Paracoccidioidomycosis pathophysiology: Difference between revisions

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==Overview==
==Overview==
[[Spores]] of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' are commonly transmitted via the [[respiratory route]] to the human host. Following transmission, ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' particles invade the terminal [[bronchioles]] and [[alveoli]] where [[granulomas]] are formed, but can be inactive for approximately 40 years. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref> On microscopic histopathological analysis, a pilot's wheel or Mickey mouse ears-like appearance are a characteristic finding of [[Paracoccidioidomycosis|PCM]]. <ref>Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016</ref> <ref name="?">Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. ''CID''. 1996; 23: 1026-1032 </ref> <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
Spores of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' are commonly transmitted via the respiratory route to the human host. Following transmission, ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' particles invade the terminal bronchioles and alveoli where [[granulomas]] are formed, but can be inactive for up to 40 years.<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref> On microscopic histopathological analysis, a "pilot's wheel" or a "Mickey mouse ears-like" appearance is a characteristic finding of paracoccidioidomycosis (PCM).<ref>Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016</ref><ref name="?">Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. ''CID''. 1996; 23: 1026-1032 </ref><ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>


==Pathogenesis==
==Pathopysiology==
*[[Spores]] of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp]].'' are transmitted via the respiratory route to the human host.
 
*Rarely in can be transmitted via [[skin]] trauma, where the [[fungus]] attaches the skin and [[mucous membranes]]. Or via the [[digestive system]], after consuming contaminated food. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref> <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
=== Transmission ===
*Following transmission, ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' [[conidia]] and mycelial particles invade the terminal [[bronchioles]] and [[alveoli]] and convert into [[yeast]] cells. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref>
*Spores of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp]].'' are transmitted via the respiratory route to the human host.
*The organisms response to the primo-infection is: [[bronchoalveolitis]], which is normally asymptomatic.<ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*Rarely in can be transmitted via skin trauma, where the [[fungus]] attaches the skin and mucous membranes. Or via the digestive system, after consuming contaminated food.<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref><ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*After the primo-infection, the formation of [[granulomas]] start. [[Granulomas]] can be inactive for numerous years. <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*Following transmission, ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' conidia and mycelial particles invade the terminal bronchioles and alveoli where they convert into yeast cells.<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref>
*If the [[infection]] is active or gets activated, it can spread through [[lymphatic]] and hematic routes to other [[tissues]]<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref> such as: "[[kidneys]], [[spleen]], [[liver]], [[bone]], [[adrenal glands]], [[central nervous system]], and [[airways]], including the [[trachea]]." <ref name="pmid22236894">{{cite journal| author=Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL et al.| title=Thoracic paracoccidioidomycosis: radiographic and CT findings. | journal=Radiographics | year= 2012 | volume= 32 | issue= 1 | pages= 71-84 | pmid=22236894 | doi=10.1148/rg.321115052 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22236894  }} </ref>  
 
* [[Paracoccidioides brasiliensis|Paracoccidioides spp]]. has developed different mechanisms which avoid getting caught inside [[mucus]] and therefore not being eradicated by mucigen [[cilliary cells]]. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref>
=== Pathogenesis ===
*The powerful adherence characteristic of the [[species]] provides a rapid takeover of host cells and consequently the avoidance of the [[immune system]]. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref>
*The organisms response to the primo-infection is: bronchoalveolitis, which is normally asymptomatic.<ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*Following the primary infection, [[granulomas]] may form. [[Granulomas]] can be inactive for several years.<ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*If the infection is active or gets activated, it can spread through lymphatic and hematologic routes to other tissues such as: spleen, kidneys, adrenal glands, liver, bone, central nervous system, and airways.<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref><ref name="pmid22236894">{{cite journal| author=Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL et al.| title=Thoracic paracoccidioidomycosis: radiographic and CT findings. | journal=Radiographics | year= 2012 | volume= 32 | issue= 1 | pages= 71-84 | pmid=22236894 | doi=10.1148/rg.321115052 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22236894  }} </ref>  
* [[Paracoccidioides brasiliensis|''Paracoccidioides spp'']]''.'' have developed different mechanisms to avoid mucus and eradication by [[cilliary cells]].<ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref>
*The powerful adherence characteristic of the species provides a rapid takeover of host cells and consequently the avoidance of the immune system.<ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref>


