Oral Paracoccidioidomycosis affecting women: A systematic review

Abstract

Paracoccidioidomycosis (PCM) is an infection caused by fungi of the genus Paracoccidioides and is marked by a strong predilection for men; nevertheless, some women have had developed PCM and have presented oral involvement by the disease. Objectives: To review all published cases until August 2020 of oral PCM in women, with emphasis on the presence of systemic changes, deleterious habits (tobacco and alcohol) and oral manifestation features through a systematic review. Methods: Observational studies (both prospective and retrospective) and case reports indexed in the Embase, PubMed, Scopus, Web of Science and LIVIVO databases were selected by two reviewers in a two‐phase process following the pre‐established PICOS criteria. Results: Twenty‐five studies met the eligibility criteria and were selected for qualitative synthesis, of which 72 participants were enrolled. Brazilian White women between 40 and 50 years were the most affected and social history revealed them to be housewives or rural workers. Fifteen women (33.3% of the informed cases) presented any systemic change at the time of PCM diagnosis, namely pregnancy, HIV infection and/or depression. Moriform stomatitis was predominant and affected preferentially the gingivae and alveolar processes in the form of a single painful lesion. Most patients were treated with sulfamethoxazole + trimethoprim or itraconazole. Conclusions: Oral PCM in women is rare; some cases showed systemic changes at the time of PCM diagnosis, namely HIV infection, pregnancy and depression. New studies should be conducted to elucidate the influence of systemic alterations on the development of oral PCM in women.

Epidemiology of paracoccidioidomycosis in Venezuela: a retrospective study from 1954 to 2019

“…All these factors are related to hormonal impairment, contact with a massive inoculum size as observed in traditionally male activities such as farming, or immunological alterations that affect cellular response in the female hosts. 36 Of note, our series showed 21 cases of chronic form in adult women younger than 48 and one more case which had HIV coinfection; this indicates that the distribution of PCM clinical cases is in fact much more skewed than evident by a plain male: female ratio, as age stratified ratios on Table IV highlight. We suggest that female cases of PCM in reproductive age should be treated with special care, as it cannot be excluded that factors related to the fungus itself may influence the occurrence of non-climacteric, adult female cases.…”

Oral paracoccidioidomycosis: a retrospective study of 95 cases from a single center and literature review

“…The prevalence among males can be attributed to occupational (professional) issues, particularly in rural areas of Brazil, where male presence is very strong. Likewise, infections in men can be explained, in part, by a lack of the female hormone estrogen, which can inhibit the change of the saprobic mycelium form to the pathogenic yeast form of the fungus, preventing the development of PCM disease in women ( 25 , 26 ). In addition, males exhibit negative expression of estrogen receptor-alpha in oral PCM lesions ( 25 ).…”

diagnostic challenge in an individual with Paracoccidioidomycosis during hospitalization in times of COVID-19

“…Systemic physiological impairment occurs from a chronic inflammatory process, usually evolving to the formation of fibrosis in the affected regions, capable of triggering the functional impairment of the organs affected by the infection, more specifically the lungs, adrenal glands, larynx, and central nervous system 9,23 . Due to its potential morbidity, it is highly recommended that patients with disseminated forms of PCM presenting neurological disorders, respiratory failure, nutritional status deficiency, gastrointestinal impairment, jaundice, ascites, or hemodynamic changes should be considered eligible for immediate hospitalization.…”

“…Patients with immunological impairment or systemic changes that interfere with the immune response, such as diabetes or even depression, tend to have more severe infectious processes, and the presence of pathognomonic lesions in the oropharynx can be considered indicative of lung impairment 9 . As a rule, the risk of developing the disease in its clinical form is related to the personal characteristics and lifestyle of the infected individuals, including genetic background, age, sex, ethnicity, smoking, chronic alcohol abuse, or even occasional episodes of immunosuppression 10,11 .…”