New Trends in Paracoccidioidomycosis Epidemiology

Abstract

Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America and more prevalent in South America. The disease is caused by the dimorphic fungus Paracoccidioides spp. whose major hosts are humans and armadillos. The fungus grows in soil and its infection is associated with exposure to the rural environment and to agricultural activities, with a higher risk in coffee and tobacco plantations. Population studies assessing the reactivity to Paracoccidioides spp. antigens by intradermal reaction or serological tests have detected previous subclinical infections in a significant proportion of healthy individuals living in various endemic countries. Paracoccidioidomycosis-disease is manifested by a small minority of infected individuals. The risk of developing the disease and its type of clinical form are related to the personal and life style characteristics of infected individuals, including genetic background, age, sex, ethnicity, smoking habit, alcohol drinking, and eventual cellular immunosuppression. Brazil, Colombia, Venezuela, Argentina, and Ecuador have endemic areas that had already been defined in the 20th century. The incidence of paracoccidioidomycosis can be altered by climate phenomena and mainly by human migration and occupation of poorly explored territories. In Brazil, the endemy tends to expand towards the North and Center-West around the Amazon Region.

Keywords: Paracoccidioides brasiliensis; Paracoccidioides lutzii; epidemiology; paracoccidioidomycosis.

Figure 1

Rate of the Paracoccidioides spp. infection determined by intradermal test in general populations according to geographic area [7,31,38,56,57,59,60,61,62,63]. Comparatively, the marks show the places where this fungus was isolated form soil [4] or where captured animals has paracoccidioidomycosis: armadillos [8,9], two-toed sloth [73], squirrel monkey [72], and domestic dogs [70,71].

Figure 2

Geographic areas of paracoccidioidomycosis endemicity in Latin America: () First recognized areas of high endemicity; () high endemicity observed since the last decades of the 20th century; () area with some recent evidence of increasing endemicity; () areas of moderate endemicity; () low endemicity; () no areas or rare cases of paracoccidioidomycosis reported in these countries or regions.