been described in cases of [[renal transplantation]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> The small amount of cases may be because of the use of [[Trimethoprim-Sulfamethoxazole|trimethoprim-sulfamethoxazole]] as [[prophylaxis]] for ''[[Pneumocystis jiroveci]]'', which is one of the possible treatments for [[Paracoccidioidomycosis|PCM]]. <ref name="ddd">Zavascki A, Bienardt J, Severo L. Paracoccidioidomycosis in organ transplant recipient: case report. ''Rev. Inst. Med. trop. S. Paulo'' 2004;46(5), 279-281 </ref> | ||
**[[Carpal Tunnel Syndrome]]: Only seen in Immunosupressed patients. <ref name="pmid3414040">{{cite journal| author=Lytkin MI, Petlenko VP| title=[A methodological analysis of the theory of traumatic disease]. | journal=Voen Med Zh | year= 1988 | volume= | issue= 4 | pages= 11-4 | pmid=3414040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3414040 }} </ref> | **[[Carpal Tunnel Syndrome|'''Carpal Tunnel Syndrome''']]: Only seen in Immunosupressed patients. <ref name="pmid3414040">{{cite journal| author=Lytkin MI, Petlenko VP| title=[A methodological analysis of the theory of traumatic disease]. | journal=Voen Med Zh | year= 1988 | volume= | issue= 4 | pages= 11-4 | pmid=3414040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3414040 }} </ref> | ||
==Gross Pathology== | ==Gross Pathology== | ||
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==Microscopic Pathology== | ==Microscopic Pathology== | ||
[[Paracoccidioides brasiliensis|Paracoccidioides spp]]. is a nonphotosynthetic [[eukaryote]] with a rigid [[cell wall]] and [[organelles]] very similar to those of higher [[eukaryotes]]. Being a [[dimorphic fungi]], it has the ability to grow an oval [[yeast]]-like form at 37°C and an elongated mycelial form produced at room temperature. The mycelial and [[yeast]] phases differ in their morphology, biochemistry, and ultrastructure. The [[yeast]] reproduces by | [[Paracoccidioides brasiliensis|Paracoccidioides spp]]. is a nonphotosynthetic [[eukaryote]] with a rigid [[cell wall]] and [[organelles]] very similar to those of higher [[eukaryotes]]. Being a [[dimorphic fungi]], it has the ability to grow an oval [[yeast]]-like form at 37°C and an elongated mycelial form produced at room temperature. The mycelial and [[yeast]] phases differ in their morphology, biochemistry, and ultrastructure. The [[yeast]] reproduces by asexual budding, where [[Daughter cell|daughter cells]] are borne asynchronously at multiple, random positions across the cell surface. Buds begin by layers of [[cell wall]] increasing in optical density at a point that eventually gives rise to the [[daughter cell]]. Once the bud has expanded, a cleavage plane develops between the nascent cell and the mother cell. Following [[dehiscence]], the bud [[scar]] disappears. In [[tissue]], budding occurs inside the [[granulomatous]] center of the [[disease]] lesion, as visualized by [[Hematoxylin and eosin stain|hematoxylin and eosin]] (H&E) staining of histologic sections. Nonbudding cells measure 5–15 µm in diameter, whereas those with multiple spherical buds measure from 10–20 µm in diameter. In electron microscopy, cells with multiple buds have been found to have peripherally located [[nuclei]] and [[cytoplasm]] surrounding a large central [[vacuole]]. In the [[tissue]] form, [[yeast]] cells are larger with thinner walls and a narrower bud base than those of the related [[dimorphic fungi]], Blastomycosis dermatitidis. The [[yeast]]-like form contains multiple [[nuclei]], a porous two-layered [[nuclear membrane]], and a thick cell wall rich in fibers, whereas the mycelial phase has thinner cell walls with a thin, electron-dense outer layer.<ref>Paracoccidioides Brasiliensis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioides_brasiliensis. Accessed on January 12, 2016</ref> We can differenciate P. lutzii from [[Paracoccidioides brasiliensis|P. brasiliensis]] because of its elongated, rod-shaped [[conidia]]. <ref>Paracoccidioides spp. LIFE-Leading International Fungal Education.http://www.life-worldwide.org/fungal-diseases/paracoccidioides-brasiliensis. Accessed on January 14, 2016</ref> | ||
The most important microscopically characteristic is the “ship’s wheel” or “Mickey mouse ears” appereance <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | The most important microscopically characteristic is the “ship’s wheel” or “Mickey mouse ears” appereance <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | ||
Revision as of 20:26, 22 January 2016
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Paracoccidioidomycosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Paracoccidioidomycosis pathophysiology On the Web |
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American Roentgen Ray Society Images of Paracoccidioidomycosis pathophysiology |
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Risk calculators and risk factors for Paracoccidioidomycosis pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac
Overview
Spores of Paracoccidioides spp. are commonly transmitted via the respiratory route to the human host. Following transmission, Paracoccidioides spp. particles invade the terminal bronchioles and alveoli where granulomas are formed, but can be inactive for approximately 40 years. [1] On microscopic histopathological analysis, a "pilot's wheel" or a "Mickey mouse ears-like" appearance is a characteristic finding of PCM. [2] [3] [4]
Pathogenesis
- Spores of Paracoccidioides spp. are transmitted via the respiratory route to the human host.
