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Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America caused by thermodimorphic fungi of the genus Paracoccidioides. In the last two decades, enhanced understanding of the phylogenetic species concept and molecular variations has led to changes in this genus’ taxonomic classification. Although the impact of the new species on clinical presentation and treatment remains unclear, they can influence diagnosis when serological methods are employed. Further, although the infection is usually acquired in rural areas, the symptoms may manifest years or decades later when the patient might be living in the city or even in another country outside the endemic region. Brazil accounts for 80% of PCM cases worldwide, and its incidence is rising in the northern part of the country (Amazon region), owing to new settlements and deforestation, whereas it is decreasing in the south, owing to agriculture mechanization and urbanization. Clusters of the acute/subacute form are also emerging in areas with major human intervention and climate change. Advances in diagnostic methods (molecular and immunological techniques and biomarkers) remain scarce, and even the reference center’s diagnostics are based mainly on direct microscopic examination. Classical imaging findings in the lungs include interstitial bilateral infiltrates, and eventually, enlargement or calcification of adrenals and intraparenchymal central nervous system lesions are also present. Besides itraconazole, cotrimoxazole, and amphotericin B, new azoles may be an alternative when the previous ones are not tolerated, although few studies have investigated their use in treating PCM.

Objective The identification of Candida spp. in denture stomatitis, the clinical manifestations, and the antifungal susceptibility profile lead to a correct and individualized therapeutic management of the patients. This study is aimed at investigating the clinical manifestations and epidemiological and microbiological characteristics of Candida -associated denture stomatitis. Design The samples were obtained by swabbing the oral mucosa of the subjects and then seeded onto Sabouraud Dextrose Agar and onto CHROMagar® Candida plates. The identification at the species level was confirmed by Matrix Assisted Laser Desorption Time of Flight Mass Spectrometry. Clinical classification was performed according to the criteria proposed by Newton (1962): (i) pinpoint hyperemia, (ii) diffuse hyperemia, and (iii) granular hyperemia. For carrying out the antifungal susceptibility testing, we adopted the CLSI M27-S4 protocol. Results C. albicans was the most prevalent species in our study. Regarding non- albicans Candida species, C. glabrata was the most common species isolated from the oral mucosa ( n  = 4, 14.8%), while in the prosthesis, it was C. tropicalis ( n  = 4, 14.8%). The most prevalent clinical manifestation was pinpoint hyperemia and diffuse hyperemia. Candida albicans , C. glabrata , and C. parapsilosis were susceptible to all the tested antifungals. Concerning fluconazole and micafungin, only two strains showed dose-dependent sensitivity (minimum inhibitory concentration (MIC), 1 μg/mL) and intermediate sensitivity (MIC, 0.25 μg/mL). One C. tropicalis strain was resistant to voriconazole (MIC, 8 μg/mL). Conclusions C. albicans was the most common species found in oral mucosa and prosthesis. The tested antifungal drugs showed great activity against most isolates. The most prevalent clinical manifestations were Newton’s type I and type II.

Background Clinicopathological diagnosis and follow-up of oral lichen planus and leukoplakia are necessary due to its potential for malignant transformation and the need to differentiate it from other lichenoid diseases and proliferative verrucous leukoplakia. This study aimed to classify and compare sociodemographic and clinicopathological features among patients with oral lichen planus, oral lichenoid lesions and proliferative verrucous leukoplakia. Methods A transversal observational study in which oral leukoplakia and oral lichen planus patients were surveyed at the Oral Pathological Anatomy Service and Applied Biotechnology Laboratory was conducted. Sociodemographic and clinicopathological data were compared for the lesions studied with the chi-square test or Fisher’s exact test. Results After classification, 21 oral lichen planus lesions, 34 oral lichenoid lesions and 12 proliferative verrucous leukoplakia lesions were evaluated. Reticular patterns are more characteristic of oral lichen planus and plaque lesions of proliferative verrucous leukoplakia. The buccal mucosa was the most affected site in oral lichen planus lesions, and it was bilateral in all patients. Epithelial dysplasia was present in almost all patients with proliferative verrucous leukoplakia. Conclusions Compared with oral lichen planus and proliferative verrucous leukoplakia, oral lichenoid lesions presented intermediate features. This may delay proliferative verrucous leukoplakia diagnosis.

