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We report a case of unusual paracoccidioidomycosis reactivation after eyebrow micropigmentation in a Brazilian patient. The cutaneous lesion was the only clinical manifestation. Direct cutaneous inoculation in dermal tissues with Paracoccidioides sp. is extremely rare, explaining why paracoccidioidomycosis is not classically considered a cutaneous implantation mycosis.

Introdução/Objetivo: Aeromonas spp. são microrganismos ubíquos, frequentemente encontrados em ambientes aquáticos, e podem causar infecções graves em pacientes imunossuprimidos. Este estudo tem como objetivo avaliar as características clínicas e microbiológicas de pacientes oncológicos com bacteremia por este microrganismo. Métodos: Estudo retrospectivo, envolvendo pacientes com Aeromonas spp. isolado em hemoculturas no período de janeiro de 2013 a maio de 2023 em um hospital oncológico. As características clínicas e demográficas dos pacientes foram analisadas. A identificação e o perfil de sensibilidade das cepas de Aeromonas aos antimicrobianos foram determinadas por métodos automatizados (VITEK2). Resultados: Foram identificados 56 pacientes com bacteremia por Aeromonas spp. A maioria era do sexo masculino (32; 57,1%) e portador de tumor sólido (41; 73,2%), principalmente câncer de pâncreas (14; 25,0%) e de vias biliares (8; 14,3%). Quinze (26,8%) pacientes tinham doença onco-hematológica (10; 17,9% tinham leucemia mieloide aguda). Vinte (35,7%) pacientes eram neutropênicos e 37 (66,1%) receberam quimioterapia nos 30 dias antes do diagnóstico. Maioria das infecções foram identificadas na admissão (34; 60,7%) e o sitio primário de infeção foi o trato biliar na maior parte dos casos (23; 41,1%), mas 21 pacientes (37,5%) apresentaram infecção primária da corrente sanguínea. A maioria dos casos (30;53,6%) foram considerados como infecção polimicrobiana; E. coli (15; 26,8%) e K. pneumoniae (14; 25%) foram os microrganismos mais isolados. Mais de 90% das cepas de Aeromonas eram sensíveis aos aminoglicosídeos, cefalosporinas de 3ª e 4ª gerações, piperacilina-tazobactam, carbapenêmicos e fluorquinolonas. Meropenem (26; 46,4%) e piperacilina-tazobactam (19; 33,9%) foram os antimicrobianos mais utilizados para o tratamento. A mortalidade em 7 e 30 dias foi de 41,1% e 60,7%, respectivamente. Conclusão: Pacientes com câncer podem apresentar infecções intra e extra-abdominais por Aeromonas, com elevada mortalidade. A maioria das infecções eram admissionais e polimicrobianas. Os beta-lactâmicos (cefalosporinas de 3ª e 4ª gerações; piperacilina-tazobactam e carbapenêmicos), os aminoglicosídeos e as quinolonas continuam ativos contra este microrganismo.

Introdução/Objetivo: A Aspergilose Pulmonar Crônica (APC) é uma doença progressiva causada por Aspergillus spp. majoritariamente em pacientes imunocompetentes com doença pulmonar crônica subjacente. Raramente a APC é descrita em Pacientes que Vivem com HIV (PVHIV), sendo encontrada essa associação apenas em séries e relatos de casos. A infecção pelo HIV não tratada pode levar à imunossupressão e aumentar o risco de aspergilose. Nosso objetivo é avaliar as características clínicas, diagnóstico, tratamento e desfechos da APC em PVHIV. Métodos: Série de casos de pacientes diagnosticados com APC em PVHIV, com base nos critérios do ESCMID/ERS 2016, com acompanhamento em um hospital terciário na cidade de São Paulo-SP, durante o período de 2012 a 2023. Resultados: O estudo incluiu 7 pacientes, maioria era do sexo masculino (n=6). A idade variou de 25 a 59 anos. A condição pulmonar mais importante foi Tuberculose (TB) (n=5), sendo 3 pacientes com TB ativa concomitante com APC, e 2 pacientes com TB prévia. Encontramos também micobactérias não tuberculosas (n=1), criptococose pulmonar (n=1) e actinomicose pulmonar (n=1) como doenças pulmonares associadas. No momento do diagnóstico de APC, a maioria tinha CD4

