Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 associated with acquired immunodeficiency syndrome: A case report / Paracoccidioidomicosis por Paracoccidioides brasiliensis S1 asociado al síndrome de inmunodeficiencia adquirida: A propósito de un caso

BACKGROUND: Paracoccidioidomycosis (PCM) is an endemic disease in Latin America. In immunocompetent hosts, PCM occurs in two main clinical forms: acute and chronic. However, in HIV-infected patients PCM may show up simultaneous manifestations of acute and chronic forms. CASE REPORT: We present the case of a patient diagnosed with HIV who had disseminated skin lesions and generalized lymphadenopathy, as well as respiratory and central nervous system involvement. The PCM diagnosis was confirmed by direct KOH examination, double immunodiffusion and the isolation of the fungus in samples of an abscess in the subcostal region. The isolate was identified as Paracoccidioides brasiliensis S1 by species-specific PCR using primers for protein-coding gene GP43 (exon 2) followed by PCR-RFLP of the alpha-tubulin gene. CONCLUSIONS: There are few data in literature reporting species-specific molecular identification of Paracoccidioides in HIV/PCM patients. Therefore, this case report may contribute to improve the knowledge about this severe disease, its causative cryptic species, and its consequences to patients

ANTECEDENTES: La paracoccidioidomicosis (PCM) es una enfermedad endémica en Latinoamérica. En los pacientes inmunocompetentes, la PCM cursa con dos principales formas: aguda y crónica. Sin embargo, los pacientes infectados por el VIH pueden presentar manifestaciones simultáneas de las dos formas clínicas. CASO CLÍNICO: Se presenta el caso de un paciente VIH-positivo, con lesiones cutáneas diseminadas, linfadenopatía generalizada y afectación del sistema nervioso central y respiratorio. El diagnóstico de PCM se confirmó mediante un examen directo con KOH, doble inmunodifusión y el aislamiento del hongo en cultivo, a partir de muestras de un absceso en la región subcostal. La cepa aislada se identificó como Paracoccidioides brasiliensis S1 mediante PCR especie-específica del gen codificador de la proteína GP43 (exón 2), seguida de PCR-RFLP del gen de la alfa-tubulina. CONCLUSIONES: Existen pocos datos en la literatura que describan la identificación molecular especie-específica de Paracoccidioides en pacientes con VIH/PCM. Por lo tanto, la presentación de este caso clínico puede contribuir a mejorar el conocimiento sobre esta enfermedad grave, la especie críptica implicada y sus consecuencias para los pacientes

Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 associated with acquired immunodeficiency syndrome: A case report.

BACKGROUND: Paracoccidioidomycosis (PCM) is an endemic disease in Latin America. In immunocompetent hosts, PCM occurs in two main clinical forms: acute and chronic. However, in HIV-infected patients PCM may show up simultaneous manifestations of acute and chronic forms. CASE REPORT: We present the case of a patient diagnosed with HIV who had disseminated skin lesions and generalized lymphadenopathy, as well as respiratory and central nervous system involvement. The PCM diagnosis was confirmed by direct KOH examination, double immunodiffusion and the isolation of the fungus in samples of an abscess in the subcostal region. The isolate was identified as Paracoccidioides brasiliensis S1 by species-specific PCR using primers for protein-coding gene GP43 (exon 2) followed by PCR-RFLP of the alpha-tubulin gene. CONCLUSIONS: There are few data in literature reporting species-specific molecular identification of Paracoccidioides in HIV/PCM patients. Therefore, this case report may contribute to improve the knowledge about this severe disease, its causative cryptic species, and its consequences to patients.

Perfil clínico-epidemiológico da tuberculose intestinal em pacientes de um hospital universitário / Clinical and epidemiological profile of intestinal tuberculosis in patients of a university hospital

OBJETIVO: Estabelecer o perfil clínico-epidemiológico da tuberculose intestinal em pacientes assistidos em um ambulatório específico. MÉTODOS: Estudo descritivo e retrospectivo, no qual foram avaliadas as principais características da população com diagnóstico de tuberculose intestinal atendida em um hospital universitário e notificada de janeiro 2009 a junho de 2017. RESULTADOS: A população foi constituída na maioria por mulheres, com média de 47,7 anos, negativas para o anti-HIV e residentes na região metropolitana. Ao diagnóstico, 27,3% apresentavam alteração de hábito intestinal e 45,4% doença fistulizante/ estenosante. Quase todos os resultados do PPD foram positivos, e 100% das radiografias de tórax não possuíam anormalidades. No histopatológico do segmento intestinal, o achado mais prevalente foi o granuloma caseoso. CONCLUSÃO: A tuberculose deve ser investigada em pacientes com doença intestinal no nosso país. (AU)

epidemiological profile of intestinal tuberculosis in patients assisted in a specific outpatient clinic. METHODS: This was a descriptive and retrospective study evaluating the main characteristics of the population with diagnosis of Intestinal tuberculosis treated at a University Hospital, and notified from January 2009 to June 2017. RESULTS: The population consisted mostly of women, with a mean age of 47.7 years, negative for anti-HIV, and livingin the metropolitan region of the city. At diagnosis, 27.3% presented changed bowel habits, and 45.4% fistulizing/stenosing disease. Almost all PPD results were positive and 100% of chest radiographs had no abnormalities. In the histopathology of the intestinal segment, the most prevalent finding was caseous granuloma. CONCLUSION: Tuberculosis should be investigated in patients with intestinal disease in our country. (AU)

Establishment of HTLV-I-infected cell lines from peripheral blood mononuclear cells of Brazilian patients.

