Increased peripheral blood TCD4+ counts and serum SP-D levels in patients with chronic paracoccidioidomycosis, during and after antifungal therapy

• Published in: Memórias do Instituto Oswaldo Cruz Vol. 112; no. 11; pp. 748 - 755
• Main Authors: Venturini, James, Cavalcante, Ricardo Souza, Sylvestre, Tatiane Fernanda, Santos, Rodolfo Ferreira Dos, Moris, Daniela Vanessa, Carvalho, Lídia Raquel, Arruda, Maria Sueli Parreira de, Golim, Marjorie de Assis, Mendes, Rinaldo Poncio
• Format: Journal Article
• Language: English
• Published: Brazil Instituto Oswaldo Cruz, Ministério da Saúde 01-11-2017; Fundação Oswaldo Cruz (FIOCRUZ)
• Subjects: Adolescent; Adult; antifungal agents; Antifungal Agents - therapeutic use; Biomarkers - blood; CD4 Lymphocyte Count; Child; Chronic Disease; Cytokines - blood; emphysema; Female; Fibroblast Growth Factor 2 - blood; Flow Cytometry; Humans; Male; Middle Aged; paracoccidioidomycosis; Paracoccidioidomycosis - blood; Paracoccidioidomycosis - drug therapy; PARASITOLOGY; pulmonary fibrosis; Pulmonary Surfactant-Associated Protein D - blood; Severity of Illness Index; surfactant protein-D; T-lymphocyte subsets; TROPICAL MEDICINE; Young Adult; paracoccidioidomycosis; surfactant protein-D; antifungal agents; T-lymphocyte subsets; pulmonary fibrosis; emphysema
• ISSN: 0074-0276; 1678-8060; 1678-8060
• DOI: 10.1590/0074-02760170046

The main clinical forms of paracoccidioidomycosis (PCM) are the acute/subacute form (AF) and the chronic form (CF), and they both display considerable clinical variability. The immune responses of PCM patients, during and after treatment, remain neglected, mainly in the case of CF patients, due to the high prevalence of pulmonary sequelae.
To evaluate the distribution of whole blood T cell subsets, serum cytokines, and biomarkers of pulmonary fibrosis in PCM patients, according to the clinical form and at different time points, during the antifungal therapy.
Eighty-seven PCM patients, from an endemic area in Brazil, were categorised into groups, according to the clinical form (AF or CF) and the moment of treatment. The peripheral blood T lymphocyte subsets of these patients were analysed using fluorescence-activated cell sorting. The serum levels of cytokines, basic fibroblast growth factor and surfactant protein-D (SP-D) were also analysed.
In the CF patients, an expansion of the peripheral blood TCD4+ cells was observed during the treatment, and this persisted even after two years of antifungal treatment. In addition, these patients showed high serum levels of SP-D.
Our findings highlight the immunological changes CF patients undergo, during and after treatment, possibly due to the hypoxia triggered by pulmonary fibrosis and emphysema.