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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A coccidioidomicose à uma infecÃÃo sistÃmica causada pelos fungos dimÃrficos Coccidioides immitis e C. posadasii. A doenÃa acomete o homem e uma grande variedade de animais, sendo endÃmica no Estado do CearÃ, onde à causada pela espÃcie C. posadasii. O presente estudo buscou analisar as caracterÃsticas fenotÃpicas de C. posadasii e desenvolver mÃtodos independentes de cultivo para o diagnÃstico laboratorial da coccidioidomicose. O estudo fenotÃpico de 10 cepas (7 isolados clÃnicos e 3 isolados ambientais) foi conduzido por anÃlises macro e micromorfolÃgica, anÃlise da cinÃtica de crescimento frente a estresse salino, tÃrmico e de pH; testes de assimilaÃÃo de fontes de carbono e nitrogÃnio e determinaÃÃo do perfil de sensibilidade frente a antimicrobianos. Adicionalmente, foram avaliados mÃtodos de extraÃÃo de antÃgenos de cepas locais de C. posadasii e amplificaÃÃo de seqÃÃncias genÃticas exclusivas do fungo em escarro. Foram observadas trÃs variaÃÃes morfolÃgicas das cepas de C. posadasii cultivadas em Ãgar batata, Ãgar Sabouraud dextrose a 2% e Ãgar YEG. Com relaÃÃo a micromorfologia, foi detectado que a quantificaÃÃo de artroconÃdios estava relacionada à idade e a morfologia das colÃnias. A avaliaÃÃo da cinÃtica de crescimento das cepas, in vitro, revelou que as cepas de C. posadasii sÃo inibidas por elevada concentraÃÃo salina e temperaturas acima de 40 C, mas nÃo sofrem influÃncia quanto à variaÃÃo de pH do meio. A anÃlise nutricional demonstrou que vÃrios compostos, inclusive os Ãons oxidados nitrito e nitrato, podem ser utilizados como fontes de carbono e/ou nitrogÃnio. Todas as cepas de C. posadasii foram sensÃveis Ãs drogas antifÃngicas anfotericina B, caspofungina e aos derivados azÃlicos cetononazol, itraconazol, fluconazol e voriconazol. Foi observado que, a exceÃÃo da pirazinamida, todos as demais drogas antituberculose alteraram o crescimento das cepas de C. posadasii in vitro. CombinaÃÃes formadas pelos quimioterÃpicos antituberculose tambÃm mostraram efeito inibitÃrio sobre o crescimento das cepas. Os protocolos experimentais culminaram com uma preparaÃÃo antigÃnica estÃvel e imunoreativa, adequada para utilizaÃÃo em testes sorolÃgicos presuntivos para diagnÃstico da coccidioidomicose. A identificaÃÃo molecular de C. posadasii foi realizada, com sucesso, a partir da amplificaÃÃo da seqÃÃncia do gene pra diretamente de culturas filamentosas e escarro contendo estruturas parasitÃrias do fungo. Acredita-se que as caracterÃsticas fenotÃpicas descritas para as cepas de C. posadasii poderÃo auxiliar estudos futuros que objetivem a individualizaÃÃo biolÃgica das espÃcies C. immitis e C. posadasii. Os resultados desse estudo contribuÃram para o estabelecimento de estratÃgias para o maior conhecimento da coccidioidomicose no Brasil / Coccidiodomycosis is a systemic infection caused by the dimorphic fungi species Coccidioides immitis and C. posadasii. The disease affects both humans and animals, and is considered endemic in the semiarid areas of Cearà State (Northeast Brazil), where it is caused by C. posadasii. The aims of this study were to analyse the phenotypical characteristics of C. posadasii and to develop culture independent methods for improving of the laboratorial diagnosis of coccidioidomycosis. The phenotypical study was conducted with 10 strains (7 from clinical and 3 from ambiental sources) by macro and micromorphology analyses; in vitro growth under different conditions of salinity, temperature and pH; nutritional analysis and antimicrobial susceptibility tests. In addition, methods of antigens extraction and amplification of C. posadasii DNA directly in sputum were also tested. The mycological analysis showed three morphological variations of C. posadasii strains cultivated in potato agar, Sabouraud agar and YEG agar. Regarding to micromorphology, it was observed that arthroconidia counts were related to colony aging and texture. Growth rates of C. posadasii strains were inhibited by high salt concentrations, temperatures above 40 C, but were not affected by the range of pH. Nutritional analyses showed that several compounds, including the oxidized ions, nitrite and nitrate, were efficiently metabolized by C. posadasii strains as carbon and/ or nitrogen sources. The antifungal susceptibility analysis showed that all of the strains of C. posadasii were sensitive to amphotericin B, caspofungin and the azoles ketoconazole, itraconazole, fluconazole, and voriconazole. With the exception of pyrazinamide, all of the tested drugs interfered with the in vitro growth of C. posadasii. Combined antituberculosis drugs also inhibit fungal growth in vitro. Experimental protocols produced a stable and immunoreactive antigen, suitable in presumptive serologic tests for the diagnosis of coccidioidomycosis. Molecular identification of C. posadasii was achieved by PCR amplification of the specific pra gene directly from filamentous cultures and sputum with fungal parasitic structures. The data obtained by phenotypical analyses may be useful in future studies for biological distinction of C. immitis and C. posadasii species. The results of this study provided approaches for a better understanding of coccidioidomycosis in Brazil