To investigate epidemiological and pathogenetic features of HTLV-I infection, a cohort of carriers has been followed at the USP Teaching Hospital since 1991. This study describes the establishment of cell lines from peripheral blood mononuclear cells (PBMC) of infected subjects. Ex vivo PBMC were cultured with those from a seronegative donor and morphologic evidence of cell transformation was obtained after 90 days with detection of multinucleated cells exhibiting cerebriform nuclei. Integration of HTLV-I proviral DNA and expression of viral antigens was demonstrated in culture by PCR and immunofluorescence. Cell lines were maintained for 240 days, gradually weaned from exogenous IL-2. Immunophenotyping of cell lines on flow cytometry yielded evidence of cell activation. Establishment of HTLV-I-infected cell lines from ex vivo PBMC is feasible and may be useful for studies on lymphocyte phenotypic changes and on mechanisms of HTLV-induced cell proliferation. Moreover they may be used with diagnostic purposes in immunofluorescence tests.

Establishment of HTLV-I-infected cell lines from peripheral blood mononuclear cells of Brazilian patients

Para investigar a epidemiologia e patogênese da infecção por HTLV-I seguimos coorte de portadores dessa retrovirose no HC-FMUSP desde 1991. Este estudo descreve o estabelecimento de linhagens celulares a partir de células mononucleares periféricas (CMP) de indivíduos infectados. As CMP foram cultivadas com as de doador soronegativo, verificando-se após 90 dias evidência morfológica de transformação celular com detecção de células multinucleadas com núcleos cerebriformes. Demonstrou-se integração do DNA proviral e expressão in vitro de antígenos virais pela PCR e imunofluorescência. As linhagens celulares transformadas foram mantidas por 240 dias, com retirada gradual de IL-2 exógena. A imunofenotipagem por citometria de fluxo revelou ativação celular. O estabelecimento de linhagens celulares infectadas por HTLV-I a partir de CMP ex-vivo é exeqüível e pode ser útil na investigação de alterações fenotípicas linfocitárias e dos mecanismos de proliferação celular induzida por esse retrovírus. Podem ainda ser utilizadas com intuito diagnóstico em reações de imunofluorescência.

Identification of human T-lymphotropic virus type I (HTLV-I) subtypes using restricted fragment length polymorphism in a cohort of asymptomatic carriers and patients with HTLV-I-associated myelopathy/tropical spastic paraparesis from São Paulo, Brazil.

Although human T-lymphotropic virus type I (HTLV-I) exhibits high genetic stability, as compared to other RNA viruses and particularly to human immunodeficiency virus (HIV), genotypic subtypes of this human retrovirus have been characterized in isolates from diverse geographical areas. These are currently believed not to be associated with different pathogenetic outcomes of infection. The present study aimed at characterizing genotypic subtypes of viral isolates from 70 HTLV-I-infected individuals from São Paulo, Brazil, including 42 asymptomatic carriers and 28 patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), using restricted fragment length polymorphism (RFLP) analysis of long terminal repeat (LTR) HTLV-I proviral DNA sequences. Peripheral blood mononuclear cell lysates were amplified by nested polymerase chain reaction (PCR) and amplicons submitted to enzymatic digestion using a panel of endonucleases. Among HTLV-I asymptomatic carriers, viral cosmopolitan subtypes A, B, C and E were identified in 73.8%, 7.1%, 7.1% and 12% of tested samples, respectively, whereas among HAM/TSP patients, cosmopolitan A (89.3%), cosmopolitan C (7.1%) and cosmopolitan E (3.6%) subtypes were detected. HTLV-I subtypes were not statistically significant associated with patients' clinical status. We also conclude that RFLP analysis is a suitable tool for descriptive studies on the molecular epidemiology of HTLV-I infections in our environment.

Identification of Human T-lymphotropic Virus Type I (HTLV-I) Subtypes Using Restrited Fragment Length Polymorphism in a Cohort of Asymptomatic Carriers and Patients with HTLV-I-associated Myelopathy/tropical Spastic Paraparesis from Säo Paulo, Brazil

Although human T-lymphotropic virus type I (HTLV-I) exhibits high genetic stability, as compared to other RNA viruses and particularly to human immunodeficiency virus (HIV), genotypic subtypes of this human retrovirus have been characterized in isolates from diverse geographical areas. These are currently believed not to be associated with different pathogenetic outcomes of infection. The present study aimed at characterizing genotypic subtypes of viral isolates from 70 HTLV-I-infected individuals from Säo Paulo, Brazil, including 42 asymptomatic carriers and 28 patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), using restricted fragment length polymorphism (RFLP) analysis of long terminal repeat (LTR) HTLV-I proviral DNA sequences. Peripheral blood mononuclear cell lysates were amplified by nested polymerase chain reaction (PCR) and amplicons submitted to enzymatic digestion using a panel of endonucleases. Among HTLV-I asymptomatic carriers, viral cosmopolitan subtypes A, B, C and E were identified in 73.8 percent, 7.1 percent, 7.1 percent and 12 percent of tested samples, respectively, whereas among HAM/TSP patients, cosmopolitan A (89.3 percent), cosmopolitan C (7.1 percent) and cosmopolitan E (3.6 percent) subtypes were detected. HTLV-I subtypes were not statistically significant associated with patients' clinical status. We also conclude that RFLP analysis is a suitable tool for descriptive studies on the molecular epidemiology of HTLV-I infections in our environment