Paracoccidioidomycosis in a western Brazilian Amazon State: Clinical-epidemiologic profile and spatial distribution of the disease

Abstract

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 fi ndings suggest that Rondônia is the state in the northern region with the highest mortality rate for PCM.

Brazilian guidelines for the clinical management of paracoccidioidomycosis

“…Estimates of annual incidence in Brazil range from 0.71 to 3.7 cases per 100,000 inhabitants 21 . However, recent records of incidence in Rondônia report 9.4 cases per 100,000 inhabitants, with two municipalities reporting incidences close to 40 cases per 100,000 inhabitants 14 . Between 1980 and 1995, the Ministry of Health documented 3,181 cases of PCM-related deaths, resulting in a PCM mortality rate of 1.45 cases per one million inhabitants (2.59 for the South, 2.35 for the Midwest, 1.81 for the Southeast, 1.08 for the North, and 0.2 for the northeast regions) 22 .…”

“…In the stratified analysis by municipality, periods of almost 40 cases per 100,000 inhabitants were documented in the southern region of the state 14 .…”

“…In Rondônia, about one-third of the patients with PCM had a diagnosis based on clinicalepidemiological criteria 14 , as serological examination was not an available method during this period. In the last 4 years, data on more than 100 PCM cases treated at the Tropical Medicine Center of Rondônia showed a predominance of the chronic form with frequent mucosal involvement.…”

II Consenso Brasileiro em Paracoccidioidomicose - 2017*

“…Além disso, fatores ambientais, com abertura de novas fronteiras, derrubada de florestas e produção de café, contribuíram para o panorama atual, com elevados níveis de incidência em algumas regiões de Rondônia. 14 Influências da umidade do solo decorrente da estação chuvosa e temperatura entre 18-28 o C, pos-sivelmente favorecendo a esporulação e dispersão aérea, bem como alterações climáticas decorrentes do fenômeno El Niño ocorrido em 1982/1983 foram associados a um surto de casos agudos, descrito um a dois anos após, na região Sudeste do Brasil. 15…”

Paracoccidioidomycosis: level of pulmonary sequelae in high resolution computed tomography images from patients of two endemic regions of Brazil

“…The majority of the PCM cases (around 80%) are reported in Brazil (7,8), which is the first one cause of death among systemic mycoses disease in the country (1,9). Different distribution in endemic areas and the difficult to notify the Original Article Paracoccidioidomycosis: level of pulmonary sequelae in high resolution computed tomography images from patients of two endemic regions of Brazil disease are facts, which contributes negatively to establish incidence and prevalence of PCM (10,11).…”