title: Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues.
abstract: Acquired by inhalation of the thermal dimorphic fungi Paracoccidioides spp. conidia, paracoccidioidomycosis ranges from symptomatic to severe and potentially fatal disseminated disease. The main focus of this review is to highlight clinical aspects of paracoccidioidomycosis and, its pathogens' diversity ecology and particularities. In addition, we present strategies for therapy, including DNA vaccines and nanostructured drugs. Molecular and morphological data supported the split of the Paracoccidioides genus into two species, Paracoccidioides brasiliensis and Paracoccidioides lutzii. An acute form of the disease affects approximately 5% of cases and involves the phagocytic mononuclear system, resulting in progressive lymphadenopathy. The chronic form affects adult men and frequently involves lungs, skin and mucous membranes, lymph nodes, and adrenal glands. The clinical manifestations depend on the ability of the host to control the fungal multiplication and dissemination. The long survival time of the fungus in the host tissues allows it to evade immune responses; therefore, successful treatment often requires long-time therapy. The consensus for treatment must consider the severity of the disease and includes sulfone derivatives, amphotericin B and azoles. Novel strategies for therapy, based on DNA vaccines and nanostructured drugs are also presented and discussed in this review.
authors.affiliation: Biological Sciences Institute, Universidade de Brasília, Brasília, DF, Brazil.
authors.forename: Anamelia Lorenzetti
authors.initials: AL
authors.lastname: Bocca
authors.forename: André Corrêa
authors.initials: AC
authors.lastname: Amaral
authors.forename: Marcus Melo
authors.initials: MM
authors.lastname: Teixeira
authors.forename: Paula Keiko
authors.initials: PK
authors.lastname: Sato
authors.forename: Paula
authors.initials: P
authors.lastname: Sato
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Shikanai-Yasuda
authors.forename: Maria Sueli
authors.initials: MS
authors.lastname: Soares Felipe
mesh_terms: D000311:Adrenal Glands / Q000382:microbiology / Q000473:pathology; D000935:Antifungal Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003881:Dermatomycoses / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008172:Lung Diseases, Fungal / Q000382:microbiology / Q000473:pathology; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008206:Lymphatic Diseases / Q000209:etiology / Q000473:pathology; D008297:Male; D009092:Mucous Membrane / Q000382:microbiology / Q000473:pathology; D010228:Paracoccidioides / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D010229:Paracoccidioidomycosis / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D019444:Vaccines, DNA / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D019444:Vaccines, DNA