RESUMO
The epidemiological dynamics of paracoccidioidomycosis (PCM) has been changing over the years. We analyzed secondary public data from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS), focusing on PCM-related hospitalizations and in-hospital deaths. In the period between 2010 and 2019, 396 hospitalizations and 30 deaths were related to PCM among 7 073 334 hospitalizations registered in Rio de Janeiro. We highlight the rising rates, reflecting the increase in the number of acute forms previously reported. Urgent public health policies are essential to prevent poor outcomes related to this neglected mycosis.
Epidemiology of paracoccidioidomycosis has been changing in endemic areas. We analyzed secondary data on hospitalizations in Rio de Janeiro, an important endemic area. There is a trend on increasing rates of hospitalizations and in-hospital deaths mainly in the Metropolitan belt.
Assuntos
Mortalidade Hospitalar , Hospitalização , Paracoccidioidomicose , Brasil/epidemiologia , Humanos , Paracoccidioidomicose/epidemiologia , Paracoccidioidomicose/mortalidade , Hospitalização/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Feminino , Adulto , Idoso , Adolescente , Adulto Jovem , Criança , Pré-Escolar , Idoso de 80 Anos ou maisRESUMO
The acute-subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute-subacute PCM, to determine a mortality risk factor and to propose a test for non-survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15 years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P < .05). Through a period of 38 years, 141 children and adolescents were diagnosed with acute-subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole-trimethoprim (SMX-TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut-off for serum albumin was 2.18 g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute-subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage ≤ 2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard.
Assuntos
Paracoccidioidomicose/diagnóstico , Doença Aguda , Adolescente , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/mortalidade , Pesquisa Qualitativa , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
Paracoccidioidomycosis (PCM) is a systemic mycosis prevalent among immunocompetent patients in Latin America. This study aimed to describe the frequency, demographics and clinical characteristics of central nervous system PCM (NPCM) and PCM in an endemic region, and the impact of human immunosuppression virus (HIV) co-infection. This was a retrospective study of autopsy and biopsy reports from the Medical Pathology Section of the Hospital de Clinicas, UFPR, Curitiba, Southern Brazil, between 1951 and 2014. PCM was present in 0.1% of 378,323 cases examined, with 5.7% being NPCM. Infection was prevalent in working-age men, agricultural workers and rural residents. Numbers of HIV autopsy cases increased over time, while those of PCM cases decreased. Prevalence of co-infection of HIV/PCM and HIV/NPCM was 1.6%, and 0.4%, respectively. Adrenals were affected more frequently in the NPCM group compared with the PCM group. Mortality was higher on NPCM group. The clinical course of PCM in HIV patients resembles an acute/sub-acute infection. Association of NPCM and HIV is rare, while diagnosis of NPCM is difficult, it should be considered a differential diagnosis in HIV patients who live in, or have visited, endemic areas and present with neurological symptoms.
Assuntos
Infecções Fúngicas do Sistema Nervoso Central/patologia , Coinfecção/patologia , Infecções por HIV/complicações , Paracoccidioidomicose/patologia , Adulto , Autopsia , Biópsia , Brasil/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/mortalidade , Coinfecção/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Paracoccidioidomicose/epidemiologia , Paracoccidioidomicose/mortalidade , Prevalência , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Paracoccidioidomycosis (PCM) is a fungal disease restricted to Latin countries, and its etiologic agents derive from the Paracoccidioides genus. Attenuation or loss of virulence in Paracoccidioides spp. following successive subculturing has been described. However, virulence can be recovered by passage in mammalian host. In this study, the recovery of adhesion of P. brasiliensis through passage in mice was compared to that in the insect Galleria mellonella. Analysis of in vitro fungal-host cell interaction, gene expression of adhesins, and analysis of the survival curves revealed that Galleria mellonella is useful for the reactivation of P. brasiliensis adhesion.
Assuntos
Adesinas Bacterianas/metabolismo , Mariposas/microbiologia , Paracoccidioides/patogenicidade , Paracoccidioidomicose/microbiologia , Paracoccidioidomicose/mortalidade , Fatores de Virulência/metabolismo , Adesinas Bacterianas/genética , Animais , Modelos Animais de Doenças , Perfilação da Expressão Gênica , Regulação da Expressão Gênica/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Paracoccidioides/genética , Paracoccidioidomicose/patologia , Taxa de Sobrevida , Virulência/genética , Fatores de Virulência/genéticaRESUMO
Sarcoidosis is a multisystem disorder that is characterized by noncaseous epithelioid cell granulomas, which may affect almost any organ. Thoracic involvement is common and accounts for most of the morbidity and mortality associated with this disease. The diagnosis is based on exhaustive exclusion of differential diagnoses, particularly granulomatous infections. We report data on eight patients with paracoccidioidomycosis mimicking sarcoidosis. Five patients presented with a chronic pulmonary type infection and three had a disseminated form after immunosuppressive treatment. The mycological diagnosis in noncaseating granulomas is emphasized and reviewed.
