Treatment options for paracoccidioidomycosis and new strategies investigated (original) (raw)
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Revista da Sociedade Brasileira de Medicina Tropical
Paracoccidioidomycosis (PCM) is a systemic infection caused by the fungus Paracoccidioides brasiliensis. PCM is considered one of the most important systemic mycoses in Latin America. This is a clinical, epidemiological, retrospective, quantitative study of PCM cases in patients attending the National Health Service in the State of Rondônia in 1997-2012. The examined variables included sex, age group, year of diagnosis, education level, profession, place of residence, diagnostic test, prior treatment, medication used, comorbidities and case progress. During the study period, 2,163 PCM cases were registered in Rondônia, and the mean annual incidence was 9.4/100,000 people. The municipalities with the highest rates were located in the southeastern region of Rondônia, and the towns of Pimenteiras do Oeste and Espigão do Oeste had the highest rates in the state, which were 39.1/100,000 and 37.4/100,000 people, respectively. Among all cases, 90.2% and 9.8% were observed in men and women,...
Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues
Future Microbiology, 2013
Paracoccidioidomycosis (PCM), caused by the human fungal pathogens from the Paracoccidioides genus, is the highest cause of mortality among systemic mycoses in Brazil and the eighth most important cause of mortality from chronic infectious diseases, causing 1.65 deaths per 10 6 inhabitants [1]. PCM is endemic to populations that live in rural areas. This mainly affects individuals related to agricultural activities who, by manipulating the soil, generate aerosols containing fungal spores, which are inhaled [2]. The annual incidences of new cases vary within endemic areas ranging from 1 to 3 new cases per 10 5 inhabitants [3]. The disease is geographically restricted to central and South America (from Mexico to Argentina) showing high prevalence in Brazil, Colombia, Venezuela and Argentina [4]. Imported cases have been recorded in the USA, Europe and Asia [5]. In some regions of Brazil, such as the state of Rondonia, more than 1170 cases have been reported between 1998 and 2005 [Durlacher R, Lima S, Pers. Comm.]. The large predominance observed in male adult patients has not been observed in child or young adult patients (1-2 men to each woman) [3]. The ability of estrogens to inhibit the transformation of mycelium or conidia to yeast or the higher exposure of men than women to the soil in rural areas may explain these differences [6]. Transmission of the mycosis from one person to another has not been reported. Tobacco and alcohol intake increased the risk of PCM as shown in a case-control study in Brazil [7]. According to geospatial technologies, association between climatic factors and clinical diagnosis of PCM, Paracoccidioides should occur preferentially at sites of soil with a high rainfall index and optimum permeability, which is associated with a high relative humidity and abundance of vegetation and Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues
Paracoccidioidomycosis mortality in Brazil (1980-1995)
Cadernos de Saúde …, 2002
This study analyzes 3,181 deaths from paracoccidioidomycosis in Brazil, based on 16 years of sequential data (from 1980 to 1995). During this period paracoccidioidomycosis showed considerable magnitude and low visibility, representing the eighth most common cause of death from predominantly chronic or recurrent types of infectious and parasitic diseases. It also had the highest mortality rate among the systemic mycoses. The mean annual mortality rate was 1.45 per million inhabitants, indicating a downward long-term trend (reduction of 31.28%), while spatial distribution among the different regions and States of Brazil was non-homogenous. The South (with the highest regional rate) and the Southeast showed a downward trend, while the Central West had the second highest rate in the country. At least one-fifth of Brazilian municipalities (or 22.71% of the country's total area) reported deaths from paracoccidioidomycosis. Overall nationwide mortality per area was 3.73/10,000km 2. The disease was endemic in non-metropolitan areas. The majority of deaths occurred in males (84.75%), and there was a sex ratio of 562 men/100 women. The 30-59-year and over-60-year age groups were the most affected. The study showed that the mortality rate justifies classifying this disease as a major health problem in Brazil.
The American journal of tropical medicine and hygiene, 1999
This paper describes the clinical-seroepidemiologic characteristics of patients with paracoccidioidomycosis (PCM) who visited the University Hospital at the State University of Campinas (Campinas, Sao Paulo, Brazil). The study group consisted of 584 individuals (492 males and 92 females) with ages ranging from 5 to 87 years. The highest incidence of the disease occurred between the ages of 41 and 50 years for men and between 11 and 40 years for women. Rural activities were the principal occupation of 46% of the patients. The diagnosis was confirmed by histopathologic examination and demonstration of fungus in scrapings, secretions, or in the sputum. Serologic test results for PCM were positive in 80% of the 584 patients studied. The significant number of patients, including 33 children less than 14 years old, indicates the presence of the fungus in the area and that this region is an important endemic area for PCM.
Mycoses
BackgroundThe Americas are home to biologically and clinically diverse endemic fungi, including Blastomyces, Coccidioides, Emergomyces, Histoplasma, Paracoccidioides and Sporothrix. In endemic areas with high risk of infection, these fungal pathogens represent an important public health problem.ObjectivesThis report aims to summarise the main findings of the regional analysis carried out on the status of the endemic mycoses of the Americas, done at the first International Meeting on Endemic Mycoses of the Americas (IMEMA).MethodsA regional analysis for the Americas was done, the 27 territories were grouped into nine regions. A SWOT analysis was done.ResultsAll territories reported availability of microscopy. Seventy percent of territories reported antibody testing, 67% of territories reported availability of Histoplasma antigen testing. None of the territories reported the use of (1–3)‐β‐d‐glucan. Fifty two percent of territories reported the availability of PCR testing in reference...
Brazilian guidelines for the clinical management of paracoccidioidomycosis
Revista da Sociedade Brasileira de Medicina Tropical, 2017
Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis ( P. brasiliensis ) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii ( P. lutzii ), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients' sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for be...
Paracoccidioidomycosis in Mexico: clinical and epidemiological data from 93 new cases (1972-2012)
Mycoses, 2014
of Latin America. The few registered cases in Mexico most likely do not reflect the real frequency. Disseminate the epidemiological and clinical data of unreported cases of PCM in Mexico from 1972 until 2012 is the aim of this work. Epidemiological and clinical information of non-published cases of PCM was requested from the principal mycological diagnosis centres in Mexico. A total of 93 cases were received. The infection was found predominantly in men (95.7%), peasants (88.5%) and individual between 31 and 60 years of age. Most of the cases were found in tropical areas of the Gulf of Mexico (54.84%) and the Pacific littoral (20.3%). The main sites of dissemination were the oral mucosa (39.38%) and skin (34.05%). The most effective treatments were itraconazole alone and the combination of itraconazole with sulfamethoxazole-trimethoprim. PCM is a subdiagnosed pathology in Mexico. Therefore, adequate training is necessary to determine the current status of this mycosis.