Paracoccidioidomycosis (PCM) is an important endemic, systemic disease in Latin America caused by Paracoccidioides spp. This mycosis has been associated with high morbidity and sequels, and its clinical manifestations depend on the virulence of the infecting strain, the degree and type of immune response, infected tissues, and intrinsic characteristics of the host. The T helper(Th)1 and Th17/Th22 cells are related to resistance and control of infection, and a Th2/Th9 response is associated with disease susceptibility. In this study, we focused on interleukin(IL)-12p35 (IL12A), IL-18 (IL18), and IFN-γ receptor 1 (IFNGR1) genetic polymorphisms because their respective roles have been described in human PCM. Real-time PCR was employed to analyze IL12A-504 G/T (rs2243115), IL18-607 C/A (rs1946518), and IFNGR1-611 A/G (rs1327474) single nucleotide polymorphisms (SNP). One hundred forty-nine patients with the acute form (AF), multifocal chronic (MC), or unifocal chronic (UC) forms of PCM and 110 non-PCM individuals as a control group were included. In the unconditional logistic regression analysis adjusted by ethnicity and sex, we observed a high risk of the IL18-607 A-allele for both AF [p = 0.015; OR = 3.10 (95% CI: 1.24–7.77)] and MC groups [p = 0.023; OR = 2.61 (95% CI: 1.14–5.96)] when compared with UC. The IL18-607 A-allele associated risk for the AF and MC groups as well as the protective role of the C-allele in UC are possibly linked to higher levels of IL-18 at different periods of the course of the disease. Therefore, a novel role of IL18-607 C/A SNP is shown in the present study, highlighting its importance in the outcome of PCM.

Background Progressive disseminated histoplasmosis is a significant issue in Latin America, particularly in Brazil, contributing to high mortality rates. Objectives Our objectives were to comprehensively describe histoplasmosis treatment with various amphotericin B (AmB) formulations, including mortality rates, adverse effects and risk factors for mortality. Methods This multicentre retrospective cohort study (January 2014–December 2019) evaluated medical records of patients with proven or probable histoplasmosis treated with at least two doses of AmB in seven tertiary medical centres in Brazil. We assessed risk factors associated with death during hospitalization using univariate and multivariate analyses. Results The study included 215 patients, mostly male (n  = 158, 73%) with HIV infection (n  = 187, 87%), and a median age of 40 years. Only 11 (5%) patients initiated treatment with liposomal amphotericin B (L-AmB). Amphotericin B deoxycholate (D-AmB) was administered to 159 (74%) patients without changes in the treatment. The overall mortality during hospitalization was 23% (50/215). Variables independently associated with mortality were use of D-AmB (OR 4.93) and hospitalization in ICU (OR 9.46). There was a high incidence of anaemia (n  = 19, 90%), acute kidney injury (n  = 96, 59%), hypokalaemia (n  = 73, 55%) and infusion reactions (n  = 44, 20%) during treatment. Conclusions We found that D-AmB was the main formulation, which was also associated with a higher mortality rate. Lipid formulations of AmB have become more readily available in the public health system in Brazil. Further studies to evaluate the effectiveness of L-AmB will likely show improvements in the treatment outcomes for patients with disseminated histoplasmosis. [ABSTRACT FROM AUTHOR]

Abstract Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis ( P. brasiliensis ) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii ( P. lutzii ), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients’ sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.

Background: The radiological manifestations of central nervous system (CNS) cryptococcosis are diverse and often subtle. There is heterogeneity on how different neuroimaging patterns impact prognosis. This study aims to assess the association between the neuroimaging and clinical outcomes of CNS cryptococcosis. Methods: All patients with CNS cryptococcosis between July 2017 and April 2023 who underwent brain magnetic resonance imaging (MRI) were included. The primary outcome was mortality during hospitalisation. Secondary outcomes were readmission, ventricular shunting, duration of hospitalisation and time to the first negative cerebrospinal fluid culture. We compared the outcomes for each of the five main radiological findings on the brain MRI scan. Results: We included 46 proven CNS cryptococcosis cases. The two main comorbidity groups were HIV infection (20, 43%) and solid organ transplantation (10, 22%), respectively. Thirty‐nine patients exhibited at least one radiological abnormality (85%), with the most common being meningeal enhancement (34, 74%). The mortality rates occurred at 11% (5/46) during hospitalisation. We found no significant disparities in mortality related to distinct radiological patterns. The presence of pseudocysts was significantly associated with the need for readmission (p =.027). The ventricular shunting was significantly associated with the presence of pseudocysts (p =.005) and hydrocephalus (p =.044). Conclusion: In this study, there is no association between brain MRI findings and mortality. Larger studies are needed to evaluate this important issue. [ABSTRACT FROM AUTHOR]

