Introduction.The sensitivity of the double agar gel immunodiffusion test is about 90% in patients with untreated paracoccidioidomycosis (PCM), but it is much lower in cases of relapse. In addition, serum from patients with PCM caused by Paracoccidioides lutzii, frequent in the Midwest region of Brazil, does not react with the classical antigen obtained from Pb B-339.  These findings showed the need for alternative diagnostic methods, such as biological markers through proteomics. Objectives.The aim of this study was to identify biomarkers for the safe identification of PCM relapse and specific proteins that could distinguish infections caused by Paracoccidioidesbrasiliensis from those produced by Paracoccidioideslutzii. Patients and Methods.Proteomic analysis was performed in serum from 9 patients with PCM caused by P. brasiliensis, with and without relapse, from 4 patients with PCM  produced by P. lutzii, and from 3 healthy controls. The proteomic approach was performed in four steps - protein quantification, protein digestion in solution, peptide sequencing by mass spectrometry and data analysis for protein identification.Results.The comparative evaluation of the 29 identified plasma proteins suggested that the presence of the immunoglobulin (Ig) alpha-2 chain C region and the absence of Ig heavy chain V-III TILindicate infection by P. lutzii. In addition, the absence of complement factor B protein might be a predictor of relapse.Conclusion.  The proteomic methodology provided the selection of two proteins to differentiate the species causing the infection and another one to predict a late relapse. The evaluation of these proteins in serum samples from a higher number of patients should be carried out in order to validate these findings.

Serological proteomic biomarkers to identify Paracoccidioides species and risk of relapse.