R P Mendes

São Paulo State University, San Paulo, São Paulo, Brazil

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Publications (77)129.61 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper describes four new cases of lymphomas, two Hodgkin lymphomas and two non-Hodgkin lymphomas in patients with paracoccidioidomycosis. All had mycosis diagnosed before lymphomas with Paracoccidioides brasiliensis demonstrated in several lymph nodes, as seen in the disseminated form of the disease. When lymphoma was diagnosed, one patient was under regular paracoccidioidomycosis treatment and in clinic-serological remission for this disease, another was under regular treatment but with clinic-serological mycosis activity, one had abandoned paracoccidioidomycosis treatment 6 years earlier, and the other had not yet received any kind of antifungal drugs. Three patients received treatment for lymphomas with one remaining in remission until now, one achieving tumor remission which relapsed years later, and one having only residual lymphoma in bone marrow for a decade but clinically well. All three experienced paracoccidioidomycosis clinical remission, however, serology became negative just in one. Similar previously described cases were reviewed: five Hodgkin lymphomas, three non-Hodgkin lymphomas, and one described only as "lymphoma" without specifying type; a summary of their findings is presented. Finally, there is also a brief discussion on the possible pathophysiological mechanisms involved in the concomitance of these two disorders.
    Mycopathologia 12/2014; 179(3-4). DOI:10.1007/s11046-014-9851-4 · 1.55 Impact Factor
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    ABSTRACT: Background Paracoccidioidomycosis (PCM) is systemic mycosis caused by the thermal dimorphic fungus of genus Paracoccidioides, leading to either acute/subacute (AF) or chronic (CF) clinical forms. Numerous CF patients after treatment exhibit sequels, such as pulmonary and adrenal fibrosis. Monocytes are cells that are involved in the inflammatory response during active infection as well as in the fibrogenesis. These cells comprise a heterogeneous population with distinct phenotypic and functional activities. The scope of this study was to identify changes regarding functional and phenotypical aspects in monocytes comparing CF PCM patients on antifungal treatment versus non-treated patients (PMC-p).Methods Twenty-three CF PCM composed of 11 non-treated patients (NTG) and 12 patients in apparent cure (ACG) were studied. Sixteen healthy individuals were used as control group (CG). Monocyte subsets were determined by immunophenotyping based on CD14 and CD16 expression. Cellular function was measured in vitro with and without stimulation with lipopolysaccharide (LPS) and P. brasiliensis exoantigen (PbAg) for 24 hours. Independent samples were compared using unpaired t tests, dependent samples were analyzed by paired t-test. Groups of more than two independent samples were analyzed using an ANOVA, with Tukey¿s post-test. Significance was set up at p <0.05.ResultsOur results showed high counts of peripheral blood CD14+CD16+ and CD14+CD16++ monocytes in untreated PCM-p accompanied by intense production of pro-inflammatory cytokines (IL-1ß and TNF-¿) and profibrotic growth factors (TGF-ß1 and bFGF) by monocytes challenged with P. brasiliensis antigens. After the introduction of antifungal therapy, the counts of CD14+CD16+ cells returned to baseline while CD14+CD16++ counts remained high. Interestingly, counts of CD14+CD16++ monocytes remained elevated even 52¿±¿7 months after successful antifungal treatment. Furthermore, the ACG-patients showed preserved pro-inflammatory activity in the presence of specific antigen stimuli and high spontaneous production of TNF-¿ by monocytes.Conclusions Infection with Paracoccidioides leads to initiation of a specific proinflammatory response by monocytes of PCM-p during active disease and in the apparent cure. A profibrotic profile by monocytes was observed only at admission. Furthermore, PCM-p with apparent cure showed high spontaneous production of TNF-¿ and high counts of CD14+CD16++ monocytes, probably induced by hypoxia duo to fibrotic sequelae.
