XI International Meeting on Paracoccidioidomycosis

XI International Meeting on Paracoccidioidomycosis

Resume:43-1

Poster (Painel)

43-1

Prevalence of relapse in paracoccidioidomycosis-patients and its identification by an agar gel precipitin test.

Authors:

Tatiane Fernanda Sylvestre (UNESP - FMB - Faculdade de Medicina de Botucatu) ; Daniela Vanessa Moris (UNESP - FMB - Faculdade de Medicina de Botucatu) ; Ricardo Souza Cavalcante (UNESP - FMB - Faculdade de Medicina de Botucatu) ; Adriele Dandara Levorato (UNESP - FMB - Faculdade de Medicina de Botucatu) ; Lídia Raquel Carvalho (UNESP-IBB - Instituto de Biociências - Departamento de Bioestatística) ; Rinaldo Poncio Mendes (UNESP - FMB - Faculdade de Medicina de Botucatu)

Abstract

Introduction. Treatment of paracoccidioidomycosis-PCM leads to clinical and radiological cure, negativation of agar gel precipitin tests and recovery of the cell mediated immunity. However, persistence of Paracoccidioides brasiliensis latent foci can be responsible for a disease relapse. Double agar gel immunodiffusion test-DID has been the choice for serological diagnosis and patient’s follow-up, due to its specificity. This study aims to evaluate the frequency of relapse in PCM-patients and DID test positivation. Patients and Methods. Two hundred and ten patients with PCM confirmed by identification of the typical P. brasiliensis yeast forms and/or by the DID test, 51 of whom with the acute/subacute (AF) and 159 with the chronic form (CF), were evaluated. Relapse was defined as the recurrence of signs and symptoms compatible with PCM, associated with the identification of the typical P. brasiliensis yeast forms in any clinical specimen after appropriate treatment. The treatment was considered appropriate when symptomatology disappeared, erythrocyte sedimentation rate (ESR) returned to normal values and antibody serum levels evaluated by DID were persistently negative for one year with antifungal compound and one year without therapy. Frequencies were compared by Fisher’s exact test and significance was set up at p &le 0.05. Results. Fifteen patients (7.1%) relapsed 48 to 300 months (MD=96) after the beginning of the treatment, and 10 to 264 months (Md=50) after its discontinuation. Relapse frequencies did not differ as to clinical form (AF=5.9%; CF=7.5%; p > 0.05). Among the fifteen relapsed patients, only eight (53,3%) showed positive DID test. Conclusions. Relapses showed low prevalence and late occurrence. As it must be soon diagnosed, other serological tests should be studied, and evaluation of the enzyme-linked immunosorbent assay (ELISA) is in progress.

Keyword: Disease relapse, Double agar gel immunodiffusion test-DID, Enzyme-linked immunosorbent assay (ELISA, Paracoccidioides brasiliensis, Paracoccidioidomycosis

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