Paracoccidioidomycosis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac
Overview
Spores of Paracoccidioides spp. are transmitted via the respiratory route to the human host. Following transmission, Paracoccidiodes 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-like appearance is a characteristic finding of PMC. [2] [3]
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. [1]
- Following transmission, Paracoccidiodes spp. conidia and mycelial particles invade the terminal brochioles and alveoli and convert into yeast cells. [1]
- The organisms response to the primo-infection is: bronchoalveolitis, which is normally asymptomatic.[3]
- After the primo-infection, the formation of granulomas start. Granulomas can be inactive for numerous years. [3]
- If the infection is active or gets activated, it can spread through lymphatic and hematic routes to other tissues. [1]
- Paracoccidioides spp. has developed different mechanisms which avoid getting caught inside mucus and therefore not being eradicated by mucigen cilliary cells. [4]
- The powerful adherence characteristic of the species provides a rapid takeover of host cells and consequently the avoidance of the immune system. [4]
Associated Conditions
Paracoccidioidomycosis is a opportunistic disease in Latin America. Associated conditions are:
- HIV/AIDS: Endemic areas of Paracoccidioides spp. in Brazil have the majority of HIV/AIDS patients.[3] Nevertheless, the incidence of HIV/AIDS and paracoccidioidomycosis is minimum, this may be because the prophylaxis (trimetropin-sulfamethoxazole) used for Pneumocystis jiroveci is the one of the possible treatments for PCM. [3]
- Carcinoma: 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. [3]
- Transplants: The small amount of cases may be because of the use of trimetropin-sulfamethoxazole as prophylaxis for Pneumocystis jiroveci, which is one of the possible treatments for PCM. [3]
- Carpal Tunnel Syndrome: Only seen in Immunosupressed patients. [5]
Microscopic Pathology
Paracoccidiodes spp. most important "characteristic is its dimorphism thermally driven. At 37ºC, a yeast-like form is produced whereas at 25ºC is a filamentous fungus. At 37ºC the colonies are white or cream with variable texture. Spherical cell produce piriform microconidia by synchronous budding forming the characteristic “steering wheels” of this fungus. At 25ºC slowly growing mycelial phase is developed with white to brownish colonies. Microscopically, conidia are usually absent, intercalary chlamydospores cells might be present. If seen, conidia may show a 'bicorn cocked hat’ appearance and barrel-shaped conidia are common to both species. P. lutzii frequently produces elongated, rod-shaped conidia, which is sufficiently distinctive to be used for species diagnosis." [6]
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, 2015
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 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 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.
- ↑ Lytkin MI, Petlenko VP (1988). "[A methodological analysis of the theory of traumatic disease]". Voen Med Zh (4): 11–4. PMID 3414040.
- ↑ Paracoccidioides spp. LIFE-Leading International Fungal Education.http://www.life-worldwide.org/fungal-diseases/paracoccidioides-brasiliensis. Accessed on January 14, 2015