    BMC Infectious Diseases 10/2014; 14(1):552. DOI:10.1186/s12879-014-0552-x · 2.61 Impact Factor
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    ABSTRACT: Aim: To determine the immunoreactivity of synthetic Cryptococcus-derived peptides. Materials & methods: A total of 63 B-cell epitopes from previously identified Cryptococcus gattii immunoreactive proteins were synthesized and evaluated as antigens in ELISAs. The peptides were first evaluated for their ability to react against sera from immunocompetent subjects carrying cryptococcal meningitis. Peptides that yielded high sensitivity and specificity in the first test were then retested with sera from individuals with other fungal pathologies for cross-reactivity determination. Results: Six of 63 synthetic peptides were recognized by antibodies in immunoassays, with a specificity of 100%, sensitivity of 78% and low cross-reactivity. Conclusion: We successfully determined the immunoreactivity of selected synthetic peptides of C. gattii derived proteins.
    Future Microbiology 07/2014; 9(7):871-8. DOI:10.2217/fmb.14.49 · 3.82 Impact Factor
  • Mycoses 05/2014; 57:100-100. · 1.81 Impact Factor
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    ABSTRACT: A review of 400 clinical records of paracoccidioidomycosis (PCM) patients, 93 with the acute/subacute (AF) and 307 with the chronic form (CF), attended from 1977 to 2011, selected as to the schedule of release for study by the Office of Medical Records at the University Hospital of the Faculdade de Medicina de Botucatu - São Paulo State University - UNESP, was performed to detect cases in relapse. The control of cure was performed by clinical and serological evaluation using the double agar gel immunodiffusion test (DID). In the diagnosis of relapse, DID, enzyme-linked immunosorbent assay (ELISA) and immunoblotting assay (IBgp70 and IBgp43) were evaluated. Out of 400 patients, 21 (5.2%) went through relapse, 18 of them were male and 3 were female, 6∶1 male/female ratio. Out of the 21 patients in relapse, 15 (4.8%) showed the CF, and 6 (6.4%) the AF (p>0.05). The sensitivity of DID and ELISA before treatment was the same (76.1%). DID presented higher sensitivity in pre-treatment (80%) than at relapse (45%; p = 0.017), while ELISA showed the same sensitivity (80% vs 65%; p = 0.125). The serological methods for identifying PCM patients in relapse showed low rates of sensitivity, from 12.5% in IBgp70 to 65.0% in IBgp43 identification and 68.8% in ELISA. The sensitivity of ELISA in diagnosing PCM relapse showed a strong tendency to be higher than DID (p = 0.06) and is equal to IBgp43 (p = 0.11). In sum, prevalence of relapse was not high in PCM patients whose treatment duration was based on immunological parameters. However, the used methods for serological diagnosis present low sensitivity. While more accurate serological methods are not available, we pay special attention to the mycological and histopathological diagnosis of PCM relapse. Hence, direct mycological, cytopathological, and histopathological examinations and isolation in culture for P. brasiliensis must be appropriately and routinely performed when the hypothesis of relapse is considered.
    PLoS Neglected Tropical Diseases 05/2014; 8(5):e2834. DOI:10.1371/journal.pntd.0002834 · 4.49 Impact Factor
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    ABSTRACT: There are no published reports on studies comparing itraconazole (ITC), sulfamethoxazole-trimethoprim (cotrimoxazole, CMX), and ITC followed by CMX (ITC/CMX) in the treatment of paracoccidiodomycosis. This study aimed to compare the efficacy, effectiveness, safety and time to clinical and serologic cure in paracoccidioidomycosis patients treated with ITC or CMX, the antifungal agents most widely used. A quasi-experimental study was performed in 177 patients with a confirmed or probable diagnosis of paracoccidioidomycosis. Treatment was divided into two stages: 1) initial, which was continued until clinical cure was achieved and the erythrocyte sedimentation rate decreased to normal values; 2) complementary, which was continued until serologic cure was achieved. Medians were compared via the Mann-Whitney test, and frequencies were compared via the chi-squared test. The assessment of variables as a function of time was performed using Kaplan-Meier curves and Cox regression. The significance level was established as p≤0.05. No difference was found in the efficacy and effectiveness of the initial treatment of 47 individuals given ITC and 130 individuals given CMX; however, the time to clinical cure was shorter in the former compared with the latter group (105 vs. 159 days; p = 0.001), specifically in patients with the chronic form. Efficacy and effectiveness of the three regimens were similar in the complementary treatment; however, the time to serologic cure was shorter when ITC (161 days) or CMX (495 days) was used compared with ITC/CMX (881 days) [p = 0.02]. The independent predictors of a shorter time to serologic cure were treatment with ITC [risk ratio = 6.61 (2.01-21.75)] or with CMX [risk ratio = 5.11 (1.91-13.67)]). The prevalence of side effects was lower with ITC (6.4%) than with CMX (20.0%; p = 0.03). Since ITC induced earlier clinical cure and was better tolerated than CMX, such triazole should be considered the first-choice for PCM treatment.
