Volume 98, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Negative results in serological routine screening of patients with microbiologically proven Paracoccidioidomycosis (PCM) are occasionally reported. Failure in detecting anti- antibodies has been ascribed to factors either related to serological techniques or to the status of the host immune reactivity. Recently, this issue has been renewed by the recognition that the genera comprises two species, and , which have distinct antigenic profiles and, therefore, may elicit different host antibody responses. We describe a patient with the acute form PCM due to with negative results on two reference centers’ routine screening for antibodies, but positive results with antigens. The present case report suggests that antibodies elicited during infection recognize antigenic fractions shared by both species, highlighting the difficulties in distinguishing the two infections by means of the currently available routine serological assays.


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  1. Vidal MS, Del Negro GM, Vicentini AP, Svidzinski TI, Mendes-Giannini MJ, Almeida AM, Martinez R, de Camargo ZP, Taborda CP, Benard G, , 2014. Serological diagnosis of paracoccidioidomycosis: high rate of inter-laboratorial variability among medical mycology reference centers. PLoS Negl Trop Dis 8: e3174. [Google Scholar]
  2. del Negro GM, Benard G, de Assis CM, Vidal MS, Garcia NM, Otani C, Shikanai-Yasuda MA, da S Lacaz C, , 1995. Lack of reactivity of paracoccidioidomycosis sera in the double immunodiffusion test with the gp43 antigen: report of two cases. J Med Vet Mycol 33: 113116. [Google Scholar]
  3. Do Valle AC, Costa RL, Fialho Monteiro PC, Von Helder J, Muniz MM, Zancopé-Oliveira RM, , 2011. Interpretation and clinical correlation of serological tests in paracoccidioidomycosis. Med Mycol 39: 373377. [Google Scholar]
  4. Neves AR, Mamoni RL, Rossi CL, de Camargo ZP, Blotta MH, , 2003. Negative immunodiffusion test results obtained with sera of paracoccidioidomycosis patients may be related to low-avidity immunoglobulin G2 antibodies directed against carbohydrate epitopes. Clin Diagn Lab Immunol 10: 802807. [Google Scholar]
  5. Vidal MS, Benard G, de Brito T, Dantas KC, Pereira CN, França FO, da Silva AM, Martins JE, , 2005. Atypical serological response marked by a lack of detectable anti-gp43 antibodies in a patient with disseminated paracoccidioidomycosis. J Clin Microbiol 43: 30143016. [Google Scholar]
  6. Restrepo A, , 1992. Report of activities of the committee on paracoccidioidomycosis serodiagnosis. ISHAM Mycoses Newsletter 59: 4. [Google Scholar]
  7. Shikanai-Yasuda MA, 2017. Brazilian guidelines for the clinical management of paracoccidioidomycosis. Rev Soc Bras Med Trop 50: 715740. Erratum in Rev Soc Bras Med Trop 2017;50(5). [Google Scholar]
  8. Benard G, Costa AN, Leopércio AP, Vicentini AP, Kono A, Shikanai-Yasuda MA, , 2013. Chronic paracoccidioidomycosis of the intestine as single organ involvement points to an alternative pathogenesis of the mycosis. Mycopathologia 176: 353357. [Google Scholar]
  9. Paniago AM, de Freitas AC, Aguiar ES, Aguiar JI, da Cunha RV, Castro AR, Wanke B, , 2005. Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12 cases observed in an endemic region in Brazil. J Infect 51: 248252. [Google Scholar]
  10. Bellissimo-Rodrigues F, Vitali LH, Martinez R, , 2010. Serological diagnosis of paracoccidioidomycosis in HIV-coinfected patients. Mem Inst Oswaldo Cruz 105: 904907. [Google Scholar]
  11. Gegembauer G, Araujo LM, Pereira EF, Rodrigues AM, Paniago AM, Hahn RC, de Camargo ZP, , 2014. Serology of paracoccidioidomycosis due to Paracoccidioides lutzii. PLoS Negl Trop Dis 8: e2986. [Google Scholar]
