ABSTRACT
This report describes the differences in isotype antibody reactivity against a crude Paracoccidioides brasiliensis antigenic preparation in the sub-acute (SAF) and chronic (CF) forms of paracoccidioidomycosis before treatment. IgG antibodies were detected in all patients, with a slightly but not significantly higher reactivity in the SAF. IgG1 antibodies were present, frequently at high levels, in both forms, whereas IgG3 was always low or absent. IgG2 antibodies were detectable in most patients, but at high levels in only a few CF patients. IgG4 was found mainly in SAF patients, whereas IgA was detected almost only in CF patients, probably due to a Th2 pattern of immune response in the more severe SAF, and the characteristic mucosal involvement of the CF, respectively. Immunoblot analysis showed that, in addition to the 43-kDa immunodominant fraction, other less well-characterised fractions were also recognised differentially by the isotypes and deserve further investigation.
Subject(s)
Antibodies, Fungal/blood , Antigens, Fungal/immunology , Immunoglobulin Isotypes/blood , Paracoccidioides/immunology , Paracoccidioidomycosis/immunology , Acute Disease , Chronic Disease , Enzyme-Linked Immunosorbent Assay , Humans , ImmunoblottingABSTRACT
Several serological tests have been used successfully in the diagnosis of paracoccidioidomycosis (PCM). In contrast, data about the use of these tests in the follow-up of PCM patients have been heterogeneous. In this study, serum samples from 43 PCM patients with different clinical forms were analysed by counter-immuno-electrophoresis (CIE), complement fixation (CF) and ELISA before treatment. With CIE and ELISA, the chronic unifocal form showed significantly lower antibody levels compared with chronic multifocal and acute forms. Acute form patients had significantly higher titres than patients with multifocal disease by CIE but not by ELISA. No significant differences were observed with CF. Twenty-seven of these patients were followed-up for 2 years and showed a decline in antibody levels by all three tests, paralleling clinical improvement. However, only patients with unifocal disease cleared their antibodies after 1 year of treatment as analysed by CF and ELISA and after 2 years by CIE, suggesting that these patients may need shorter courses of therapy. Patients with the other clinical form of the disease needed > or =2 years of therapy to clear their antibodies. Sera from a further five patients who presented with a relapse were analysed. At the time of relapse all showed increases in antibody levels by CIE and ELISA, but only three showed increases by CF tests. Therefore, CIE and ELISA demonstrated a better clinical correlation than CF, probably reflecting the fungal burden of PCM patients more accurately.
Subject(s)
Antibodies, Fungal/blood , Paracoccidioides/immunology , Paracoccidioidomycosis/immunology , Acute Disease , Antibodies, Fungal/biosynthesis , Antifungal Agents/therapeutic use , Chronic Disease , Complement Fixation Tests , Counterimmunoelectrophoresis , Enzyme-Linked Immunosorbent Assay , Evaluation Studies as Topic , Follow-Up Studies , Humans , Immunodiffusion , Paracoccidioidomycosis/drug therapyABSTRACT
A literatura médica, no Brasil, registra rasos casos de paracoccidioidomicose em pacientes aidéticos (Bernard et al., em publicaçäo; Carnaúba et al.; Pedro et al; Goldani et al. e Bakos et al. totalizando 7 (sete) observaçöes, publicadas ou comunicadas em congressos. Esta ocorrência contrasta com a grande freqüência de candidíase (incluindo formas profundas), criptococose e histoplasmose, associadas a infecçäo pelo vírus HIV. Tal fato talves possa ser explicado por ser a AIDS síndrome infecciosa predominante urbana e a paracoccidioidomicose doença essencialmente de zonas rurais. Em soros de 50 pacientes com paracoccidioidomicose, 40 do sexo masculino (80%) e 10 do sexo feminino (20%) foram pesquisados anticorpos HIV-1 pela técnica ELISA e, em 19 casos limítrofes (38%) foi realizado teste confirmatório, pela técnica de Western-blot. Somente em um caso de paracoccidioidomicose foram detectados anticorpos específicos HIV-1 em 5 pacientes (10%) foram revelados anticorpos, provavelmente inespecíficos, anti-p24; gp160 em 3 casos (6%); gpl120 em dois casos (4%); e gp3 em um caso (2%). Dos sete soros de pacientes com bandas consideradas inespecíficas, repetidas as provas sorológicas para AIDS, com amostras colhidas alguns meses após (ver dados anexos), apenas em 1 foram registrados resultados positivos, com faixas de baixa intensidade. Tais pacientes, examinados na época, näo apresentaram nenhuma manifestaçäo clínica de AIDS ou de pré-AIDS