    PLoS Neglected Tropical Diseases 04/2014; 8(4):e2793. DOI:10.1371/journal.pntd.0002793 · 4.49 Impact Factor
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    ABSTRACT: With the objective to evaluate the behavior of paracoccidioidomycosis in the last three decades, clinical and epidemiological data of 595 patients admitted to clinical services of the Federal University of Mato Grosso do Sul from 1980 to 2009 were investigated. Gender, age distribution, clinical form, comorbidity with tuberculosis or AIDS, and mortality were compared by decades of clinical admission. It was shown that during the three decades there was a decrease in women percentage, and the same manner occurred a reduction in participants in the age group of 20 to 39 years. Moreover, the acute/subacute forms have been diminished in the period. These fluctuations are closely related and can be simultaneously analyzed. Increased AIDS co-infection prevalence from the first to the second decade was also revealed, coinciding with the appearance of the retroviral epidemic and stabilizing during the third decade. No change in the tuberculosis co-infection rate was observed (overall = 6.9%). It reinforces the importance of this co-morbidity. The overall mortality rate remained steady at 6.7%, not varying significantly from one decade to another. The persistent mortality rate calls attention to the importance of this neglected disease.
    Revista do Instituto de Medicina Tropical de São Paulo 03/2014; 56(2):121-5. DOI:10.1590/S0036-46652014000200006 · 0.91 Impact Factor
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    ABSTRACT: Candidiasis or thrush is a fungal infection (mycosis) of any of the Candida species. Also commonly referred to as a yeast infection, candidiasis encompasses infections that range from superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening diseases. In this book, the authors discuss the epidemiology, symptoms and treatment options of candidiasis. Topics include invasive candidiasis and candida parapsilosis complex diagnoses and treatment; conventional and alternative treatment options for oral candidiasis; candida spp. in the oral cavity of children with immunodeficiencies; oxidative stress and the development of antifungal agents for the treatment of candidiasis; inhalation and topical steroid therapy and oral candidiasis; and fluorescent staining for the diagnosis of oral erythematous candidiasis. (Imprint: Nova Biomedical)
    Candidiasis: Epidemiology, Symptoms and Treatment Options, 1st edited by Felipe Contreras and Pedro Fuentes, 09/2013: chapter Candida parapsilosis Complex.: pages 1-37; Nova publishers., ISBN: 978-1-62618-871-6
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    ABSTRACT: We aimed to evaluate whether the occurrence of cryptic species of Paracoccidioides brasiliensis, S1, PS2, PS3 and Paracoccidioides lutzii, has implications in the immunodiagnosis of paracoccidioidomycosis (PCM). Small quantities of the antigen gp43 were found in culture filtrates of P. lutzii strains and this molecule appeared to be more variable within P. lutzii because the synonymous-nonsynonymous mutation rate was lower, indicating an evolutionary process different from that of the remaining genotypes. The production of gp43 also varied between isolates belonging to the same species, indicating that speciation events are important, but not sufficient to fully explain the diversity in the production of this antigen. The culture filtrate antigen AgEpm83, which was obtained from a PS3 isolate, showed large quantities of gp43 and reactivity by immunodiffusion assays, similar to the standard antigen (AgB-339) from an S1 isolate. Furthermore, AgEpm83 was capable of serologically differentiating five serum samples from patients from the Botucatu and Jundiaí regions. These patients had confirmed PCM but, were non-reactive to the standard antigen, thus demonstrating an alternative for serological diagnosis in regions in which S1 and PS2 occur. We also emphasise that it is not advisable to use a single antigen preparation to diagnose PCM, a disease that is caused by highly diverse pathogens.