==Genetics==
==Genetics==
*The majority of patients in countries such as Colombia and Brazil, with high prevalence of [[Paracoccidioidomycosis|PCM]], had "[[HLA-A9]], [[HLA-B13]], and [[HLA-B4]]" [[antigens]]. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
*The majority of patients in countries such as Colombia and Brazil, with high prevalence of PCM, had [[HLA-A9]], [[HLA-B13]], and HLA-B4 antigens.<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
*Chronic [[Paracoccidioidomycosis|PCM]] is associated with patients that have "C4B*-00 [[antigen]] of the [[class III major histocompatibility complex]]". <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
*Chronic PCM is associated with patients that have C4B*-00 antigen of the [[Major histocompatibility complex|class III major histocompatibility complex]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>


==Associated Conditions==
==Associated Conditions==
*Paracoccidiodomycosis has been associated with:
**[[Infectious diseases]]: The most important infectous disease that can be found concomitant with [[Paracoccidioidomycosis|PCM]] is pulmonary [[tuberculosis]] ([[Tuberculosis|TB]]). [[Tuberculosis|TB]] can hold up the diagnosis of [[Paracoccidioidomycosis|PCM]], because they have similar clinical manifestations. Other [[infectious diseases]] associated with PCM because they have the same risk factors are: " [[leishmaniasis]], [[leprosy]], [[Chagas disease|Chagas]] disease and [[strongyloidiasis]]." <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
**[[Cancer]]: The majority of patients with [[carcinoma]] and [[Paracoccidioidomycosis|PCM]], have the same organ or adjacent tissues involved. A risk factor for [[carcinoma]] is [[chronic inflammation]] with [[squamous metaplasia]], which has been described in 33% cases of [[Paracoccidioidomycosis|PCM]] in a study. <ref name="ccc">Da Silva G, Bittencourt C, De Mattos F, Da Silva J, Prolla J Severo L. Association between paracoccidioidomycosis and cancer. ''J. bras. pneumol.'' 2010;36(3), 356-362 </ref>


*Paracoccidioidomycosis is also considered an [[opportunistic infection]] in Latin America. Associated conditions are:
==== Paracoccidiodomycosis has been associated with: ====
**[[HIV AIDS|HIV/AIDS]]: [[Endemic]] areas of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp]]''. in Brazil have the majority of [[HIV AIDS|HIV/AIDS]] patients.<ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;Vol 6(2):89-117''</ref> Nevertheless, the incidence of [[HIV AIDS|HIV/AIDS]] and paracoccidioidomycosis is minimum, this may be because the [[prophylaxis]] ([[Sulfamethoxazole-Trimethoprim]]) used for ''[[Pneumocystis jiroveci]]'' is the one of the possible treatments for [[Paracoccidioidomycosis|PCM]]. <ref name="bbb">Amoroso A. A Man With Newly Diagnosed HIV/AIDS With Unusual Severe Opportunistic Infection and No AIDS-Defining Disease. ''CID''. 2014;58:1484-1485</ref>
* '''Concomitant infections'''
**[[Cancer]]: The majority of patients have been diagnosed at the same time (40%) or after the neoplasm diagnostic (60%). It is highly associated with solid organ and [[Hematological malignancies|hematologic neoplasias]]. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
**The most important infectious disease that can be found concomitant with PCM is pulmonary [[tuberculosis]] ([[Tuberculosis|TB]]). [[Tuberculosis|TB]] can hold up the diagnosis of PCM, because they have similar clinical manifestations. Other infectious diseases associated with PCM because they have the same risk factors are: [[leishmaniasis]], [[leprosy]], [[Chagas disease|Chagas disease]] and [[strongyloidiasis]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
**Transplants: [[Paracoccidioidomycosis|PCM]] has been described in cases of [[renal transplantation]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> The small amount of cases may be because of the use of [[Sulfamethoxazole-Trimethoprim]] as [[prophylaxis]] for ''[[Pneumocystis jiroveci]]'', which is one of the possible treatments for [[Paracoccidioidomycosis|PCM]]. <ref name="ddd">Zavascki A, Bienardt J, Severo L. Paracoccidioidomycosis in organ transplant recipient: case report. ''Rev. Inst. Med. trop. S. Paulo'' 2004;46(5), 279-281 </ref>
 