Introduction Paracoccidioidomycosis is a systemic mycosis endemic to Latin America, with frequent reports of poor treatment adherence resulting in worse clinical outcomes. The present study evaluated factors related to treatment adherence in patients with paracoccidioidomycosis. Methods This cross‐sectional study included data from medical records of patients with paracoccidioidomycosis treated between 2005 and 2018 in a reference hospital in southeastern Brazil. Clinical variables, demographic characteristics, and smoking and alcohol consumption were collected and analyzed. Results Of the 198 cases included, most were adults (median age = 51 years), males (93.4%), presented chronic paracoccidioidomycosis (83.8%), reported smoking (90.4%) and alcohol consumption (84.8%), and 56.6% adhered to treatment. Treatment adherence was associated with the discontinuation of alcohol consumption (odds ratios (OR) = 5.227; 95% confidence interval (CI) = 2.697–10.129) and smoking (OR = 3.365; 95% CI = 1.781–6.358) during therapy. Conclusions Patients' continued consumption of alcohol and tobacco was associated with non‐adherence to treatment, suggesting that a joint therapeutic approach that addresses alcohol and tobacco use alongside paracoccidioidomycosis treatment may hold promise for improving adherence and patients' quality of life. Non‐adherence to treatment is common among paracoccidioidomycosis patients. Continued consumption of alcohol and tobacco contributes to non‐adherence to treatment. A joint therapeutic approach that addresses alcohol and tobacco use alongside paracoccidioidomycosis treatment may hold a promise in improving adherence and patients' quality of life.

Introduction A primary cutaneous CD-30 positive T -cell lymphoproliferative disorders are rare and heterogeneous group of primary skin tumors, which include primary cutaneous anaplastic large cell lymphoma (PCALCL) and lymphomatoid papulois. Case report We report a rare an atypical case of PCALCL with an aggressive and refractory behavior that occurred in the lip vermilion, and that had been initially diagnosed as aggressive herpes. The lesion was recurrent and refractory to the CHOEP chemotherapy protocol followed by radiotherapy, but after hyper CVAD (acronym) + brentuximab with a considerable improvement. After 4 cycles of hyper CVAD plus brentuximab, the patient underwent 100% compatible sibling bone marrow transplantation, with success in the procedure. Conclusion Primary cutaneous anaplastic large cell lymphoma is a rare disease of difficult diagnosis and may be confused with chronic infectious diseases, postponing treatment.

Objective This study aims to analyze the prevalence of Candida spp. colonization in oral leukoplakia and oral lichen planus lesions, verify the influence of systemic and local factors, besides identify and determine the in vitro antifungal susceptibility profile of Candida species. Materials and Methods Samples were collected by swabbing from oral lesions and healthy mucosa and cultured on Sabouraud Dextrose and CHROMagar® Candida plates. Species identification was confirmed with MALDI-TOF MS analysis. Results Candida spp. was found in 36.8% of cases of oral leukoplakia and 18.2% of cases of oral lichen planus. Candida albicans was the only species found in oral lichen planus lesions ( n  = 2, 100%) and the most prevalent in oral leukoplakia ( n  = 5, 76.4%). Among the non- albicans Candida species found in oral leukoplakia were C. parapsilosis ( n  = 2, 25.5%) and C. tropicalis ( n  = 1, 14.1%). Candida isolates were susceptible to all antifungals tested. Conclusion C. albicans was the most commonly found species in the studied lesions. No correlation was found between systemic and local factors with positive cases of oral lichen planus. However, smoking and alcohol consumption may be associated with positive cases of oral leukoplakia, especially the non-homogeneous clinical form. In addition, there is a possible predisposition to associated Candida colonization in cases of epithelial dysplasia found in oral leukoplakia. The antifungal medications tested showed excellent efficacy against isolates.