Class of 2013 Abstract / Specific Aims: To describe the characteristics of patients who were switched to or prescribed posaconazole or voriconazole for the treatment of coccidioidomycosis including duration of previous anti-fungal treatment and rationale for changing from the first-line agents to posaconazole or voriconazole. Methods: This was a retrospective medical chart review of all patients admitted to an academic medical center with a diagnosis of coccidioidomycosis and prescribed posaconazole or voriconazole between January 2008 and December 2011. Subjects for the study were identified by ICD-9 codes for coccidioidomycosis (114.0-114.9) and through the pharmacy system for orders for posaconazole or voriconazole. Data collected included demographic information, antifungal prescription data, and outcome of fungal infection, if available. Main Results: A total of 41 subjects were identified as being prescribed either voriconazole or posaconazole for a diagnosis for coccidioidomycosis. The majority of subjects were prescribed voriconazole (93%) rather than posaconazole. While the majority of subjects were diagnosed with only pulmonary disease, 44% of subjects’ coccidioidomycosis diagnoses were classified as disseminated and 46% were admitted to an intensive care unit. The median (range) duration of first-line antifungal therapy was 3 (2-10) days for the posaconazole group and 3 (0-25) days for the voriconazole group. Overall, the reason(s) for switching antifungal therapy was listed as: failure of first-line therapy (26%), adverse drug event (4.3%), other (35%), and unknown (35%). Conclusion: There was no significant difference in baseline or disease characteristics between patients who were prescribed voriconazole or posaconazole for coccidioidomycosis. The main limitation of this retrospective evaluation is that the reason for use of voriconazole or posaconazole rather than first-line agents was often not easily determined based on the documentation in the medical records.

Veterinarians in Tucson and Phoenix were surveyed by mail, requesting information about their patients recently diagnosed or treated for Valley Fever. Information obtained included risk factors and outcome.

Four to six month old healthy puppies were enrolled in a longitudinal study of their serostatus against the Coccidioides spp. Dog were tested every six months for one year. At the request of investigators, some dogs continued to be tested every six months for two years. Dogs that became ill with clinical signs consistent with coccidioidomycosis received additional testing. Owners were asked to complete a questionnaire regarding exposure risk factors at each routine testing visit.

381 dogs between 4 and 18 months of age were tested for the presence of antibodies to Coccidioides one time. Dogs were reported as either healthy or sick by the referring veterinarian. Owners were asked to complete a questionnaire regarding their dog's risk factors associated with exposure to Coccidioides at the time of sample collection.

