Comparison of clinico-epidemiological and radiological features in paracoccidioidomycosis patients regarding serological classification using antigens fromParacoccidioides brasiliensiscomplex andParacoccidioides lutzii

Author summary Paracoccidioidomycosis (PCM) is a disease caused by fungi living in the soil, which are inhaled mainly by rural workers from Latin America. These fungi are classified into theParacoccidioides brasiliensiscomplex andParacoccidioides lutzii. PCM may involve any organ and its treatment frequently results in fibrotic scars and functional limitations, which not rarely lead to early retirement. The mycological examination performed by routine laboratory tests cannot identify these species. However, the serological tests can suggest what species the etiological agent is, long as an antigen from both species is used. In order to determine whether there are differences in epidemiological aspects, clinical manifestations, severity, treatment response, and intensity of lung lesions according to the species involved, we compared 51 patients with serological profile suggestive of PCM caused byP.brasiliensiscomplex with 16 others caused byP.lutzii. Our results showed no differences between these species related to the parameters evaluated. Nevertheless, other clinical variables should be evaluated to detect differences regarding species. This study reinforces the importance of using antigens from both species for serological tests in PCM diagnosis, determination of severity, treatment follow-up and control of cure. Genotyping of the genusParacoccidioidesshowed its diversity and geographical distribution. Four species constituting theParacoccidioides brasiliensiscomplex andParacoccidioides lutziiare etiological agents of paracoccidioidomycosis (PCM). However, there are no studies comparing the clinical and epidemiological aspects between PCM caused by theP.brasiliensiscomplex and byP.lutzii. Demographic and clinical data from 81 patients with PCM-confirmed by mycological and/or histopathological examination-from Mato Grosso do Sul state (Brazil) were studied. All patients underwent serology by immunodiffusion with antigens obtained from theP.brasiliensiscomplex (ExoPband gp43) and Cell Free Antigens obtained fromP.lutzii(CFAPl).The cases were classified regarding their serological profile into three groups: G1: PCM patients seropositive to ExoPband/or gp43 and seronegative to CFAPl(n = 51), assumed to have PCM caused byP.brasiliensiscomplex; G2: PCM patients seronegative to gp43 and seropositive to CFAPl(n = 16), with PCM caused byP.lutzii; and G3: PCM patients seropositive to ExoPbor gp43 and seropositive to CFAPl(n = 14), with undetermined serological pr