Paracoccidioidomycosis: Current Status and Future Trends.

IF 19 1区 医学 Q1 MICROBIOLOGY
Rosane Christine Hahn, Ferry Hagen, Rinaldo Poncio Mendes, Eva Burger, Andreia Ferreira Nery, Nathan Pereira Siqueira, Armando Guevara, Anderson Messias Rodrigues, Zoilo Pires de Camargo
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引用次数: 21

Abstract

Paracoccidioidomycosis (PCM), initially reported in 1908 in the city of São Paulo, Brazil, by Adolpho Lutz, is primarily a systemic and neglected tropical mycosis that may affect individuals with certain risk factors around Latin America, especially Brazil. Paracoccidioides brasiliensis sensu stricto, a classical thermodimorphic fungus associated with PCM, was long considered to represent a monotypic taxon. However, advances in molecular taxonomy revealed several cryptic species, including Paracoccidioides americana, P. restrepiensis, P. venezuelensis, and P. lutzii, that show a preference for skin and mucous membranes, lymph nodes, and respiratory organs but can also affect many other organs. The classical diagnosis of PCM benefits from direct microscopy culture-based, biochemical, and immunological assays in a general microbiology laboratory practice providing a generic identification of the agents. However, molecular assays should be employed to identify Paracoccidioides isolates to the species level, data that would be complemented by epidemiological investigations. From a clinical perspective, all probable and confirmed cases should be treated. The choice of treatment and its duration must be considered, along with the affected organs, process severity, history of previous treatment failure, possibility of administering oral medication, associated diseases, pregnancy, and patient compliance with the proposed treatment regimen. Nevertheless, even after appropriate treatment, there may be relapses, which generally occur 5 years after the apparent cure following treatment, and also, the mycosis may be confused with other diseases. This review provides a comprehensive and critical overview of the immunopathology, laboratory diagnosis, clinical aspects, and current treatment of PCM, highlighting current issues in the identification, treatment, and patient follow-up in light of recent Paracoccidioides species taxonomic developments.

副球孢子菌病:现状和未来趋势。
副球孢子菌病(Paracoccidioidomycosis, PCM)最初由Adolpho Lutz于1908年在巴西圣保罗市报道,主要是一种被忽视的全身性热带真菌病,可能影响拉丁美洲,特别是巴西地区具有某些危险因素的个体。巴西严格副球虫(paracoccidiides brasiliensis sensu stricto)是一种典型的与PCM相关的热形态真菌,长期以来被认为是一个单型分类群。然而,分子分类学的进展揭示了几种隐种,包括美洲副球虫、P. restrepiensis、P. venezuela和P. lutzii,它们表现出对皮肤和粘膜、淋巴结和呼吸器官的偏好,但也可以影响许多其他器官。PCM的经典诊断受益于在一般微生物实验室实践中直接显微镜培养,生化和免疫学分析,提供了药物的一般鉴定。然而,应采用分子测定法在种水平上鉴定副球虫分离物,这些数据将得到流行病学调查的补充。从临床角度看,所有可能和确诊病例都应得到治疗。必须考虑治疗的选择及其持续时间,以及受影响的器官、过程的严重程度、以前治疗失败的历史、给予口服药物的可能性、相关疾病、妊娠和患者对拟议治疗方案的依从性。然而,即使经过适当的治疗,也可能出现复发,通常发生在治疗后明显治愈5年后,而且,真菌病可能与其他疾病混淆。本文综述了PCM的免疫病理、实验室诊断、临床方面和目前的治疗,并根据最近的副球虫物种分类发展,重点介绍了当前在鉴定、治疗和患者随访方面的问题。
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来源期刊
Clinical Microbiology Reviews
Clinical Microbiology Reviews 医学-微生物学
CiteScore
54.20
自引率
0.50%
发文量
38
期刊介绍: Clinical Microbiology Reviews (CMR) is a journal that primarily focuses on clinical microbiology and immunology.It aims to provide readers with up-to-date information on the latest developments in these fields.CMR also presents the current state of knowledge in clinical microbiology and immunology.Additionally, the journal offers balanced and thought-provoking perspectives on controversial issues in these areas.
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