Mass spectrometry (MS) has proven itself to be indispensable for the analysis of biomolecules and molecular systems. This research has three goals: (1) expand on prior work toward the discovery of novel diagnostic targets for Valley Fever, (2) evaluate current mass spectrometry based proteomics for the discovery of non-host protein in complex host biological samples, and (3) investigate the potential for two gas phase techniques, surface induced dissociation, and ion mobility for the analysis of carbohydrate based molecules. Mass spectrometry has allowed for great advances in the identification of proteins in biological samples through implementing liquid chromatography tandem mass spectrometry and bioinformatics techniques known as proteomics. Proteomics techniques were used to elucidate a portion of the biosignature of Valley Fever (VF), a disease of great importance in the arid regions of the western United States. Current diagnostics for this fungal lung disease are remarkably unreliable which creates a need for an unfailing diagnostic method. Using a new generation of instrumentation along with directed methods, four previously discovered VF marker proteins were evaluated for their presence in mouse plasma, lung homogenate and bronchoalveolar lavage fluid samples. Due to inconclusive data, discovery proteomics approaches were then used to identify possible diagnostic targets in both human and mouse bronchoalveolar lavage fluid. In human bronchoalveolar lavage fluid, one potential target was discovered in five out of eight VF positive samples, and two further identifications of VF in negative samples. Mouse bronchoalveolar lavage fluid also showed the presence of this protein. Multiple-reaction monitoring based validation, using two-dimensional online separations for the presence of either the newly discovered protein or the four previously discovered proteins, was inconclusive. Emerging from the difficulties observed by the author and colleagues in identifying infectious agent proteins in complex host biological samples, an investigation of the feasibility of undertaking such endeavors was performed. One of the main complications thwarting the discovery of infectious agent proteins is the dynamic range of protein concentration in the host biological sample. This issue was resolved by using commercially available mass spectrometry and a two-dimensional liquid chromatographic separations platform. This enhanced separation combined with cost-effective protein normalization techniques, identified non-host proteins with good sequence coverage and spectral counts. Combining antibody-based depletion of highly abundant plasma proteins in bronchoalveolar lavage fluid, with at least a three fraction sample analysis enabled detection of a low abundant non-host protein (2pmol in 50μg host protein) with high sequence coverage. Glycosylation, an abundant post-translational modification of protein composed of carbohydrate oligomers may hold within its structure more biologically relevant information than the DNA that encoded the protein on which the glycan resides. The analysis of glycosylation plays a critical role in understanding biology. Carbohydrate based moieties pose many distinct challenges to their analysis; two of which are isobaric fundamental units and complex branching chemistry. Mass spectrometry provides a way of overcoming some of these challenges. To examine the complex biomolecules, a gas phase ion separation technique, known as ion mobility, and a non-traditional ion activation technique, surface-induced dissociation, were used. Surface-induced dissociation provides analogous fragmentation patterns to those generated via collision-induced dissociation (CID); however, much more extensive fragmentation can be achieved in a single tandem MS experiment. Using the gas-phase separations power of ion mobility showed that multiple conformations were adopted by relatively simple oligosaccharides. Ion mobility was also successfully used to determine fragment ion lineage of isobaric fragment ions, through inline separation between two differential fragmentation experiments.

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Coccidioidomycosis is a growing problem in the United States. There is still an incomplete understanding of the immunological response associated with human coccidioido-mycosis, although previous studies have indicated that cell-mediated immunity (CMI) is critical in the control of this disease. We have examined necrotizing pulmonary coccidioidal granulomata using immunohistochemical staining for lymphocyte subsets and for the cytokines interleukin-10 (IL-10) and gamma interferon (IFN-?). Discrete perigranulomatous lymphocytic clusters were identified containing roughly equal numbers of T (CD3+) and B (CD20+) lymphocytes. While the number of cells expressing IL-10 was similar in the mantle and in the perigranulomatous clusters, there were significantly more cells expressing IFN-? in the mantle compared to the clusters (P = 0.037). Confocal microscopy revealed that CD4+ T lymphocytes and B lymphocytes are associated with IL-10 production. CD4+CD25+ T lymphocytes were also identified in the perigranulomatous clusters but were not associated with IL-10 production. This is the first report noting perigranulomatous lymphocyte clusters and IL-10 in association with human coccidioidal granulomata, suggesting a down-regulation of cellular immune response.IL-12 is critical in driving a T helper type 1 (Th1) immune response. To understand the mechanism associated with hyporesponsiveness to IL-12 stimulation seen in some anergic patients with disseminated coccidioidomycosis, IL-12 receptor expression and function were determined in PBMCs from immune and nonimmune healthy donors. By using a relative quantitative RT-PCR technique, we found that IL-12R?1 is constitutively expressed in PBMCs and is equally up-regulated by coccidioidal antigen preparation T27K in both immune and nonimmune donors. On the other hand, the IL-12R?2 expression level is increased by T27K only in PBMCs from immune but not nonimmune donors. In addition, the increased IL-12R?2 expression in immune PBMCs is correlated with Stat4 activation and the induction of IFN-? production by IL-12. These data suggest that the IL-12R?2 expression and signal transduction is functional in host immunity against Coccidioides infection. Subsequent research, which involved the stimulation of lymphocytes with autologous dendritic cells (DCs) pulsed with T27K, revealed that the up-regulation of IL-12R?2 expression and signal transduction is associated with the induction of IFN-? production by DCs pulsed with T27K.