Macedo Priscila Marques de, Almeida-Paes Rodrigo, Almeida Marcos de Abreu, Coelho Rowena Alves, Andrade Hugo Boechat, Ferreira Ana Beatriz Teixeira Brandão Camello, Zancopé-Oliveira Rosely Maria, Valle Antonio Carlos Francesconi do
Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil.
Mem Inst Oswaldo Cruz. 2018 Mar;113(3):167-172. doi: 10.1590/0074-02760170310.
Paracoccidioidomycosis (PCM) is one of the most important systemic mycoses in Latin America and the leading fungal cause of mortality in non-immunosuppressed individuals in Brazil. However, HIV/PCM co-infection can increase the clinical severity in these co-infected patients. This co-infection is rarely reported in the literature mainly because of the different epidemiological profiles of these infections. Furthermore, PCM is a neglected and non-notifiable disease, which may underestimate the real importance of this disease. The advent of molecular studies on the species of the genus Paracoccidioides has expanded the knowledge regarding the severity and the clinical spectrum in PCM. In this context, the development of studies to describe the association of the Paracoccidioides phylogenetic cryptic species in vulnerable populations, such as HIV-infected patients, appears relevant.
To describe the clinical, epidemiological, therapeutic and prognostic aspects in HIV/PCM co-infected patients, along with the molecular identification of the Paracoccidioides species involved in these cases.
The investigators performed a molecular and clinical retrospective study involving HIV/PCM co-infected patients, from a reference centre for PCM care in the endemic area of Rio de Janeiro, Brazil, from 1998 to 2015. Molecular identification of the fungal strains was done by amplification of partial sequences of arf and gp43 genes.
Of 89 patients diagnosed with PCM by fungal isolation in the culture, a viable isolate was recovered for molecular analysis from 44 patients. Of these 44 patients, 28 (63.6%) had their serum samples submitted for enzyme immunoassay tests for screening of HIV antibodies, and 5 (17.9%) had a positive result. All cases were considered severe, with a variable clinical presentation, including mixed, acute/subacute clinical forms and a high rate of complications, requiring combination therapy. Paracoccidioides brasiliensis S1 was the species identified in all cases.
HIV/PCM co-infection can change the natural history of this fungal disease. The authors reinforce the need to include HIV screening diagnostic tests routinely for patients with PCM.
副球孢子菌病（PCM）是拉丁美洲最重要的系统性真菌病之一，也是巴西非免疫抑制个体中主要的真菌致死原因。然而，HIV/PCM合并感染会增加这些合并感染患者的临床严重程度。这种合并感染在文献中很少报道，主要是因为这两种感染的流行病学特征不同。此外，PCM是一种被忽视且无需上报的疾病，这可能低估了该疾病的实际重要性。对副球孢子菌属物种的分子研究的出现，扩展了关于PCM严重程度和临床谱的知识。在此背景下，开展研究以描述副球孢子菌系统发育隐性物种在诸如HIV感染患者等脆弱人群中的关联显得很有必要。
描述HIV/PCM合并感染患者的临床、流行病学、治疗和预后情况，以及对这些病例中涉及的副球孢子菌物种进行分子鉴定。
研究人员对1998年至2015年期间来自巴西里约热内卢地方病地区PCM治疗参考中心的HIV/PCM合并感染患者进行了分子和临床回顾性研究。通过扩增arf和gp43基因的部分序列对真菌菌株进行分子鉴定。
在89例通过培养真菌分离确诊为PCM的患者中，从44例患者中获得了可用于分子分析的活分离株。在这44例患者中，28例（63.6%）的血清样本接受了酶免疫测定试验以筛查HIV抗体，5例（17.9%）结果呈阳性。所有病例均被认为病情严重，临床表现多样，包括混合型、急性/亚急性临床形式，且并发症发生率高，需要联合治疗。所有病例中鉴定出的物种均为巴西副球孢子菌S1。
HIV/PCM合并感染可改变这种真菌病的自然病程。作者强调对PCM患者常规进行HIV筛查诊断试验的必要性。
