Acute‐subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non‐survival predictor

Abstract

Summary The acute‐subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute‐subacute PCM, to determine a mortality risk factor and to propose a test for non‐survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15 years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P < .05). Through a period of 38 years, 141 children and adolescents were diagnosed with acute‐subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole‐trimethoprim (SMX‐TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut‐off for serum albumin was 2.18 g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute‐subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage ≤ 2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard.

A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited

“…Before puberty, PCM (disease) tends to affect both sexes more closely. This is well illustrated in the study by Romaneli et al, which showed that, in children up to 12 y/o, the male-to-female ratio was 1.5:1, while male predominance started in children between 12 and 15 y/o (7:1) [4]. In studies of large cohorts consisting predominantly of adults, women corresponded to less than 5% of the cases [5][6][7][8].…”

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

“…When comparing the two periods of the study, the proportion was similar (1.6% versus 1.9%), despite the increase in acute forms. This might be associated with a higher chance of dissemination due to a delay in diagnosis, since the acute form is rare and unknown by professionals in basic health units [ 10 , 21 ].…”

Overview of invasive fungal infections in children in South America – the threat of resistant Candida species and the role of climate change in the new geographic distribution of endemic systemic mycosis

“…Deaths due to paracoccidioidomycosis are caused by extremely disseminated lesions, respiratory insufficiency, adrenal insufficiency and may occur a long time after antifungal treatment [50]. Romanelli et al [53] studying PCM in children in Campinas, Brazil, showed a relapse rate of 7.8%, renal insufficiency of 8.3% and a mortality of 5.7%, significantly associated with low serum albumin. Giusiano et al [55] reported an increase of juvenile PCM in Northeast Argentina, an area that suffered deforestation and a change in the agricultural practices, with soybean replacing cotton; one of the biggest hydroelectric dams in South America, Yacyret a, was constructed there.…”

“…The acute–subacute form is usually observed in children and adolescents without epidemiological risk activities, corresponding to 5–25% of all PCM cases; sick infected children/adolescents have a T cell immune response which is inadequate to control the fungal infection [50,51 ▪ ]. PCM usually presents with fever, weight loss, multiple skin lesions, generalized lymphadenopathy with draining fistula from lymph nodes and hepatosplenomegaly [52,53] (Fig. 1).…”