**[[Carpal Tunnel Syndrome]]: Only seen in Immunosupressed patients. <ref name="pmid3414040">{{cite journal| author=Lytkin MI, Petlenko VP| title=[A methodological analysis of the theory of traumatic disease]. | journal=Voen Med Zh | year= 1988 | volume=  | issue= 4 | pages= 11-4 | pmid=3414040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3414040  }} </ref>
* '''Cancer'''
**The majority of patients with [[carcinoma]] and PCM, have the same organ or adjacent tissues involved. A risk factor for [[carcinoma]] is chronic inflammation with [[squamous metaplasia]], which has been described in 33% cases of PCM in a study.<ref name="ccc">Da Silva G, Bittencourt C, De Mattos F, Da Silva J, Prolla J Severo L. Association between paracoccidioidomycosis and cancer. ''J. bras. pneumol.'' 2010;36(3), 356-362 </ref>
 
==== Paracoccidioidomycosis is also considered an opportunistic infection in Latin America. Associated conditions are: ====
* '''HIV/AIDS''':
**Endemic areas of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp]]''. in Brazil have the majority of [[HIV AIDS|HIV/AIDS]] patients.<ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;Vol 6(2):89-117''</ref> Nevertheless, the incidence of [[HIV AIDS|HIV/AIDS]] and paracoccidioidomycosis is minimum, this may be because the prophylaxis ([[Trimethoprim-Sulfamethoxazole|trimethoprim-sulfamethoxazole]]) used for ''[[Pneumocystis jiroveci]]'' is the one of the possible treatments for PCM.<ref name="bbb">Amoroso A. A Man With Newly Diagnosed HIV/AIDS With Unusual Severe Opportunistic Infection and No AIDS-Defining Disease. ''CID''. 2014;58:1484-1485</ref>
 
* '''Cancer''':
**The majority of patients have been diagnosed at the same time (40%) or after the neoplasm diagnostic (60%). PCM is highly associated with solid organ and [[Hematological malignancies|hematologic neoplasias]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
*'''Organ Transplantation''':
**PCM has been described in cases of [[renal transplantation]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> The small amount of cases may be because of the use of [[Trimethoprim-Sulfamethoxazole|trimethoprim-sulfamethoxazole]] as [[prophylaxis]] for ''[[Pneumocystis jiroveci]]'', which is one of the possible treatments for PCM.<ref name="ddd">Zavascki A, Bienardt J, Severo L. Paracoccidioidomycosis in organ transplant recipient: case report. ''Rev. Inst. Med. trop. S. Paulo'' 2004;46(5), 279-281 </ref>
 
* '''Carpal Tunnel Syndrome''':
**Only seen in Immunosupressed patients.<ref name="pmid3414040">{{cite journal| author=Lytkin MI, Petlenko VP| title=[A methodological analysis of the theory of traumatic disease]. | journal=Voen Med Zh | year= 1988 | volume=  | issue= 4 | pages= 11-4 | pmid=3414040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3414040  }} </ref>


==Gross Pathology==
==Gross Pathology==
[[Granulomas]] merge and form different shape [[nodules]] which can be seen macroscopically in the [[lungs]]. With time, the [[nodules]] tend to [[Necrosis|necrose]] and then cavitate. <ref name="pmid19608361">{{cite journal| author=Marchiori E, Valiante PM, Mano CM, Zanetti G, Escuissato DL, Souza AS et al.| title=Paracoccidioidomycosis: high-resolution computed tomography-pathologic correlation. | journal=Eur J Radiol | year= 2011 | volume= 77 | issue= 1 | pages= 80-4 | pmid=19608361 | doi=10.1016/j.ejrad.2009.06.017 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19608361  }} </ref>
*[[Granulomas]] merge and form different shape [[nodules]] which can be seen macroscopically in the lungs. With time, the [[nodules]] tend to necrose and then cavitate.<ref name="pmid19608361">{{cite journal| author=Marchiori E, Valiante PM, Mano CM, Zanetti G, Escuissato DL, Souza AS et al.| title=Paracoccidioidomycosis: high-resolution computed tomography-pathologic correlation. | journal=Eur J Radiol | year= 2011 | volume= 77 | issue= 1 | pages= 80-4 | pmid=19608361 | doi=10.1016/j.ejrad.2009.06.017 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19608361  }} </ref>


