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

Abstract

Introduction: Coccidioidomycosis, a disease caused by Coccidioides immitis or Coccidioides posadasii, is endemic in arid climatic regions in Northeast Brazil. Its prevalence is higher among young adult males living in rural areas. Existing literature about this disease in Ceará, a Northeast Brazilian state, are scarce. Here, we aimed to outline the clinical and epidemiological profiles, radiological patterns, and therapeutic responses of patients with coccidioidomycosis in a reference center in Ceará, Brazil. Methods: This is a descriptive study with quantitative analysis. Patients who underwent medical follow-up in São José Hospital of Infectious Diseases and received confirmed mycological diagnosis of coccidioidomycosis between January, 2007 and December 2017 were included. Epidemiological, clinical, radiological, and therapeutic response data were collected from medical charts. Results: Thirty patients were included. The patients were males with median age of 30 years, and 73% were considered to have high-risk exposure to Coccidioides owing to professional activities. Cough (96.7%), dyspnea (63.3%), fever (86.7%), and pleuritic pain (60%) were the most prevalent clinical manifestations. Interstitial pattern (91.3%) was the most frequent pulmonary radiological finding. Fluconazole, amphotericin B, and itraconazole were administered for treatment (in 82.1%, 42.8%, and 21.4% of cases, respectively). A favorable outcome was observed in 83.8% of patients. Conclusions: Coccidioidomycosis was more prevalent in the central and southern regions of the State of Ceará. Understanding the local epidemiology and clinical manifestations of the disease, in addition to the pulmonary radiologic findings, may aid the early detection of coccidioidomycosis and facilitate early diagnosis.

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“…No Brasil, o primeiro caso de coccidioidomicose foi descrito em 1978, na Bahia, seguido por outro caso no Piauí em 1979. Desde então, várias ocorrências foram relatadas em outros estados nordestinos, região que se constitui na maior área endêmica do país atualmente (MORAIS et al, 2020).…”

Coccidioidomycosis in Brazil: Historical Challenges of a Neglected Disease

“…In Brazil, CM occurs exclusively in the northeast region, where approximately 136 cases of the disease have been reported since 1978: 94 cases in the state of Piauí [ 61 ]; six cases in the state of Maranhão [ 18 , 61 , 62 ]; 30 cases in the state of Ceará [ 63 , 64 , 65 , 66 , 67 , 68 ]; two cases in the state of Bahia [ 55 , 68 ]; four cases in the state of Pernambuco [ 59 , 60 ] ( Figure 2 ).…”

“…One patient developed pericarditis without pulmonary involvement [ 35 ]. Although there are no official clinical-epidemiological data, the scientific literature indicates that only two cases of acute pulmonary disease evolved to death, despite antifungal treatment [ 63 , 69 ]. Most patients were treated with deoxycolate amphotericin B and oral fluconazole; a minority of patients were treated with only one of these drugs alone.…”