    Memórias do Instituto Oswaldo Cruz 08/2013; 108(5):637-43. DOI:10.1590/0074-0276108052013016 · 1.57 Impact Factor
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    ABSTRACT: At present few data are available on prevalence and susceptibilities of Candida parapsilosis complex, which is composed by 3 species; C. parapsilosis sensu stricto, C. metapsilosis and C. orthopsilosis, in HIV-infected individuals. Fifteen isolates of 318 Candida spp. were identified as C. parapsilosis complex by means of polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Prevalence of the C. parapsilosis complex was 4.7%, with 2.2% being C. parapsilosis sensu stricto and 2.5% C. metapsilosis, while no C. orthopsilosis was isolated. This is the first study which identifies isolates of C. metapsilosis obtained from the oral cavity of HIV - infected individuals. Antifungal susceptibility tests indicated that all isolates were susceptible to amphotericin B (AMB), fluconazole (FLC), ketoconazole (KTC), itraconazole (ITC), voriconazole (VRC) and caspofungin (CASPO). Although C. parapsilosis sensu stricto and C. metapsilosis isolates were susceptible to FLC a tendency to higher MICs (≥1.0 mg l(-1)) was observed for C. metapsilosis. Based upon the frequency of candidiasis and that certain isolates of C. parapsilosis complex respond differently to FLC therapy, our data may be of therapeutic relevance with respect to susceptibility to specific antifungal agents and to the potential of drug resistance. Our data suggest that C. metapsilosis can be a human commensal. Its importance as a pathogen has to be confirmed yet.
    Journal of Medical Microbiology 09/2012; 61(12). DOI:10.1099/jmm.0.045112-0 · 2.27 Impact Factor
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    ABSTRACT: Obtaining a semi-automatic quantification of pathologies found in the lung, through images of high resolution computed tomography (HRCT), is of great importance to aid in medical diagnosis. Paraccocidioidomycosis (PCM) is a systemic disease that affects the lung and even after effective treatment leaves sequels such as pulmonary fibrosis and emphysema. It is very important to the area of tropical diseases that the lung injury be quantified more accurately. In this stud, we propose the development of algorithms in computational environment Matlab® able to objectively quantify lung diseases such as fibrosis and emphysema. The program consists in selecting the region of interest (ROI), and through the use of density masks and filters, obtaining the lesion area quantification in relation to the healthy area of the lung. The proposed method was tested on 15 exams of HRCT of patients with confirmed PCM. To prove the validity and effectiveness of the method, we used a virtual phantom, also developed in this research.
    World Congress on Medical Physics and Biomedical Engineering May 26-31, 2012, Beijing, China IFMBE Proceedings; 05/2012
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    ABSTRACT: In 1956, Africanized honeybees (AHB) migrated from Brazil to other regions of the Western Hemisphere, including South, Central, and North America, except for Canada. Despite being productive, they are highly aggressive and cause fatal accidents. This study aimed to evaluate patients at the Clinical Hospital of Botucatu Medical School (HC-FMB) and to propose treatment guidelines. From 2005 to 2006, the clinical and laboratorial aspects of 11 patients (7 male and 4 female) and the anatomopathological aspects of one patient who had died in 2003 were analyzed. The age of the surviving patients varied from 5 to 87 years, with a mean of 42.5 years. The majority of accidents occurred in the afternoon, and the number of stings ranged from 20 to 500. The principal signs and symptoms were pain and local inflammatory signs, nausea, tachycardia, and vomiting. Biochemical findings presented increased levels of creatine phosphokinase, lactate dehydrogenase, and aspartate/alanine aminotransferase. An 11-year-old male patient died upon entering the attic of a two-story building where he was attacked by a swarm, receiving more than 1,000 stings. He was sent to HC-FMB where he was treated, but he died 24h later. Observed at the autopsy were erythematous-purpuric skin lesions besides necrosis at the sting locations, rhabdomyolysis, focal myocardial necrosis, tubular hydropic degeneration and focal tubular acute necrosis of the kidneys, myoglobinuria, and centrolobular necrosis in the liver. Accidents caused by multiple AHB stings always constitute a medical emergency. As there is no specific antivenom, we have developed guidelines, including first aid, drugs, and the proper removal of stingers.
