Abstract

In the last years basic and clinical immunological research has provided us with significant new data on the host-parasite interaction in paracoccidioidomycsis, which, however, has not yet translated into direct benefits to patient management. We still don’t know what makes some few among hundreds or thousands of exposed individuals to be susceptible of developing the acute/subacute form of the disease, nor what mechanisms underly the development of the chronic form of the disease in individuals who have long been infected (sometimes decades ealier). Fungus virulence factors are also not well known. The evidence that gp43 would represent a virulence factor may be challenged by the fact that it is mutated in the new P. lutzii species, which causes a severe disease otherwise similar to that one caused by P. brasiliensis. We describe here some patients who presented clinical conditions that exemplifies the difficulties in understanding the host-parasite relationship in PCM. The first patient is a young man who concomitantly presented oral and facial lesions which, on immunohistochemistry, showed distinct immune responses patterns: Th-2/Th-17 and Th-1, respectively. We also present two children with the severe, acute form of the disease, in whom the clinical manifestations could, paradoxically, only be controlled by immunosuppressive doses of corticosteroids. We also present two additional cases in whom the immune responses apparently became uncontrollable and led to fatal inflammatory syndromes such as the adult respiratory distress syndrome and septic shock. The elucidation of immunological mechanisms underlying these atypical cases may help to understand better the immunopathogenesis of PCM. ਀㰀瀀㸀 Financial support: Fapesp and CNPq਀㰀⼀昀漀渀琀㸀㰀⼀瀀㸀㰀戀爀㸀㰀戀㸀䬀攀礀眀漀爀搀㨀 㰀⼀戀㸀☀渀戀猀瀀㬀倀愀琀椀攀渀琀Ⰰ 倀⸀ 戀爀愀猀椀氀椀攀渀猀椀猀Ⰰ 倀⸀ 氀甀琀稀椀椀Ⰰ 䰀攀猀椀漀渀㰀⼀琀搀㸀㰀⼀琀爀㸀㰀⼀琀愀戀氀攀㸀㰀⼀琀爀㸀㰀⼀琀搀㸀㰀⼀琀愀戀氀攀㸀㰀⼀戀漀搀礀㸀㰀⼀栀琀洀氀㸀