PMID- 36074014 OWN - NLM STAT- MEDLINE DCOM- 20221223 LR - 20230918 IS - 1098-6618 (Electronic) IS - 0893-8512 (Print) IS - 0893-8512 (Linking) VI - 35 IP - 4 DP - 2022 Dec 21 TI - Paracoccidioidomycosis: Current Status and Future Trends. PG - e0023321 LID - 10.1128/cmr.00233-21 [doi] LID - e00233-21 AB - Paracoccidioidomycosis (PCM), initially reported in 1908 in the city of Sao Paulo, Brazil, by Adolpho Lutz, is primarily a systemic and neglected tropical mycosis that may affect individuals with certain risk factors around Latin America, especially Brazil. Paracoccidioides brasiliensis sensu stricto, a classical thermodimorphic fungus associated with PCM, was long considered to represent a monotypic taxon. However, advances in molecular taxonomy revealed several cryptic species, including Paracoccidioides americana, P. restrepiensis, P. venezuelensis, and P. lutzii, that show a preference for skin and mucous membranes, lymph nodes, and respiratory organs but can also affect many other organs. The classical diagnosis of PCM benefits from direct microscopy culture-based, biochemical, and immunological assays in a general microbiology laboratory practice providing a generic identification of the agents. However, molecular assays should be employed to identify Paracoccidioides isolates to the species level, data that would be complemented by epidemiological investigations. From a clinical perspective, all probable and confirmed cases should be treated. The choice of treatment and its duration must be considered, along with the affected organs, process severity, history of previous treatment failure, possibility of administering oral medication, associated diseases, pregnancy, and patient compliance with the proposed treatment regimen. Nevertheless, even after appropriate treatment, there may be relapses, which generally occur 5 years after the apparent cure following treatment, and also, the mycosis may be confused with other diseases. This review provides a comprehensive and critical overview of the immunopathology, laboratory diagnosis, clinical aspects, and current treatment of PCM, highlighting current issues in the identification, treatment, and patient follow-up in light of recent Paracoccidioides species taxonomic developments. FAU - Hahn, Rosane Christine AU - Hahn RC AUID- ORCID: 0000-0003-2686-8193 AD - Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiaba, Mato Grosso, Brazil. AD - Julio Muller Hospital, EBSERH, Cuiaba, Mato Grosso, Brazil. FAU - Hagen, Ferry AU - Hagen F AUID- ORCID: 0000-0002-5622-1916 AD - Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands. AD - Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands. AD - Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands. FAU - Mendes, Rinaldo Poncio AU - Mendes RP AD - Faculdade de Medicina de Botucatu, Sao Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil. AD - Faculdade de Medicina, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil. FAU - Burger, Eva AU - Burger E AD - Department of Microbiology and Immunology, Federal University of Alfenasgrid.411180.d (UNIFAL), Alfenas, Minas Gerais, Brazil. FAU - Nery, Andreia Ferreira AU - Nery AF AD - Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiaba, Mato Grosso, Brazil. AD - Julio Muller Hospital, EBSERH, Cuiaba, Mato Grosso, Brazil. FAU - Siqueira, Nathan Pereira AU - Siqueira NP AD - Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiaba, Mato Grosso, Brazil. FAU - Guevara, Armando AU - Guevara A AD - Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiaba, Mato Grosso, Brazil. FAU - Rodrigues, Anderson Messias AU - Rodrigues AM AUID- ORCID: 0000-0003-0891-4563 AD - Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil. AD - Department of Medicine, Discipline of Infectious Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil. FAU - de Camargo, Zoilo Pires AU - de Camargo ZP AUID- ORCID: 0000-0002-2971-7983 AD - Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil. AD - Department of Medicine, Discipline of Infectious Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20220908 PL - United States TA - Clin Microbiol Rev JT - Clinical microbiology reviews JID - 8807282 SB - IM MH - Humans MH - *Paracoccidioidomycosis/diagnosis/drug therapy/epidemiology MH - Brazil MH - Skin MH - *Paracoccidioides PMC - PMC9769695 OTO - NOTNLM OT - Paracoccidioides OT - Paracoccidioides brasiliensis OT - Paracoccidioides lutzii OT - diagnostics OT - dimorphic fungi OT - endemic mycosis OT - epidemiology OT - mycology COIS- The authors declare no conflict of interest. EDAT- 2022/09/09 06:00 MHDA- 2022/12/24 06:00 PMCR- 2023/09/08 CRDT- 2022/09/08 10:07 PHST- 2022/09/09 06:00 [pubmed] PHST- 2022/12/24 06:00 [medline] PHST- 2022/09/08 10:07 [entrez] PHST- 2023/09/08 00:00 [pmc-release] AID - 00233-21 [pii] AID - cmr.00233-21 [pii] AID - 10.1128/cmr.00233-21 [doi] PST - ppublish SO - Clin Microbiol Rev. 2022 Dec 21;35(4):e0023321. doi: 10.1128/cmr.00233-21. Epub 2022 Sep 8.