    Revista da Sociedade Brasileira de Medicina Tropical 12/2011; 44(6):755-61. DOI:10.1590/S0037-86822011000600020 · 0.94 Impact Factor
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    ABSTRACT: The identification of appropriate laboratory measures to confirm clinical hypotheses is important in routine paracoccidioidomycosis medical care. The clinical records and laboratory reports of 401 paracoccidioidomycosis patients attended at the Tropical Diseases Area, Faculdade de Medicina de Botucatu, from 1974 to 2008 were reviewed. Direct mycological (DM), cell block (CB), histopathological (HP), and double immunodiffusion (DID) tests were evaluated before treatment. Typical Paracoccidioides brasiliensis yeast forms were observed in clinical specimens of 86% of the patients, but 14% were detected only by serological test. DM of 51 different tissue specimens produced 74.5% sensitivity, and 62.5% sensitivity was observed in 112 sputum samples. CB in 483 sputum samples generated 55.3% sensitivity. HP performed in 239 samples from different tissues revealed 96.7% sensitivity. Serology carried out in 351 patients and 200 healthy controls provided 90.0% sensitivity, 100.0% specificity, 100.0% positive predictive value, 85.1% negative predictive value and 93.6% accuracy. Comparisons of laboratory measurements performed in the same patient showed that sensitivity decreases from HP to DID to CB and DM, with the last two assays providing similar sensitivities. This study demonstrated that P. brasiliensis identification by HP, CB, and/or DM associated with DID is sufficient to establish the laboratorial diagnosis of paracoccidioidomycosis in practically all cases.
    Transactions of the Royal Society of Tropical Medicine and Hygiene 06/2011; 105(8):473-8. DOI:10.1016/j.trstmh.2011.03.001 · 1.93 Impact Factor
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    ABSTRACT: Identifying clusters of acute paracoccidioidomycosis cases could potentially help in identifying the environmental factors that influence the incidence of this mycosis. However, unlike other endemic mycoses, there are no published reports of clusters of paracoccidioidomycosis. A retrospective cluster detection test was applied to verify if an excess of acute form (AF) paracoccidioidomycosis cases in time and/or space occurred in Botucatu, an endemic area in São Paulo State. The scan-test SaTScan v7.0.3 was set to find clusters for the maximum temporal period of 1 year. The temporal test indicated a significant cluster in 1985 (P<0.005). This cluster comprised 10 cases, although 2.19 were expected for this year in this area. Age and clinical presentation of these cases were typical of AF paracccidioidomycosis. The space-time test confirmed the temporal cluster in 1985 and showed the localities where the risk was higher in that year. The cluster suggests that some particularities took place in the antecedent years in those localities. Analysis of climate variables showed that soil water storage was atypically high in 1982/83 ( approximately 2.11/2.5 SD above mean), and the absolute air humidity in 1984, the year preceding the cluster, was much higher than normal ( approximately 1.6 SD above mean), conditions that may have favored, respectively, antecedent fungal growth in the soil and conidia liberation in 1984, the probable year of exposure. These climatic anomalies in this area was due to the 1982/83 El Niño event, the strongest in the last 50 years. We describe the first cluster of AF paracoccidioidomycosis, which was potentially linked to a climatic anomaly caused by the 1982/83 El Niño Southern Oscillation. This finding is important because it may help to clarify the conditions that favor Paracoccidioides brasiliensis survival and growth in the environment and that enhance human exposure, thus allowing the development of preventive measures.