Fingolimod is a sphingosine-1-phosphate receptor modulator used to treat multiple sclerosis. While fingolimod has been associated with an increased risk of cryptococcal meningitis, its correlation with other deep mycoses remains unclear. In this study, we conducted a scoping review of fingolimod associated with histoplasmosis, based on a case report, a literature review, and data from the FDA Adverse Events Reporting System (FAERS) as of January 24th, 2023. A 30-year-old Brazilian woman diagnosed with relapsing-remitting multiple sclerosis, receiving a daily dose of 0.5 mg of fingolimod, presented with a two-month history of fever and unintended weight loss, accompanied by lymphadenopathy, splenomegaly, and lung involvement was investigated. Biopsy of a lung nodule revealed fungal structures suggestive of Histoplasma sp. Additionally, serological testing yielded positive for Histoplasma capsulatum. Disseminated histoplasmosis should be considered in the differential diagnosis of febrile syndromes in patients undergoing fingolimod therapy for multiple sclerosis, particularly in the Americas, where this mycosis is endemic. Treatment with itraconazole and modification of immunotherapy can achieve excellent clinical outcomes.

Naganishia albida (Cryptococcus albidus) is considered saprophytic fungi, and is rarely reported as a human pathogen. Cutaneous infections caused by non-neoformans cryptococcus are rare. We describe a case of an immunocompetent older male with cutaneous cryptococcosis caused by Naganishia albida following skin trauma, and conduct a literature review in PubMed, Lilacs, and Embase. Only six previous similar reports were found. The seven cases (including ours) were widely distributed geographically (Brazil, the US, the UK, Hungary, South Korea, and Iran), all males, and their ages varied, ranging from 14 to 86 years. Four individuals had underlying skin diseases (Sezary Syndrome, psoriasis, and skin rash without etiology) plus potentially immunosuppressive underlying conditions (diabetes mellitus, kidney transplantation, and the use of etanercept, adalimumab, and methylprednisolone). Cutaneous presentation was polymorphic, with lesions characterized as warts, ulcers, plaques, and even macules. Two patients presented disseminated disease. Serum cryptococcal antigen was negative in six patients, and diagnosis was made by fungal culture in all. There is a lack of data on optimal antifungal treatment and outcomes.

Chronic pulmonary aspergillosis (CPA) is divided into five subtypes. The diagnosis of CPA is complicated due to poor sensitivity of the laboratory tests. Diagnostic performance of different antigen, serological, and microbiological methods in subtypes of CPA is unknown. The purpose of this study was to evaluate the diagnostic performance in different subtypes of CPA. A total of 91 participants with CPA were included, and the study was performed at Hospital das Clínicas of University of São Paulo. Bronchoalveolar lavage galactomannan (73%, 11/15), serology by immunodiffusion test (81%, 61/75), and histology (78%, 39/50) had the best sensitivity. The counterimmunoelectrophoresis (CIE) titers had a significant statistical difference between the CPA subtypes (P < 0.001), in which the forms chronic fibrosing pulmonary aspergillosis (CFPA) and subacute invasive aspergillosis (SAIA) had higher titers: 1/64 (interquartile range [IQR]: 1/32-1/256) and 1/64 (1/32-1/128). C-reactive protein generally presented lower values (median 15 mg/L, IQR: 6-33), with higher values in SAIA and lower values for Aspergillus nodule. Overall, we found a low diagnostic sensitivity of current tests. Regarding the CPA subtypes, we did not find great differences in the performance of the tests, but it is observed that the inflammatory markers and CIE titers tend to be higher in forms of the more extensive lung parenchyma involvement, such as SAIA and CFPA.