Estudo clínico e laboratorial de controle de cura de pacientes submetidos a tratamento para paracoccidioidomicose atendidos no Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias do Hospital das Clínicas da Universidade Federal de Minas Gerais

Abstract

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis, which affects predominantly Latin America, with high prevalence in Brazil. The right moment to interrupt the treatment and the control of cure are not well established questions that influence the management of patients. This study aimed to evaluate patients treated for PCM, and considered clinically cured, to verify the applicability of serological markers in the control of cure of the disease. From March 2009 to June 2012, 26 patients were evaluated at the Ambulatory of PCM of the Center of Reference and Training in Infectious and Parasitic Diseases of the General Hospital of the Federal University of Minas Gerais. Patients were clinically evaluated and blood samples were collected during the treatment and after its interruption, until 42 months of follow-up. The serological analysis was performed by ELISA, to measure the levels of IgG anti-P. brasiliensis using Mexo and rPb27 as antigens, sTNF-RI, sTNFRII, CXCL9, CCL3, CCL11 and CCL24. The 26 patients were classified in nine groups: 19 patients during treatment (dt); 22 patients at the day of interruption of treatment (t0); 22 patients at six months after interruption of treatment (t6); 18 patients at 12 months after interruption (t12); 13 patients at 18 months after interruption (t18); nine patients at 24 months after interruption (t24); six patients at 30 months after interruption (t30); five patients at 36 months after interruption (t36) and three patients at 42 months after interruption of treatment (t42). The serological markers were tested in 10 healthy individuals that formed a negative control group (NC). The serological levels of IgG, sTNF-RI and sTNF-RII remained high during all the period of follow-up, what madepossible the segregation of patients treated for PCM from the NC group in practically all the time of the study. In the analysis of CCL3, 31,6% of patients presented serological concentrations below the cut-off point during the treatment and 45,5% at the moment of its interruption, with a tendency of decreasing in the values along the time. 95% of patients presented concentrations of CCL11 below the cut-off point during thetreatment, with an increase in these values from the moment of its interruption. 42% of patients presented concentrations of CCL24 below the cut-off point, without relevant changes over the time. The concentrations of CXCL9 remained low during the control of cure, for the majority of patients. Although, during the treatment, the concentrationsof CXCL9 were also low, and there was not association between active disease and high concentrations of this chemokine. These results show the insecurity to use those markers in the follow-up of patients in control of cure, since, its levels were variable, and it was not found a clear association with clinical cure.