title: Incubation Period and Early Natural History Events of the Acute Form of Paracoccidioidomycosis: Lessons from Patients with a Single Paracoccidioides spp. Exposure.
abstract: Several aspects of the natural history of paracoccidioidomycosis are still poorly understood. Different from the most prevalent, chronic form of the disease, the acute form represents a continuum from the initial respiratory infection to the full-blown disease, thus providing an opportunity to elucidate the pathogenesis of the early phase of this mycosis. We describe, for the first time, two patients with a single time point exposure to Paracoccidioides spp., for whom we were able to determine the time lapsed between exposure to the fungus Paracoccidioides spp. and the onset of signs and symptoms. In case 1, the pulmonary infection was unapparent, and the first manifestations of the acute/subacute form of the disease presented 4 months after Paracoccidioides spp.
  
  
  METHODS
  In case 2, self-limited, non-specific respiratory and systemic symptoms presented 45 days after infection. Thus, our patients confirm that, within a few weeks of infection, Paracoccidioides spp. affects the pulmonary lymphatic system and initially causes no or mild-to-moderate self-limited symptoms, eventually causing abnormalities on a chest X-ray, all of which spontaneously subside. These cases provide some insight into the natural history of this mycosis, the extent of the host exposure to the fungus, and the determination of its incubation period.
authors.affiliation: Laboratory of Medical Investigation in Medical Mycology, University of São Paulo Medical School, Avenida Doutor Arnaldo, 455. Cerqueira Cesar, São Paulo, Brazil. renatabuccheri@gmail.com.|Instituto de Infectologia Emílio Ribas, Avenida Doutor Arnaldo, 165. Cerqueira Cesar, São Paulo, SP, Brazil. renatabuccheri@gmail.com.
authors.forename: Renata
authors.identifier: http://orcid.org/0000-0002-3217-5898
authors.initials: R
authors.lastname: Buccheri
authors.affiliation: Instituto de Infectologia Emílio Ribas, Avenida Doutor Arnaldo, 165. Cerqueira Cesar, São Paulo, SP, Brazil.
authors.forename: Zarifa
authors.initials: Z
authors.lastname: Khoury
authors.affiliation: Hospital Santa Catarina, Avenida Paulista, 200. Bela Vista, São Paulo, Brazil.
authors.forename: Luis Carlos Barradas
authors.initials: LC
authors.lastname: Barata
authors.affiliation: Laboratories of Medical Investigation in Dermatology and Immunodeficiencies and Medical Mycology, University of São Paulo Medical School, Avenida Doutor Arnaldo, 455. Cerqueira Cesar, São Paulo, Brazil.
authors.forename: Gil
authors.initials: G
authors.lastname: Benard
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D055256:Infectious Disease Incubation Period; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008853:Microscopy; D010228:Paracoccidioides / Q000302:isolation & purification*; D010229:Paracoccidioidomycosis / Q000473:pathology*; D013902:Radiography, Thoracic; D012867:Skin / Q000473:pathology; D013997:Time Factors
keywords: Natural history; Paracoccidioidomycosis; Pathogenesis; Pulmonary involvement