==Microscopic Pathology==
==Microscopic Pathology==
[[Paracoccidioides brasiliensis|Paracoccidioides spp]]. is a nonphotosynthetic [[eukaryote]] with a rigid [[cell wall]] and [[organelles]] very similar to those of higher [[eukaryotes]]. Being a [[dimorphic fungi]], it has the ability to grow an oval [[yeast]]-like form at 37°C and an elongated mycelial form produced at room temperature. The mycelial and [[yeast]] phases differ in their morphology, biochemistry, and ultrastructure. The [[yeast]] reproduces by asexualbudding, where [[Daughter cell|daughter cells]] are borne asynchronously at multiple, random positions across the cell surface. Buds begin by layers of [[cell wall]] increasing in optical density at a point that eventually gives rise to the [[daughter cell]]. Once the bud has expanded, a cleavage plane develops between the nascent cell and the mother cell. Following [[dehiscence]], the bud [[scar]] disappears. In [[tissue]], budding occurs inside the [[granulomatous]] center of the [[disease]] lesion, as visualized by [[Hematoxylin and eosin stain|hematoxylin and eosin]] (H&E) staining of histologic sections.  Nonbudding cells measure 5–15 µm in diameter, whereas those with multiple spherical buds measure from 10–20 µm in diameter. In electron microscopy, cells with multiple buds have been found to have peripherally located [[nuclei]] and [[cytoplasm]] surrounding a large central [[vacuole]]. In the [[tissue]] form, [[yeast]] cells are larger with thinner walls and a narrower bud base than those of the related [[dimorphic fungi]], Blastomycosis dermatitidis. The [[yeast]]-like form contains multiple [[nuclei]], a porous two-layered [[nuclear membrane]], and a thick cell wall rich in fibers, whereas the mycelial phase has thinner cell walls with a thin, electron-dense outer layer.<ref>Paracoccidioides Brasiliensis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioides_brasiliensis. Accessed on January 12, 2016</ref> We can differenciate P. lutzii from [[Paracoccidioides brasiliensis|P. brasiliensis]] because of its elongated, rod-shaped [[conidia]]. <ref>Paracoccidioides spp. LIFE-Leading International Fungal Education.http://www.life-worldwide.org/fungal-diseases/paracoccidioides-brasiliensis. Accessed on January 14, 2016</ref>
* The most important microscopically characteristic is the '''“ship’s wheel”''' or '''“Mickey mouse ears'''” appereance<ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
The most important microscopically characteristic is the “ship’s wheel” or “Mickey mouse ears” appereance <ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
<gallery>
Image:527_lores.jpg|Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.<ref>Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016</ref>
Image:498_lores.jpg|Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.<ref>Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016</ref>
Image:Paracoccidioidomycosis-37.jpg|This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.<ref>Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016</ref>
</gallery>


[[Image:527_lores.jpg|thumb|none|Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.<ref>Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016</ref>]] [[Image:498_lores.jpg|thumb|none|Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.<ref>Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016</ref>]] [[Image:Paracoccidioidomycosis-37.jpg|thumb|none|This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.. Methenamine silver stain.<ref>Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016</ref>]]
==References==
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{{reflist|2}}


[[Category:Fungal diseases]]
[[Category:Fungal diseases]]
[[Category:Infectious diseases]]

Latest revision as of 18:37, 18 September 2017

Paracoccidioidomycosis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac

Overview

Spores of Paracoccidioides spp. are commonly transmitted via the respiratory route to the human host. Following transmission, Paracoccidioides spp. particles invade the terminal bronchioles and alveoli where granulomas are formed, but can be inactive for up to 40 years.[1] On microscopic histopathological analysis, a "pilot's wheel" or a "Mickey mouse ears-like" appearance is a characteristic finding of paracoccidioidomycosis (PCM).[2][3][4]

