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Pathogenesis and Classification of Paracocidioidomycosis: New Insights From Old Good Stuff

Gil Benard1

  • 1Laboratory of Medical Investigation Units 53 and 56, Division of Clinical Dermatology, Clinics Hospital, and Laboratory of Medical Mycology, Institute of Tropical Medicine, School of Medicine University of São Paulo, São Paulo, Brazil.

Open Forum Infectious Diseases
|March 17, 2021
PubMed

Insights

A new classification for paracoccidioidomycosis (PCM) is proposed, suggesting a continuum from initial infection to chronic disease. This framework aims to better characterize and manage patients with this fungal infection.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Paracoccidioidomycosis (PCM) classifications have evolved since 1908, with a consensual one proposed in 1987.
  • Existing classifications and natural history views inadequately encompass all observed patient presentations.
  • Many patients do not fit neatly into the 1987 classification or current pathogenesis models.

Purpose of the Study:

  • To reassess the concepts of PCM infection, primary pulmonary PCM (PP-PCM), and subclinical forms.
  • To propose a new clinical classification for PCM that includes subtle but distinct outcomes.
  • To offer new insights for better characterization and management of PCM patients.

Main Methods:

  • Revisiting historical classifications of paracoccidioidomycosis.
  • Analyzing case reports and case series to identify discrepancies with existing classifications.
  • Developing a new conceptual framework and clinical classification for PCM.

Main Results:

  • Identified numerous patients whose clinical presentations did not align with the 1987 PCM classification.
  • Proposed a continuum model linking PP-PCM to the chronic form of the disease.
  • Hypothesized that incomplete resolution of initial infection may lead to chronic PCM.

Conclusions:

  • The proposed classification aims to encompass all subtle yet distinct outcomes of PCM.
  • A continuum between PP-PCM and chronic disease offers an alternative to the reactivation hypothesis.
  • This new classification may improve the characterization and management of paracoccidioidomycosis.
Keywords:
classificationimmune responseparacocidioidomycosispathogenesissubclinical infection

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