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. 2017 Mar 29;11(3):e0005500.
doi: 10.1371/journal.pntd.0005500. eCollection 2017 Mar.

Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro, Brazil

Priscila Marques de Macedo  1 , Rodrigo Almeida-Paes  2 , Dayvison Francis Saraiva Freitas  1 , Andréa Gina Varon  3 , Ariane Gomes Paixão  3 , Anselmo Rocha Romão  4 , Ziadir Francisco Coutinho  5 , Claudia Vera Pizzini  2 , Rosely Maria Zancopé-Oliveira  2 , Antonio Carlos Francesconi do Valle  1
Affiliations

Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro, Brazil

Priscila Marques de Macedo et al. PLoS Negl Trop Dis. .

Abstract

Background: Paracoccidioidomycosis (PCM) is a systemic mycosis caused by pathogenic dimorphic fungi of the genus Paracoccidioides. It is the most important systemic mycosis in Latin America and the leading cause of hospitalizations and death among them in Brazil. Acute PCM is less frequent but relevant because vulnerable young patients are affected and the severity is usually higher than that of the chronic type.

Methods: The authors performed a retrospective cohort study from 2001 to 2009 including acute juvenile PCM patients from a reference center in Rio de Janeiro, Brazil. Clinical, epidemiological, diagnostic, therapeutic, and prognostic data were reported.

Results: Twenty-nine patients were included. The average age was 23 years old and the male to female ratio was 1:1.07. All cases were referred from 3 of 9 existing health areas in the state of Rio de Janeiro, predominantly from urban areas (96.5%). Lymph nodes were the most affected organs (100%), followed by the skin and the spleen (31% each). Twenty-eight patients completed treatment (median 25 months) and progressed to clinical and serological cure; 1 death occurred. Twenty-four patients completed 48-month median follow-up. Four patients abandoned follow-up after the end of treatment. The most frequent sequela was low adrenal reserve. Paracoccidioides brasiliensis S1 was identified by partial sequencing of the arf and gp43 genes from 4 patients who presented a viable fungal culture.

Conclusion: Acute juvenile PCM is a severe disease with a high rate of complications. There are few cohort clinical studies of acute PCM in the literature. More studies should be developed to promote improvement in patients' healthcare.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Map of the state of Rio de Janeiro showing georeferenced PCM cases from this study according to health access and urban-rural distribution.
Fig 2
Fig 2. Lymph node and skin involvement in 2 patients from the present study.
(A) Cervical lymph node enlargement with a “bull’s neck” appearance in a female patient. (B) The same patient after 35 months of amphotericin B, itraconazole, and sulfamethoxazole/trimethoprim treatment. (C) Extensive ulcerative skin lesions on the face of a male patient. (D) The same patient after 48 months of sulfamethoxazole/trimethoprim treatment. Photographs by ACFV were obtained for registration of the patients’ recovery. Both individuals agreed to have their photographs taken and published.
Fig 3
Fig 3. Therapeutic regimen prescribed for the treatment of 29 acute juvenile PCM cases from this study.
AMB (amphotericin B) and SMZ/TMP (sulfamethoxazole/trimethoprim). Others: itraconazole + SMZ/TMP; AMB + SMZ/TMP; and AMB + fluconazole + SMZ/TMP.
See this image and copyright information in PMC

References

    1. Colombo AL, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M. (2011) Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol 49: 785–798. 10.3109/13693786.2011.577821 - DOI - PubMed
    1. Coutinho ZF, Silva Dd, Lazera M, Petri V, Oliveira RM, et al. (2002) Paracoccidioidomycosis mortality in Brazil (1980–1995). Cad Saude Publica 18(5): 1441–1454. - PubMed
    1. Coutinho ZF, Wanke B, Travassos C, Oliveira RM, Xavier DR et al. (2015) Hospital morbidity due to paracoccidioidomycosis in Brazil (1998–2006). Tropical Medicine and International Health 20(5): 673–680. 10.1111/tmi.12472 - DOI - PubMed
    1. Prado M, Silva MB, Laurenti R, Travassos LR, Taborda CP. (2009) Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006. Mem Inst Oswaldo Cruz 104(3): 513–521. - PubMed
    1. Bocca AL, Amaral AC, Teixeira MM, Sato PK, Shikanai-Yasuda MA, et al. (2013) Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinic and therapeutics issues. Future Microbiol 8:1177–1191. 10.2217/fmb.13.68 - DOI - PubMed

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