Assuntos
Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/patologia , Sarcoidose/diagnóstico , Sarcoidose/patologia , Diagnóstico Diferencial , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Paracoccidioidomicose/microbiologia , Paracoccidioidomicose/mortalidade , Sarcoidose/microbiologiaRESUMO
INTRODUCTION: 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. METHODS: 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. RESULTS: 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, respectively, and most cases (58.2%) were observed in patients aged between 40 and 59 years. Itraconazole was used to treat 91.6% (1,771) of cases, followed by sulfamethoxazole in combination with trimethoprim (4.4% [85] of cases). One hundred thirty-one (6%) patients died. CONCLUSIONS: The State of Rondônia has a high incidence of PCM, and the municipalities in the southeastern region of the state were found to have the highest incidence rates of this disease. Our findings suggest that Rondônia is the state in the northern region with the highest mortality rate for PCM.
Assuntos
Paracoccidioidomicose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/mortalidade , Estudos Retrospectivos , Fatores Socioeconômicos , Conglomerados Espaço-Temporais , Topografia Médica , Adulto JovemRESUMO
Introduction: 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. Methods: 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. Results: 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, respectively, and most cases (58.2%) were observed in patients aged between 40 and 59 years. Itraconazole was used to treat 91.6% (1,771) of cases, followed by sulfamethoxazole in combination with trimethoprim (4.4% [85] of cases). One hundred thirty-one (6%) patients died. Conclusions: The State of Rondônia has a high incidence of PCM, and the municipalities in the southeastern region of the state were found to have the highest incidence rates of this disease. Our findings suggest that Rondônia is the state in the northern region with the highest mortality rate for PCM. .
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Paracoccidioidomicose/epidemiologia , Distribuição por Idade , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/mortalidade , Estudos Retrospectivos , Fatores Socioeconômicos , Conglomerados Espaço-Temporais , Topografia MédicaRESUMO
Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the thermodimorphic fungus Paracoccidioides brasiliensis. Leukotrienes and lipoxins are lipid mediators produced after 5-lipoxygenase (5-LO) activation that exhibit pro- and anti-inflammatory roles, respectively. Here, we have investigated the contribution of 5-LO enzymatic activity in PCM using an experimental model of P. brasiliensis infection. B6.129 wild-type (B6.129) and 5-LO-deficient (5-LO(-/-)) mice were intravenously inoculated with a virulent strain of P. brasiliensis (Pb18), and the survival rate of the infected mice was investigated on different days after yeast infection. 5-LO(-/-) mice exhibited an increased survival rate associated with a decreased number of CFU. The resistance of 5-LO(-/-) during PCM was associated with augmented nitric oxide (NO) production and the formation of compact granulomas. In addition, the absence of 5-LO was associated with a diminished number of CD4(+) CD25(+) regulatory T cells, higher levels of gamma interferon and interleukin-12, and increased T-bet (a T-box transcription factor that directs Th1 lineage commitment) mRNA levels in the lungs. Taken together, our results show for the first time that 5-LO enzymatic activity increases susceptibility to P. brasiliensis, suggesting that this pathway may be a potential target for therapeutic intervention during PCM.
Assuntos
Araquidonato 5-Lipoxigenase/metabolismo , Paracoccidioides/patogenicidade , Paracoccidioidomicose/microbiologia , Paracoccidioidomicose/mortalidade , Animais , Araquidonato 5-Lipoxigenase/deficiência , Contagem de Colônia Microbiana , Modelos Animais de Doenças , Perfilação da Expressão Gênica , Granuloma/microbiologia , Granuloma/patologia , Interferon gama/biossíntese , Interleucina-12/biossíntese , Masculino , Camundongos , Camundongos Knockout , Óxido Nítrico/metabolismo , Paracoccidioidomicose/patologia , Análise de Sobrevida , Proteínas com Domínio T/biossíntese , Linfócitos T Reguladores/imunologia , Fatores de TempoRESUMO
INTRODUCTION: The study investigated the incidence of disease and death events among patients with paracoccidioidomycosis who were residents in the Itaipu Lake region from 2008 to 2009. METHODS: A review of patient records was conducted at the Department of Tuberculosis of the Epidemiology Center of the City of Foz do Iguaçu, Paraná. RESULTS: The results identified 102 new cases of paracoccidioidomycosis in the period described, 72 men and 30 women, and 15 deaths were recorded during the study. CONCLUSIONS: It can be concluded that the Itaipu Lake region is an endemic region.
Assuntos
Paracoccidioidomicose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Incidência , Lagos , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/mortalidade , Adulto JovemRESUMO
INTRODUCTION: The study investigated the incidence of disease and death events among patients with paracoccidioidomycosis who were residents in the Itaipu Lake region from 2008 to 2009. METHODS: A review of patient records was conducted at the Department of Tuberculosis of the Epidemiology Center of the City of Foz do Iguaçu, Paraná. RESULTS: The results identified 102 new cases of paracoccidioidomycosis in the period described, 72 men and 30 women, and 15 deaths were recorded during the study. CONCLUSIONS: It can be concluded that the Itaipu Lake region is an endemic region.
INTRODUÇÃO: O estudo investigou a incidência da doença e eventos de morte entre os portadores de paracoccidiodomicose residentes na região do Lago de Itaipu, no período de 2008 a 2009. MÉTODOS: Foi realizado levantamento em registros de pacientes do Setor de Tuberculose do Centro de Epidemiologia da Cidade de Foz do Iguaçu, Paraná, entre o período de janeiro de 2008 e julho de 2009. RESULTADOS: Os resultados apontam 102 novos casos de paracoccidiodomicose, 72 homens e 30 mulheres, foram registrados 15 óbitos durante o estudo. CONCLUSÕES: Conclui-se que a região do Lago de Itaipu é uma região endêmica.