- Rarely in can be transmitted via skin trauma, where the fungus attaches the skin and mucous membranes. Or via the digestive system, after consuming contaminated food. [1] [4]
- Following transmission, Paracoccidioides spp. conidia and mycelial particles invade the terminal bronchioles and alveoli and convert into yeast cells. [1]
- The organisms response to the primo-infection is: bronchoalveolitis, which is normally asymptomatic.[4]
- After the primo-infection, the formation of granulomas start. Granulomas can be inactive for several years. [4]
- If the infection is active or gets activated, it can spread through lymphatic and hematic routes to other tissues[1] such as:, spleen, kidneys, adrenal glands, liver, bone, central nervous system, and airways. [5]
- Paracoccidioides spp. has developed different mechanisms which avoid getting caught inside mucus and therefore not being eradicated by mucigen cilliary cells. [6]
- The powerful adherence characteristic of the species provides a rapid takeover of host cells and consequently the avoidance of the immune system. [6]
Genetics
- The majority of patients in countries such as Colombia and Brazil, with high prevalence of PCM, had HLA-A9, HLA-B13, and HLA-B4 antigens. [7]
- Chronic PCM is associated with patients that have C4B*-00 antigen of the class III major histocompatibility complex. [7]
Associated Conditions
- Paracoccidiodomycosis has been associated with:
- Concomitant infections
- The most important infectious disease that can be found concomitant with PCM is pulmonary tuberculosis (TB). TB can hold up the diagnosis of PCM, because they have similar clinical manifestations. Other infectious diseases associated with PCM because they have the same risk factors are: leishmaniasis, leprosy, Chagas disease and strongyloidiasis. [7]
- Cancer
- The majority of patients with carcinoma and PCM, have the same organ or adjacent tissues involved. A risk factor for carcinoma is chronic inflammation with squamous metaplasia, which has been described in 33% cases of PCM in a study. [8]
- Concomitant infections
- Paracoccidioidomycosis is also considered an opportunistic infection in Latin America. Associated conditions are:
- HIV/AIDS: Endemic areas of Paracoccidioides spp. in Brazil have the majority of HIV/AIDS patients.[9] Nevertheless, the incidence of HIV/AIDS and paracoccidioidomycosis is minimum, this may be because the prophylaxis (trimethoprim-sulfamethoxazole) used for Pneumocystis jiroveci is the one of the possible treatments for PCM. [10]
- Cancer: The majority of patients have been diagnosed at the same time (40%) or after the neoplasm diagnostic (60%). It is highly associated with solid organ and hematologic neoplasias. [7]
- Organ Transplantation: PCM has been described in cases of renal transplantation.[7] The small amount of cases may be because of the use of trimethoprim-sulfamethoxazole as prophylaxis for Pneumocystis jiroveci, which is one of the possible treatments for PCM. [11]
- Carpal Tunnel Syndrome: Only seen in Immunosupressed patients. [12]
Gross Pathology
- Granulomas merge and form different shape nodules which can be seen macroscopically in the lungs. With time, the nodules tend to necrose and then cavitate. [13]
Microscopic Pathology
Paracoccidioides spp. is a nonphotosynthetic eukaryote with a rigid cell wall and organelles very similar to those of higher eukaryotes. Being a dimorphic fungi, it has the ability to grow an oval yeast-like form at 37°C and an elongated mycelial form produced at room temperature. The mycelial and yeast phases differ in their morphology, biochemistry, and ultrastructure. The yeast reproduces by asexual budding, where daughter cells are borne asynchronously at multiple, random positions across the cell surface. Buds begin by layers of cell wall increasing in optical density at a point that eventually gives rise to the daughter cell. Once the bud has expanded, a cleavage plane develops between the nascent cell and the mother cell. Following dehiscence, the bud scar disappears. In tissue, budding occurs inside the granulomatous center of the disease lesion, as