  12. Camargo ZP, Unterkircher C, Travassos LR, , 1989. Identification of antigenic polypeptides of Paracoccidioides brasiliensis by immunoblotting. J Med Vet Mycol 27: 407412. [Google Scholar]
  13. Puccia R, Travassos LR, , 1991. 43-kilodalton glycoprotein from Paracoccidioides brasiliensis: immunochemical reactions with sera from patients with paracoccidioidomycosis, histoplasmosis, or Jorge Lobo’s disease. J Clin Microbiol 29: 16101615. [Google Scholar]
  14. De Mattos Grosso D, de Almeida SR, Mariano M, Lopes JD, , 2003. Characterization of gp70 and anti-gp70 monoclonal antibodies in Paracoccidioides brasiliensis pathogenesis. Infect Immun 71: 65346542. [Google Scholar]
  15. Bialek R, Ibricevic A, Aepinus C, Najvar LK, Fothergill AW, Knobloch J, Graybill JR, , 2000. Detection of Paracoccidioides brasiliensis in tissue samples by a nested PCR assay. J Clin Microbiol 38: 29402942. [Google Scholar]
  16. Teixeira Mde M, Theodoro RC, Oliveira FF, Machado GC, Hahn RC, Bagagli E, San-Blas G, Soares Felipe MS, , 2014. Paracoccidioides lutzii sp. nov.: biological and clinical implications. Med Mycol 52: 1928. [Google Scholar]
  17. Campos MC, Gesztesi JL, Vincentini AP, Lopes JD, Camargo ZP, , 1995. Expression and isoforms of gp43 in different strains of Paracoccidioides brasiliensis. J Med Vet Mycol 33: 223227. [Google Scholar]
  18. Souza MC, Gesztesi JL, Souza AR, Moraes JZ, Lopes JD, Camargo ZP, , 1997. Differences in reactivity of paracoccidioidomycosis sera with gp43 isoforms. J Med Vet Mycol 35: 1318. [Google Scholar]
  19. Theodoro RC, Teixeira MM, Felipe MSS, Paduan KS, Ribolla PM, San-Blas G, Bagagli E, , 2012. Genus Paracoccidioides: species recognition and biogeographic aspects. PLoS One 7: e37694. [Google Scholar]
  20. Rodrigues EG, Travassos LR, , 1994. Nature of the reactive epitopes in Paracoccidioides brasiliensis polysaccharide antigen. J Med Vet Mycol 32: 7781. [Google Scholar]
  21. Machado GC, Moris DV, Arantes TD, Silva LR, Theodoro RC, Mendes RP, Vicentini AP, Bagagli E, , 2013. Cryptic species of Paracoccidioides brasiliensis: impact on paracoccidioidomycosis immunodiagnosis. Mem Inst Oswaldo Cruz 108: 637643. [Google Scholar]
  22. Leitão NP, Jr Vallejo MC, Conceição PM, Camargo ZP, Hahn R, Puccia R, , 2014. Paracoccidioides lutzii Plp43 is an active glucanase with partial antigenic identity with P. brasiliensis gp43. PLoS Negl Trop Dis 8: e3111. [Google Scholar]
  23. Hahn RC, Rodrigues AM, Fontes CJ, Nery AF, Tadano T, Queiroz Lde P, Jr de Camargo ZP, , 2014. Fatal fungemia due to Paracoccidioides lutzii. Am J Trop Med Hyg 91: 394398. [Google Scholar]
  24. Queiroz Júnior Lde P, de Camargo ZP, Tadano T, Rodrigues AM, Takarara DT, Gegembauer G, Araujo LM, Hahn RC, , 2014. Serological and antigenic profiles of clinical isolates of Paracoccidioides spp. from central western Brazil. Mycoses 57: 466472. [Google Scholar]
  25. Batista J, De Camargo ZP, Fernandes GF, Vicentini AP, Fontes CJF, Hahn RC, , 2010. Is the geographical origin of a Paracoccidioides brasiliensis isolate important for antigen production for regional diagnosis of paracoccidioidomycosis? Mycoses 53: 176180. [Google Scholar]
  26. Negroni R, , 1968. New studies on antigens for serological testing in South American blastomycosis [in Spanish]. Dermatol Iber Lat Am 4: 409416. [Google Scholar]
  27. Lenhard-Vidal A, Assolini JP, Ono MA, Bredt CS, Sano A, Itano EN, , 2013. Paracoccidioides brasiliensis and P. lutzii antigens elicit different serum IgG responses in chronic paracoccidioidomycosis. Mycopathologia 176: 345352. [Google Scholar]

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  • Received : 16 Oct 2017
  • Accepted : 31 Dec 2017
  • Published online : 05 Feb 2018

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