Paracoccidioidomycosis

Background

This fungal infection is caused by inhalation of the organism which is usually found in the soil.

EPIDEMIOLOGY CHARACTERIZATION

SYNONYMS South American Blastomycosis

GEOGRAPHY
Central and South America

LABORATORY/RADIOLOGY CHARACTERIZATION

LABORATORY

CEREBROSPINAL FLUID

Anti-gp43 Antibodies in the Cerebrospinal Fluid of Patients With Central Nervous System Involvement by Paracoccidioidomycosis

Sérgio M. de Almeida, MD, PhD,1,3 Flávio Queiroz-Telles, MD, PhD,2 Elvira M. Doi,3 Margaret Ono,3 and Lineu C. Werneck, MD, PhD

Am J Clin Pathol 2002;118:864-868 Abstract quote

Paracoccidioidomycosis (PCM) is a chronic granulomatous infectious disease, endemic in subtropical areas of Central and South America. The diagnosis of the central nervous system (CNS) involvement with PCM (neuroparacoccidioidomycosis [NPCM]) frequently is difficult. A definitive diagnosis usually is made by visualization or isolation of Paracoccidioides brasiliensis from CNS biopsy or necropsy material.

In the present study, we determined the presence of anti-gp43 antibodies in the cerebrospinal fluid (CSF) of patients with CNS involvement in PCM by enzyme-linked immunosorbent assay (ELISA) in 9 cases of NPCM and 15 control cases. ELISA anti-gp43 was compared with double immunodiffusion (DID). ELISA anti-gp43 was positive in 8 (89%) of 9 CSF samples from patients with NPCM and negative in all CSF samples of the control group. DID was negative in all CSF samples from patients with NPCM and control samples. ELISA anti-gp43 in CSF samples is better than DID for the diagnosis of NPCM.

It is a sensitive and specific diagnostic method and has high predictive values. To our knowledge, this is the first time ELISA anti-gp43 was applied to CSF.

GROSS APPEARANCE/CLINICAL VARIANTS CHARACTERIZATION

General

VARIANTS

Acute pulmonary disease

Chronic pulmonary disease

Disseminated infection

Acute disease occurs in adolescents and young adults and presents with polymorphous skin lesions, sparing the mucous membranes

Chronic disease has mucosal ulcerations of lips and mouth in 30-50% of patients

Primary cutaneous disease

Secondary cutaneous disease

HISTOLOGICAL TYPES CHARACTERIZATION

General
Mixed inflammatory cell infiltrate

Variably sized organisms ranging from 5-9 um

Single or multiple buds with distinct steering wheel appearance

Clin Infect Dis 1996;23:1026-1032.

Commonly Used Terms

Fungal

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Last Updated 12/10/2002

EPIDEMIOLOGY	CHARACTERIZATION
SYNONYMS	South American Blastomycosis
GEOGRAPHY	Central and South America

LABORATORY/RADIOLOGY	CHARACTERIZATION
LABORATORY
CEREBROSPINAL FLUID
Anti-gp43 Antibodies in the Cerebrospinal Fluid of Patients With Central Nervous System Involvement by Paracoccidioidomycosis Sérgio M. de Almeida, MD, PhD,1,3 Flávio Queiroz-Telles, MD, PhD,2 Elvira M. Doi,3 Margaret Ono,3 and Lineu C. Werneck, MD, PhD	Am J Clin Pathol 2002;118:864-868 Abstract quote Paracoccidioidomycosis (PCM) is a chronic granulomatous infectious disease, endemic in subtropical areas of Central and South America. The diagnosis of the central nervous system (CNS) involvement with PCM (neuroparacoccidioidomycosis [NPCM]) frequently is difficult. A definitive diagnosis usually is made by visualization or isolation of Paracoccidioides brasiliensis from CNS biopsy or necropsy material. In the present study, we determined the presence of anti-gp43 antibodies in the cerebrospinal fluid (CSF) of patients with CNS involvement in PCM by enzyme-linked immunosorbent assay (ELISA) in 9 cases of NPCM and 15 control cases. ELISA anti-gp43 was compared with double immunodiffusion (DID). ELISA anti-gp43 was positive in 8 (89%) of 9 CSF samples from patients with NPCM and negative in all CSF samples of the control group. DID was negative in all CSF samples from patients with NPCM and control samples. ELISA anti-gp43 in CSF samples is better than DID for the diagnosis of NPCM. It is a sensitive and specific diagnostic method and has high predictive values. To our knowledge, this is the first time ELISA anti-gp43 was applied to CSF.

GROSS APPEARANCE/CLINICAL VARIANTS	CHARACTERIZATION
General
VARIANTS
Acute pulmonary disease
Chronic pulmonary disease
Disseminated infection	Acute disease occurs in adolescents and young adults and presents with polymorphous skin lesions, sparing the mucous membranes Chronic disease has mucosal ulcerations of lips and mouth in 30-50% of patients
Primary cutaneous disease
Secondary cutaneous disease