    PLoS Neglected Tropical Diseases 03/2010; 4(3):e643. DOI:10.1371/journal.pntd.0000643 · 4.49 Impact Factor
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    TC Moreto · RP Mendes
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    ABSTRACT: Identification of appropriate laboratory procedures to confirm a clinical hypothesis is important in a routine service for paracoccidioidomycosis patients and constituted the objective of this study. Medical charts and laboratory records of 401 paracoccidioidomycosis patients attended at the Department of Tropical Diseases in the Botucatu Medical School (São Paulo, Brazil) from 1974 to 2008 were reviewed. Direct mycological examination (DM), cell block preparation (CB), histopathological examination (HP) and specific serum antibody levels evaluated through double agar gel immunodiffusion test (ID) were analyzed before treatment. Statistical analysis: the comparison between proportions for dependent or independent populations was performed by the McNemar's or binomial test. The agreement between methods was evaluated using the kappa coefficient. The relationship of more than two dependent populations was made by the Cochran test. The comparison of multiple proportions was done by Tukey test and, for two proportions, by Z test. In order to study the association between qualitative variables the chi-square test was employed. For quantitative variables, whose objective was to compare groups, the nonparametric Kruskal-Wallis test was used. The Statistical Analysis System software (SAS), version 6.12, was utilized. Significance was set up at p < 0.05. Males (88.0%) and chronic form (76.8%) were predominat. Patient distribution according to the period of assistance presented no differences. Typical P. brasiliensis yeast forms were identified in clinical specimens in 86% of the patients while 14% of them showed only a positive serological test. Direct mycological examination carried out in 51 different tissue specimens showed 74.5% sensitivity. The sensitivity was 62.5% in 112 sputum samples. Cell block preparation carried out in 483 sputum samples showed 55.3% sensitivity. Histopathological examination performed in 239 tissue samples from different organs revealed 96.7% sensitivity. Serological tests carried out in 351 patients and 200 healthy controls paired according to gender and showed 90% sensitivity, 100% specificity, 100% positive predictive value, 85% negative predictive value and 94% accuracy. Comparisons 2 x 2 of laboratory measurements carried out in the same patient showed that sensitivity decreases from HP to serology to CB and DM; the last two assays showed no differences in sensitivity. Serum samples from 32 patients with confirmed paracoccidioidomycosis but negative immunodiffusion before treatment were evaluated. As controls, positive sera from 32 additional confirmed patients were analyzed. These assays were carried out at the Research Laboratory of Tropical Diseases, Botucatu Medical School, UNESP, and at the Adolfo Lutz Institute, São Paulo. ID was performed using culture filtrate antigens from Pb-113 prepared at the Laboratory of Clinical Mycology, UNESP, Araraquara (IDr) and from Pb-113 (ID1) and Pb-B-339 (ID2) prepared at the Adolfo Lutz Institute. Immunoblotting was also carried out using Pb-113 (IB1) and PbB-339 (IB2) strains. Our findings showed that ID performed at the Research Laboratory of Tropical Diseases presented no difference in positivity among the three antigens. ID performed at Adolfo Lutz Institute presented no difference in positivity between ID1 and ID2, but results were higher than in IDr. Reproducibility between laboratories was observed with ID1 and ID2, but IDr presented a somewhat higher sensitivity at the Research Laboratory of Tropical Diseases. There was no difference in sensitivity for IB1-gp43, IB2-gp70 and IB2-gp43. However, it was higher than that found for IB2-gp70. ID positivity was lower than IB1-gp43, IB2-gp43 and IB2-gp43 recognition, but higher than IB2-gp70. This study shows that P. brasiliensis can be identified in almost all the cases, mainly by histopathological examination, and the importance of the double agar gel immunodiffusion test in a routine service, including for long periods, with different technicians, biologists and pathologists. Our findings also show that negative ID serum should be submitted to immunoblotting using Pb-113 to evaluate the gp70 because of its high sensitivity, specificity, and positive and negative predictive values.
    Journal of Venomous Animals and Toxins including Tropical Diseases 12/2009; 16(3):524-525. DOI:10.1590/S1678-91992010000300021 · 0.43 Impact Factor
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    ABSTRACT: Paracoccidioidomycosis (PCM) is Latin America's most prevalent systemic mycosis, carrying an important social burden. Its agent, Paracoccidioides brasiliensis, has rarely been identified in nature. Studies characterizing acute/subacute PCM incidence and their relationship with climate variables are not available. This work analysed a series of acute/subacute cases that occurred in the Botucatu area, São Paulo State, Brazil, from 1969 to 1999, as an outcome of weather variability. Stepwise regression of annual data was applied to model incidence, calculated based on 91 cases, from lagged variables: antecedent precipitation, air temperature, soil water storage, absolute and relative air humidity, and Southern Oscillation Index (SOI). Multiple regression analyses resulted in a model, which explains 49% of the incidence variance, taking into account the absolute air humidity in the year of exposure, soil water storage and SOI of the previous 2 years. The correlations may reflect enhanced fungal growth after increase in soil water storage in the longer term and greater spore release with increase in absolute air humidity in the short term.
