Abstract
Introduction: Paracoccidioidomycosis (PCM) is caused by the dimorphic fungus Paracoccidioides brasiliensis. Infection occurs mainly through the upper airways of the host by inhalation of spores or propagules of the micro‐organism that settle initially in the lungs. Here, we describe a clinical case report of PCM acquired by a researcher following a scientific laboratory accident; to the best of our knowledge, this is the first report of infection with the yeast form of P. brasiliensis. Case presentation: A 40‐year‐old, white, healthy, male researcher, while undertaking experimental activities in a laboratory environment with P. brasiliensis fungus infection in guinea pigs, pierced the thumb of the left hand, with a 1 ml syringe containing 50 μl of a suspension of P. brasiliensis at a concentration of 1×106 c.f.u. ml−1. Seven days after the accident, the region had local swelling, redness and pain on stimulation. He was started on medical treatment and opted for surgical removal. A biopsy revealed an inflammatory infiltrate, numerous epithelioid granulomas and a discrete quantity of yeast organisms on the dermis, some with multiple budding yeast cells presenting characteristics of viability, with conclusive diagnosis of PCM. After 90 days of itraconazole treatment at 200 mg day−1, he reported healing with scar formation. Conclusion: The yeast form of P. brasiliensis is able to cause infection. According to our knowledge, this is the first time that this has been reported in the medical literature.
Highlights
Paracoccidioidomycosis (PCM) is caused by the dimorphic fungus Paracoccidioides brasiliensis
This paper describes a clinical case report of PCM acquired by a researcher in a scientific laboratory accident with the yeast form of P. brasiliensis
Serum samples collected from the patient at 7, 30 and 90 days after the accident were assessed by ELISA using an antibody against P. brasiliensis gp43 protein. These analyses showed a significant decrease (P50.04952) in recognition of the P. brasiliensis gp43 protein between days 7 and 90 of antifungal treatment
Summary
Paracoccidioidomycosis (PCM), caused by the dimorphic fungus Paracoccidioides brasiliensis, was first described by Lutz in 1908 and is considered to be the most prevalent systemic mycosis in Latin America. For the evaluation of liver and kidney cytotoxicity caused by the use of itraconazole by the patient, the evolution of the case was observed by monthly examinations of liver enzymes (transaminases and creatinine) and a complete blood count. The results of these analyses showed no changes during the 90 days of drug administration (data not shown). Serum samples collected from the patient at 7, 30 and 90 days after the accident were assessed by ELISA using an antibody against P. brasiliensis gp protein These analyses showed a significant decrease (P50.04952) in recognition of the P. brasiliensis gp protein between days 7 and 90 of antifungal treatment. Infection caused by the yeast form of P. brasiliensis approach in the case of accidents involving P. brasiliensis and other pathogenic fungi
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