PurposeThis article shows reports of the clinical–epidemiological characteristics and serological screening in patients assisted by a reference center for PCM care, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Brazil.MethodsThe patient’s sera with PCM were analyzed by DID test at the beginning and the end treatment. Clinical and demographic data were also collected to characterize the sample.ResultsOne hundred patients with a suspected diagnosis of PCM were evaluated. Serology by DID test was used as a screen in all patients. The test was positive for 79 patients (72 for Paracoccidioides brasiliensis and 7 for Paracoccidioides lutzii). Serology was negative in 21 sera, although all of them were diagnosed PCM by histopathologic or direct exam. Serological follow-up was performed during the treatment of all patients. After treatment, 58(58%) had negative serology and 33(33%) low levels of antibodies (≤ 1:16).ConclusionOur results indicate the importance of the DID test for the screening and monitoring of PCM and that the incidence of P. lutzii might be greater than expected in areas where it is not the predominant PCM species. Therefore, this article may contribute to improving the knowledge and clinical management about this disease.

    Background and objective Paracoccidioidomycosis (PCM) is a systemic fungal disease caused by the thermodimorphic fungi P aracoccidioides spp . Their distribution is highly variable. Paracoccidioides lutzii is predominantly found in North and Middle-West Brazil and Ecuador. This study evaluated the clinicopathological characteristics of 10 patients diagnosed with PCM caused by P. lutzii in a reference center located in southeastern Brazil. Design Double immunodiffusion assay (DID) was used to investigate 35 patients’ sera with negative serology for P. brasiliensis against a P. lutzii CFA (cell-free antigen). Results Out of the 35 retested patients, 10 (28.6%) were positive for P. lutzii CFA. Four patients did not report any displacement to P. lutzii endemic areas. Our results reinforce the importance of using different antigens when testing patients with clinical manifestations of PCM and negative serological tests for P. brasiliensis , primarily in cases of the report of displacement to or former residence in P. lutzii endemic regions. Conclusions The availability of tests for different Paracoccidioides species antigens is fundamental for reaching an adequate diagnosis, patient follow-up, and definition of prognosis.

We report a case of difficult-to-control mycosis fungoides (MF), where the role of the dental surgeon was crucial for the control and prognosis of the disease. A 62-year-old female patient diagnosed with MF had a previous record of red patches and small raised bumps on the face, along with a cancerous growth in the cervical and vulvar region. The patient was initially treated with methotrexate and local radiotherapy without resolution. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone was then started (CHOP protocol). The dental team of a reference hospital was consulted to evaluate swelling in the anterior region of the palate, which had been developing for two months, reporting discomfort when eating. The role of the dentistry team was fundamental in the differential diagnosis of oral lesions with dental infections, second neoplasia, or even a new site of disease manifestation, in addition to controlling mucosal changes resulting from chemotherapy. After ruling out dental infection, the dentistry team performed a lesion biopsy to confirm the diagnosis. The histopathological and immunohistochemical analysis showed atypical lymphoid infiltration of T cells (CD3+/CD4+/CD7-/CD8-), coexpression of CD25, and presence of CD30 cells, corresponding to the finding for MF. Identifying CD30 + allowed for a new chemotherapy protocol with brentuximab vedotin (BV) combined with gemcitabine. This protocol effectively controlled MF, which previous protocols had failed to do. The diagnosis by the dental team was essential for therapeutic change and improvement of the patient’s clinical condition without the need for invasive medical procedures.

Sporotrichosis is a subcutaneous mycosis caused by traumatic inoculation into the skin by fungi species of the genus Sporothrix . The disease has different clinical manifestations (cutaneous, lymphocutaneous, and disseminated), and can also progress to a systemic infection. Despite having a worldwide distribution, sporotrichosis is most prevalent in tropical and subtropical countries. In Brazil, reports of the disease are higher frequent, where cases of the disease were found in Rio de Janeiro, Sao Paulo, Curitiba, Pernambuco, and Paraiba, among others. Certain groups of people may be more exposed to the causative agent of disease, such as residents of rural areas. Thus, this work aimed to carry out a seroepidemiological survey of the prevalence of sporotrichosis in four rural locations in the south of Minas Gerais State, Brazil. In this study, we used an indirect ELISA test in the survey on the prevalence of sporotrichosis. Data obtained in this study evaluated a population of 631 individuals and showed a prevalence of 44.69%. The distribution of seroprevalence of sporotrichosis with respect to age groups and gender showed no significant statistical difference. Thus, we found a high seroprevalence of sporotrichosis-infection in rural regions of southern Minas Gerais State, Brazil, with no difference in prevalence in relation to gender and age.