Coccidioidomycosis in Brazil: Historical Challenges of a Neglected Disease

Abstract

Coccidioidomycosis is a deep-seated fungal infection that occurs exclusively in semiarid areas in the Americas. In Brazil, coccidioidomycosis occurs exclusively in rural areas in the northeast region and affects counties that are hit by recurrent droughts, poverty and economic stagnation. Since 1978, approximately 136 cases of the disease have been reported in Brazil, according to scientific publications. However, a lack of governmental epidemiological data as well as a similarity to tuberculosis have led scientists and experts to assume that a greater number of cases occur in the country, which are not diagnosed and/or reported. In this review, general characteristics of coccidioidomycosis are presented, followed by a description of the main clinical and epidemiological data of cases in Brazil. The purpose of this article is to discuss the inclusion of coccidioidomycosis in the list of neglected tropical diseases. We believe that the adoption of coccidioidomycosis as a neglected tropical disease will enable the creation of an effective epidemiological surveillance system and the development of feasible public health solutions for its control in vulnerable populations.

Keywords: Coccidioides; coccidioidomycosis; fungal infection; neglected tropical diseases; northeastern Brazil.

Figure 1

Relevant aspects of coccidioidomycosis in Brazil. (A) Epidemiological cycle of the disease has strong association with armadillo hunting, traditionally performed by men and assisted by dogs. The disease is limited to the semi-arid region of northeastern Brazil, an area characterized by scarce and irregular rainfall, as well as Caatinga biome. (B) Timeline of major events related to coccidioidomycosis in Brazil.

Figure 2

Geographic and biogeographic information of Brazil. South America map showing location of Brazil (A). Map depicting Brazil localization. Northeastern Brazil (NEB) is shown in blue (B). Coccididoiomycosis occurs in the States of Maranhão (MA), Piauí (PI), Ceará (CE), Pernambuco (PE), and Bahia (BA). All States are located in the semi-arid area (grey) of NEB (C). Caatinga vegetation in Ceará State during rainy (D) and dry seasons (E). Detail of the Caatinga vegetation during the dry season showing xerophytic plants and deciduous trees and shrubs (F).