Pulmonary paracoccidioidomycosis: a case report of reactivation in a patient receiving biological therapy

Abstract Paracoccidioidomycosis is an endemic disease in Latin America that is rarely associated with immunosuppression and biological therapy. Herein, we report for the first time a case of pulmonary paracoccidioidomycosis reactivation after infliximab treatment. A 47-year-old man from Brazil received infliximab to treat psoriatic spondyloarthropathy and presented with cough, dyspnea, weight loss, and fever. Chest computed tomography revealed a pulmonary nodule and biopsy confirmed paracoccidioidomycosis. Treatment with sulfamethoxazole and trimethoprim was initiated for fungal infection and infliximab was reintroduced two months later. Considering his clinical improvement and favorable radiologic evolution, antifungal therapy was discontinued after 29 months.

Criptococcose cutânea primária em paciente imunocompetente / Primay cutaneous cryptococcosis in an immunocompetent patient

Os autores relatam caso de Criptococcose cutânea primária, causada pelo Cryptococcus neoformans, em paciente imunocompetente, fazendeiro que desenvolveu extensivas lesões, no antebraço, após injúria provocada por galináceo, quando fazia limpeza de seu celeiro. Tratamento oral com fluconazol resultou em cura total. A literatura relata raridade de criptococcose cutânea primária em imunocompetentes e sua relativa frequência em imunodeprimidos.

The authors report a primary cutaneous cryptococcosis, caused by Cryptococcus neoformans in immunocompetent patient, a farmer who developed extensive lesions at the site of an injury caused by one of the chickens on his right forearm, while he was cleaning out his barn. Oral treatment with fluconazole was totally successful. A review of the literature showed the rarity of cutaneous cryptococcosis in immunocompetent patients and in contrast, that skin lesions frequently occur in immunocompromised patients.

Immune responses in histoplasmosis, a prototype of respiratory mycoses.

The cellular and molecular mechanisms of host defenses to histoplasmosis, a prototype of respiratory fungal infections are described. Although, cell-mediated acquired immunity is considered as a hallmark of protective immunity to histoplasmosis, the recent findings provide mounting evidence on the importance of natural cellular immunity in host resistance to fungal infections. The natural immunity to Histoplasma capsulatum infection is primarily mediated by natural killer cells, endothelial cells and platelets but mechanisms of intercellular communication and their interactions with the pathogen are not clearly defined.

Heterogeneity of immune responses to various Aspergillus species in patients with allergic respiratory diseases.

In the present study, allergenic significance of thirteen species of Aspergillus and their allergenic and antigenic relationship was studied. Of the 3025 ID tests performed with the 13 species of Aspergillus on 289 patients suffering with allergic respiratory diseases, 627 (20.7%) were positive (1+ to 4+), 386 (12.8%) being significantly positive (2+ to 4+) . Of the 64 patients eliciting a positive cutaneous response to at least one species, 42(65.6%) were positive to 5 or less number of species while others showed a broad spectrum of positive skin reactivity to different Aspergillus extracts. In RAST inhibition assays using pooled sera ofpatients sensitive to A. tamarii dose related inhibition was produced by homologous as well as 5 of the 12 heterologous species. Similarly, in A. terreus RAST inhibition was observed with homologous and A. tamarii extracts only. Our results suggested the presence of both species specific as well as shared allergenic components among different Aspergillus species. In TDIEP experiments using rabbit antisera to A. tamarii and A. terreus extracts multiple precipitin bands were observed with the homologous extracts. However, only 1-2 bands were produced by 6 heterologous Aspergillus species in each system. Collectively, these results gave evidence that there is heterogeneity of immune response in the patients with allergic respiratory diseases to different species of Aspergillus and also in rabbits immunized with Aspergillus extracts.

La aspergilosis saprofítica intracavitaria pulmonar en Säo Paulo, Brasil

Se estudió la incidencia de la aspergilosis saprofítica pulmonar en la ciudad de Sao Paulo (Brasil), entre 105 pacientes que presentaron una imagen radiográfica compatible con aspergiloma y/o con cavidades pulmonares residuales. La contrainmunoelectroforesis (CIE) en gel de agarosa fue positiva en 18 (72%) pacientes que tenían una imagen radiográfica de un aspergiloma y en 7 (28%) de los casos que tenían una cavidad pulmonar vacía. La inmunodifusión (ID) fue positiva solamente en 20 (80%) de estos pacientes. La CIE detectó títulos de anticuerpos contra Aspergillus fumigatus en los 25 casos de aspergilosis pulmonar. La existencia del aspergiloma fue confirmada quirúrgicamente en 3 pacientes; del material de dos aspergilomas extirpados se cultivó el A. fumigatus. Aspegilos de la misma especie se cultivaron del esputo de 5 (25.7%) enfermos, de los 18 que tenían aspergiloma y en 3 de los 7 casos que tenían aspergilosis intracavitaria parietal

Hongos y pulmon / Fungi and lung

Se destacan y analizan algunas relaciones hospedero-hongo en procesos clínicos pulmonares tales como: la potencialidad inmunológica de las paredes celulares fúngicas, los mecanismos de defensa específicos e inespecíficos del hospedero; los avances en el serodiagnóstico incluyendo la detección de Ac, Ag y metabolitos fúngicos. Se comentan las dificultades en la obtención de antígenos estables y estandarizados debido a la compleja naturaleza química de estos organismos agravada por su marcado polimorfismo