Pathopysiology

Transmission

  • Spores of Paracoccidioides spp. are transmitted via the respiratory route to the human host.
  • Rarely in can be transmitted via skin trauma, where the fungus attaches the skin and mucous membranes. Or via the digestive system, after consuming contaminated food.[1][4]
  • Following transmission, Paracoccidioides spp. conidia and mycelial particles invade the terminal bronchioles and alveoli where they convert into yeast cells.[1]

Pathogenesis

  • The organisms response to the primo-infection is: bronchoalveolitis, which is normally asymptomatic.[4]
  • Following the primary infection, granulomas may form. Granulomas can be inactive for several years.[4]
  • If the infection is active or gets activated, it can spread through lymphatic and hematologic routes to other tissues such as: spleen, kidneys, adrenal glands, liver, bone, central nervous system, and airways.[1][5]
  • Paracoccidioides spp. have developed different mechanisms to avoid mucus and eradication by cilliary cells.[6]
  • The powerful adherence characteristic of the species provides a rapid takeover of host cells and consequently the avoidance of the immune system.[6]

Genetics

Associated Conditions

Paracoccidiodomycosis has been associated with:

  • Concomitant infections
    • The most important infectious disease that can be found concomitant with PCM is pulmonary tuberculosis (TB). TB can hold up the diagnosis of PCM, because they have similar clinical manifestations. Other infectious diseases associated with PCM because they have the same risk factors are: leishmaniasis, leprosy, Chagas disease and strongyloidiasis.[7]
  • Cancer
    • The majority of patients with carcinoma and PCM, have the same organ or adjacent tissues involved. A risk factor for carcinoma is chronic inflammation with squamous metaplasia, which has been described in 33% cases of PCM in a study.[8]

Paracoccidioidomycosis is also considered an opportunistic infection in Latin America. Associated conditions are:

  • Carpal Tunnel Syndrome:
    • Only seen in Immunosupressed patients.[12]

Gross Pathology

  • Granulomas merge and form different shape nodules which can be seen macroscopically in the lungs. With time, the nodules tend to necrose and then cavitate.[13]

Microscopic Pathology

  • The most important microscopically characteristic is the “ship’s wheel” or “Mickey mouse ears” appereance[4]
  • Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[14]

    Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[14]

  • Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[15]

    Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[15]

  • This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.[16]

    This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.[16]

References

  1. ↑ 1.0 1.1 1.2 1.3 Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA (2011). "Immunology of paracoccidioidomycosis". An Bras Dermatol. 86 (3): 516–24. PMID 21738969.
  2. ↑ Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016
  3. ↑ Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. CID. 1996; 23: 1026-1032
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
  5. ↑ Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL; et al. (2012). "Thoracic paracoccidioidomycosis: radiographic and CT findings". Radiographics. 32 (1): 71–84. doi:10.1148/rg.321115052. PMID 22236894.
  6. ↑ 6.0 6.1 de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F; et al. (2015). "Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis". Front Microbiol. 6: 1319. doi:10.3389/fmicb.2015.01319. PMC 4658449. PMID 26635779.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
  8. ↑ Da Silva G, Bittencourt C, De Mattos F, Da Silva J, Prolla J Severo L. Association between paracoccidioidomycosis and cancer. J. bras. pneumol. 2010;36(3), 356-362
  9. ↑ Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev.1993;Vol 6(2):89-117
  10. ↑ Amoroso A. A Man With Newly Diagnosed HIV/AIDS With Unusual Severe Opportunistic Infection and No AIDS-Defining Disease. CID. 2014;58:1484-1485
  11. ↑ Zavascki A, Bienardt J, Severo L. Paracoccidioidomycosis in organ transplant recipient: case report. Rev. Inst. Med. trop. S. Paulo 2004;46(5), 279-281
  12. ↑ Lytkin MI, Petlenko VP (1988). "[A methodological analysis of the theory of traumatic disease]". Voen Med Zh (4): 11–4. PMID 3414040.
  13. ↑ Marchiori E, Valiante PM, Mano CM, Zanetti G, Escuissato DL, Souza AS; et al. (2011). "Paracoccidioidomycosis: high-resolution computed tomography-pathologic correlation". Eur J Radiol. 77 (1): 80–4. doi:10.1016/j.ejrad.2009.06.017. PMID 19608361.
  14. ↑ Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016
  15. ↑ Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016
  16. ↑ Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016
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