    International Journal of Epidemiology 06/2009; 38(6):1642-9. DOI:10.1093/ije/dyp207 · 9.20 Impact Factor
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    ABSTRACT: To report the first eight bone marrow necrosis (BMN) cases related to paracoccidioidomycosis (PCM) from patient autopsies with well-documented bone marrow (BM) histology and cytology. A retrospective evaluation was performed on BM specimens from eight autopsied patients from Botucatu University Hospital with PCM-related BMN. Relevant BMN literature was searched and analysed. All eight patients had acute PCM. Six had histological only (biopsies) and two cytological only (smears) specimens. Five biopsy specimens revealed severe and one mild coagulation patterned necrotic areas. Five had osteonecrosis. The cytological specimens also showed typical BMN patterns. Paracoccidioides brasiliensis yeast forms were visible within necrotic areas in all cases.
    Histopathology 04/2009; 54(4):486-9. DOI:10.1111/j.1365-2559.2009.03245.x · 3.30 Impact Factor
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    D. V. Moris · M. S. C. Melhem · M. A. Martins · R. P. Mendes
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    ABSTRACT: Several yeast species of Candida genus can colonize the skin as well as the mucous membrane of the vagina and the digestive tract for short or long periods. Depending on the host's immunological state and the yeast's virulence, colonization can become an infection, invading the colonized tissues and also disseminating. AIDS is characterized by the host's intensive and progressive immunodepression which manifests as diverse symptoms, mainly lesions in the mouth. Oral candidiasis is the most prevalent opportunistic infection in individuals infected with human immunodeficiency virus (HIV) and is an important indicator of the disease progress and the immunosuppression increase. The factors involved in the equilibrium between Candida spp. and HIV-infected subjects are sometimes contradictory and were evaluated in the present study specially for colonization.
    Journal of Venomous Animals and Toxins including Tropical Diseases 12/2007; 14(2):224-257. DOI:10.1590/S1678-91992008000200004 · 0.43 Impact Factor
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    ABSTRACT: The larynx is the third most commonly involved organ in paracoccidioidomycosis (PCM). While a few studies have evaluated laryngeal sequelae, there have not been any investigations of voice abnormalities in PCM patients. To evaluate persistent dysphonia and laryngeal lesions, we studied 15 normal subjects and 30 post-treatment PCM patients, i.e., 15 with only pulmonary and 15 with both laryngeal and pulmonary involvement. Perceptual and acoustic voice analysis were performed with all patients, while endoscopic studies were also conducted with the 15 laryngeal patients. Voice analysis showed instability by perceptual analysis (P<0.01) in both groups, but more severe dysphonia was noted in the laryngeal group (P<0.01). The dysponia, seen in 66.7% of these patients (dysphonia index < 7.0), was characterized by roughness and breathness. The Dr. Speech (Tiger Electronics) analysis program did not accept five voices from the laryngeal group due to the severe dysphonia. Jitter was elevated in five laryngeal lesion patients. Endoscopy showed that 80% of patients with laryngeal lesion had two or more laryngeal structures involved. Vocal fold alterations were seen in all laryngeal lesion patients, which included involvement of the arythenoids, epiglottis, and vestibular folds. This first functional study of laryngeal sequelae in PCM revealed frequent and severe dysphonia that may have important social consequences for patients.
    Medical Mycology 06/2006; 44(3):219-25. DOI:10.1080/13693780500340320 · 2.26 Impact Factor
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    Revista da Sociedade Brasileira de Medicina Tropical 06/2006; 39(3). DOI:10.1590/S0037-86822006000300017 · 0.94 Impact Factor

Publication Stats

1k Citations
129.61 Total Impact Points

Institutions

  • 1984–2014
    • São Paulo State University
      • • Institute of Biosciences
      • • Departamento de Microbiologia e Imunologia
      • • Departamento de Patologia
      San Paulo, São Paulo, Brazil
  • 2009
    • For the Children Brazil
      Miami Beach, Florida, United States
  • 1994–2006
    • University of São Paulo
      San Paulo, São Paulo, Brazil
  • 2005
    • Universidad de Carabobo, UC
      Valencia, Carabobo, Venezuela