Trends in the Epidemiological and Clinical Profile of Paracoccidioidomycosis in the Endemic Area of Rio de Janeiro, Brazil

Abstract

Paracoccidioidomycosis (PCM) is a neglected endemic mycosis in Latin America. Most cases occur in Brazil. It is classified as PCM infection and PCM disease and is subdivided into chronic (adult type) or acute (juvenile type) disease, with the latter being less frequent and more severe. In 2016, we reported an increase in the numbers of patients diagnosed with acute PCM after a highway’s construction. We conducted a study at INI-Fiocruz, a reference center for infectious diseases, including endemic mycoses, in Rio de Janeiro, Brazil, aiming to deepen the analysis of this new clinical and epidemiological profile of PCM. The authors developed a retrospective study including 170 patients diagnosed with PCM between 2010 and 2019. There was an increase in the number of atypical and severe forms, starting in 2014. In subsequent years, we detected a higher incidence of adverse outcomes with patients requiring more hospitalizations and an increased mortality rate. We estimate that PCM has become more severe throughout the Rio de Janeiro state, affecting a greater number of young individuals and leading to a greater number of and longer hospitalizations. Surveillance measures and close monitoring of future notification data in the state, with emphasis on children, adolescents, and young adults are necessary for a better understanding of the perpetuation of this public health challenge.

Reply to Vilela, R.; Mendoza, L. Current Nomenclature of Paracoccidioides lobogeorgii’s Disease Name. Comment on “Grotta et al. Fungal Density in Lobomycosis in French Guiana: A Proposal for a New Clinico-Histological and Therapeutic Classification. J. Fungi 2023, 9, 1005”

“…In our opinion, disease names should reflect the nosological and clinical aspects. Lobomycosis/PCML/Jorge Lobo's disease presents a very different clinical pattern from the disease caused by cultivable strains of Paracoccidioides and which is known as Paracoccidioidomycosis (PCM) [7]. Renaming lobomycosis as PCML, in our opinion, does not highlight the clinical differences between cultivable and uncultivable Paracoccidioides strains and seems to consider Lobomycosis/PCML/Jorge Lobo's disease as a mere subtype of PCM.…”

“…Renaming lobomycosis as PCML, in our opinion, does not highlight the clinical differences between cultivable and uncultivable Paracoccidioides strains and seems to consider Lobomycosis/PCML/Jorge Lobo's disease as a mere subtype of PCM. Lobomycosis involves only the skin and more rarely the lymph nodes, while PCM is mostly a systemic and disseminated disease involving many organs [2,7]. The cutaneous lesions caused by PCM are various and nonspecific, while the keloid-like lesions of Lobomycosis are typical (though other, less specific cutaneous lesions can also be found in Lobomycosis).…”