Coccidioidomicose pulmonar e extrapulmonar: três casos em zona endêmica no interior do Ceará

Abstract

season and limited rainfall, concentrated in a short period of time. Therefore, coccidioidomycosis presents a limited geographic distribution, and transmission is restricted to a few months of the year. (2) The fungus disseminates as arthroconidia and is inhaled together with soil dust. In Brazil, armadillo hunting is an activity that carries a significant risk for infection.Pulmonary coccidioidomycosis is typically self-limiting but can evolve to chronicity and dissemination. (3) In a small number of indi- Introduction AbstractCoccidioidomycosis, a fungal illness acquired by the inhalation of arthroconidia of Coccidioides sp., was first described in 1894. Coccidioidomycosis is mainly restricted to areas with arid climate, alkaline soil and low rainfall. Consequently, most of the reported cases in Brazil have occurred in the northeastern region. We report three cases of pulmonary coccidioidomycosis occurring between 2005 and 2006 in an endemic area in the state of Ceará, Brazil. The three patients were immunocompetent adult males, hunters of armadillos (Dasypus novemcinctus), with complaints of cough, fever, dyspnea and pleuritic pain. All three patients presented pulmonary involvement, and one also presented cutaneous lesions. Chest X-rays and CT scans of the patients revealed characteristic coccidioidomycosis lesions. The diagnosis was confirmed by serological testing. All of the patients evolved to cure after antifungal treatment.Keywords: Coccidioidomycosis; Lung diseases, fungal; Coccidioides. ResumoA coccidioidomicose, uma doença fúngica adquirida através da inalação do agente Coccidioides sp. sob a forma de artroconídio, foi pela primeira vez descrita em 1894. Restringe-se principalmente a áreas de clima árido, solo alcalino e regiões de baixo índice pluviométrico. Não por acaso, a maioria dos casos descritos no Brasil ocorreu na região Nordeste. Relatam-se três casos de coccidioidomicose pulmonar ocorridos nos anos de 2005 e 2006, em zona endêmica no interior do Ceará. Todos eram homens imunocompetentes de idade adulta, adeptos à prática de caça a tatus (Dasypus novemcinctus) com queixas de tosse, febre, dispneia e dor pleurítica. Houve evoluções com comprometimento pulmonar e lesão cutânea foi observada em apenas um paciente. Todos apresentaram radiografia e TC de tórax com lesões características da coccidioidomicose. O diagnóstico foi confirmado através de teste sorológico. Todos evoluíram para cura após tratamento com antifúngico.

Coccidioidomycosis in a reference center in Northeast Brazil: clinical/epidemiological profile and most common radiological findings

“…In the present study, the patients were young males (median age, 30 years), living in rural areas. The data from this study corroborate those from other published studies that indicated that this disease was predominant among males with age ranging between 19 and 43 years 3,9 .…”

“…According to data, approximately 60% of coccidioidomycosis cases are symptomatic 15 . In the acute phase, the clinical presentation of coccidioidomycosis may resemble that of an acute bacterial or viral infection, based on the predominant symptoms of the disease (fever, cough, and pleuritic chest pain) 3,9,16 . In endemic regions, acute pulmonary coccididoidomycosis accounts for 29% of community-acquired penumonia 17 .…”

Climate drivers of hospitalizations for mycoses in Brazil

“…Although fungi may not be directly influenced by precipitation, it may be affected by conditions in the environment that produce favorable conditions of growth fungus 27 . There were three cases of coccidioidomycosis in Sobral (Ceará) in a hot period 28 . Shriber et al .…”

Systemic coccidioidomycosis in a dog in Northeastern Brazil

“…Northeastern Brazil occurs as outbreaks or single cases and is often associated with hunting of wild animals (COSTA et al, 2001;CORDEIRO et al, 2009;TOGASHI et al, 2009). However, there is still little information on the clinical and pathologic characteristics of canine coccidioidomycosis in this area (WANKE et al, 1999).…”