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      Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating * Translated title: Paracoccidioidomicose: atualização epidemiológica, clínica, diagnóstica e terapêutica

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          Abstract

          Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by fungi of the genus Paracoccidioides. Due to its frequent tegument clinical expression, paracoccidioidomycosis is an important disease for dermatologists, who must be up-to-date about it. This article focuses on recent epidemiological data and discusses the new insights coming from molecular studies, as well as those related to clinical, diagnostic and therapeutic aspects. In the latter section, we give particular attention to the guideline on paracoccidioidomycosis organized by specialists in this subject.

          Translated abstract

          Paracoccidioidomicose é micose sistêmica de evolução aguda a crônica e causada por espécies do gênero Paracoccidioides. Pela frequente expressão clinica tegumentar da paracoccidioidomicose os dermatologistas têm que se manter atualizados em relação à enfermidade. O presente trabalho tem enfoque na atualização epidemiológica, discutindo os avanços na área propiciados pela micológica molecular, nos aspectos clínicos incluindo avanços diagnósticos e se completa com a discussão terapêutica e nesse item com foco nos dados do consenso em paracoccidioidomicose elaborado por especialistas no tema.

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          Phylogenetic analysis reveals a high level of speciation in the Paracoccidioides genus.

          Paracoccidioidomycosis (PCM) is a systemic disease endemic to most of Latin America, with greatest impact in rural areas. The taxonomic status of one of the best studied Paracoccidioides isolates (Pb01) as P. brasiliensis remains unresolved due to its genomic differences from the other three previously described phylogenetic species (S1, PS2 and PS3; Carrero et al., 2008. Fungal Genet. Biol. 45, 605). Using the genealogic concordance method of phylogenetic species recognition (GCPSR) via maximum parsimony and Bayesian analysis, we identified a clade of 17 genotypically similar isolates, including Pb01, which are distinct from the S1/PS2/P3 clade. Consistent with GCPSR, this "Pb01-like" group can be considered a new phylogenetic species, since it is strongly supported by all independent and concatenated genealogies. "Pb01-like" species exhibit great sequence and morphological divergence from the S1/PS2/PS3 species clade, and we estimate that these groups last shared a common ancestor approximately 32 million years ago. In addition, recombination analysis revealed independent events inside both main groups suggesting reproductive isolation. Consequently, we recommend the formal description of the "Pb01-like" cluster as the new species Paracoccidioides lutzii, a tribute to Adolpho Lutz, discoverer of P. brasiliensis in 1908.
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            Cryptic speciation and recombination in the fungus Paracoccidioides brasiliensis as revealed by gene genealogies.

            Paracoccidioides brasiliensis is the etiologic agent of paracoccidioidomycosis, a disease confined to Latin America and of marked importance in the endemic areas due to its frequency and severity. This species is considered to be clonal according to mycological criteria and has been shown to vary in virulence. To characterize natural genetic variation and reproductive mode in this fungus, we analyzed P. brasiliensis phylogenetically in search of cryptic species and possible recombination using concordance and nondiscordance of gene genealogies with respect to phylogenies of eight regions in five nuclear loci. Our data indicate that this fungus consists of at least three distinct, previously unrecognized species: S1 (species 1 with 38 isolates), PS2 (phylogenetic species 2 with six isolates), and PS3 (phylogenetic species 3 with 21 isolates). Genealogies of four of the regions studied strongly supported the PS2 clade, composed of five Brazilian and one Venezuelan isolate. The second clade, PS3, composed solely of 21 Colombian isolates, was strongly supported by the alpha-tubulin genealogy. The remaining 38 individuals formed S1. Two of the three lineages of P. brasiliensis, S1 and PS2, are sympatric across their range, suggesting barriers to gene flow other than geographic isolation. Our study provides the first evidence for possible sexual reproduction in P. brasiliensis S1, but does not rule it out in the other two species.
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              [Guidelines in paracoccidioidomycosis].

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                Author and article information

                Journal
                An Bras Dermatol
                An Bras Dermatol
                An Bras Dermatol
                Anais Brasileiros de Dermatologia
                Sociedade Brasileira de Dermatologia
                0365-0596
                1806-4841
                Sep-Oct 2013
                : 88
                : 5
                : 700-711
                Affiliations
                MD, PhD - Full Professor - Department of Dermatology and Radiotherapy. Botucatu Medical School, São Paulo State University Júlio de Mesquita Filho (FMB-UNESP) - Botucatu (SP), Brazil.
                Author notes
                MAILING ADDRESS: Silvio Alencar Marques, Departamento de Dermatologia e Radioterapia, Faculdade de Medicina. Distrito de Rubião Junior - S/N. 18600-790 - Botucatu - SP, Brazil, E-mail: smarques@ 123456fmb.unesp.br
                Article
                10.1590/abd1806-4841.20132463
                3798345
                24173174
                1f382601-699a-4d7f-9f0b-0bc5fbda7741
                ©2013 by Anais Brasileiros de Dermatologia

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 January 2013
                : 18 February 2013
                Categories
                Continuing Medical Education

                clinical evolution,epidemiology,paracoccidioidomycosis,therapeutics,treatment outcome

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