visualized by hematoxylin and eosin (H&E) staining of histologic sections. Nonbudding cells measure 5–15 µm in diameter, whereas those with multiple spherical buds measure from 10–20 µm in diameter. In electron microscopy, cells with multiple buds have been found to have peripherally located nuclei and cytoplasm surrounding a large central vacuole. In the tissue form, yeast cells are larger with thinner walls and a narrower bud base than those of the related dimorphic fungi, Blastomycosis dermatitidis. The yeast-like form contains multiple nuclei, a porous two-layered nuclear membrane, and a thick cell wall rich in fibers, whereas the mycelial phase has thinner cell walls with a thin, electron-dense outer layer.[14] We can differenciate P. lutzii from P. brasiliensis because of its elongated, rod-shaped conidia. [15] The most important microscopically characteristic is the “ship’s wheel” or “Mickey mouse ears” appereance [4]
-
![Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[16]](/images/b/be/527_lores.jpg)
Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[16] -
![Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[17]](/images/2/2f/498_lores.jpg)
Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[17] -
![This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.. Methenamine silver stain.[18]](/images/d/d3/Paracoccidioidomycosis-37.jpg)
This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.. Methenamine silver stain.[18]
![Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[16]](/index.php/File:527_lores.jpg)
![Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[17]](/index.php/File:498_lores.jpg)
![This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.. Methenamine silver stain.[18]](/index.php/File:Paracoccidioidomycosis-37.jpg)
References
- ↑ 1.0 1.1 1.2 1.3 Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA (2011). "Immunology of paracoccidioidomycosis". An Bras Dermatol. 86 (3): 516–24. PMID 21738969.
- ↑ Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016
- ↑ Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. CID. 1996; 23: 1026-1032
- ↑ 4.0 4.1 4.2 4.3 4.4 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
- ↑ Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL; et al. (2012). "Thoracic paracoccidioidomycosis: radiographic and CT findings". Radiographics. 32 (1): 71–84. doi:10.1148/rg.321115052. PMID 22236894.
- ↑ 6.0 6.1 de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F; et al. (2015). "Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis". Front Microbiol. 6: 1319. doi:10.3389/fmicb.2015.01319. PMC 4658449. PMID 26635779.
- ↑ 7.0 7.1 7.2 7.3 7.4 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
- ↑ Da Silva G, Bittencourt C, De Mattos F, Da Silva J, Prolla J Severo L. Association between paracoccidioidomycosis and cancer. J. bras. pneumol. 2010;36(3), 356-362
- ↑ Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev.1993;Vol 6(2):89-117
- ↑ Amoroso A. A Man With Newly Diagnosed HIV/AIDS With Unusual Severe Opportunistic Infection and No AIDS-Defining Disease. CID. 2014;58:1484-1485
- ↑ Zavascki A, Bienardt J, Severo L. Paracoccidioidomycosis in organ transplant recipient: case report. Rev. Inst. Med. trop. S. Paulo 2004;46(5), 279-281
- ↑ Lytkin MI, Petlenko VP (1988). "[A methodological analysis of the theory of traumatic disease]". Voen Med Zh (4): 11–4. PMID 3414040.
- ↑ Marchiori E, Valiante PM, Mano CM, Zanetti G, Escuissato DL, Souza AS; et al. (2011). "Paracoccidioidomycosis: high-resolution computed tomography-pathologic correlation". Eur J Radiol. 77 (1): 80–4. doi:10.1016/j.ejrad.2009.06.017. PMID 19608361.
- ↑ Paracoccidioides Brasiliensis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioides_brasiliensis. Accessed on January 12, 2016
- ↑ Paracoccidioides spp. LIFE-Leading International Fungal Education.http://www.life-worldwide.org/fungal-diseases/paracoccidioides-brasiliensis. Accessed on January 14, 2016
- ↑ Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016
- ↑ Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016
- ↑ Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016