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

Baldo, Mario Eduardo; Raffaele, Regina Maria; Santos, Paulo Sérgio da Silva; Ramalho, Rondon Tosta; Takita, Luiz Carlos

doi:10.31686/ijier.vol10.iss2.3660

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…co-infection was described in an individual with the acute form of PCM. The scarcity of documented cases probably reflects underdiagnosis or underreporting in Latin American countries that had their health systems overwhelmed by COVID-19 [ 70 , 71 , 72 ].…”

Section: Diagnosis Of Paracoccidioidomycosismentioning

confidence: 99%

Paracoccidioidomycosis: What We Know and What Is New in Epidemiology, Diagnosis, and Treatment

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Peçanha-Pietrobom

Velloso

et al. 2022

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Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America caused by thermodimorphic fungi of the genus Paracoccidioides. In the last two decades, enhanced understanding of the phylogenetic species concept and molecular variations has led to changes in this genus’ taxonomic classification. Although the impact of the new species on clinical presentation and treatment remains unclear, they can influence diagnosis when serological methods are employed. Further, although the infection is usually acquired in rural areas, the symptoms may manifest years or decades later when the patient might be living in the city or even in another country outside the endemic region. Brazil accounts for 80% of PCM cases worldwide, and its incidence is rising in the northern part of the country (Amazon region), owing to new settlements and deforestation, whereas it is decreasing in the south, owing to agriculture mechanization and urbanization. Clusters of the acute/subacute form are also emerging in areas with major human intervention and climate change. Advances in diagnostic methods (molecular and immunological techniques and biomarkers) remain scarce, and even the reference center’s diagnostics are based mainly on direct microscopic examination. Classical imaging findings in the lungs include interstitial bilateral infiltrates, and eventually, enlargement or calcification of adrenals and intraparenchymal central nervous system lesions are also present. Besides itraconazole, cotrimoxazole, and amphotericin B, new azoles may be an alternative when the previous ones are not tolerated, although few studies have investigated their use in treating PCM.

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Section: Diagnosis Of Paracoccidioidomycosismentioning

confidence: 99%

Paracoccidioidomycosis: What We Know and What Is New in Epidemiology, Diagnosis, and Treatment

Peçanha

Peçanha-Pietrobom

Velloso

et al. 2022

JoF

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“…In 2021, Heaney et al [ 5 ] reviewed the interaction between COVID-19 and coccidioidomycosis, analyzing the risk factors and the implications of this co-infection, and highlighted how the COVID-19 pandemic might exacerbate delays in the diagnosis of the mycosis. Similarly, the difficulty of diagnosing PCM during hospitalization through the COVID-19 pandemic has also been reported, resulting in delayed diagnosis of PCM [ 6 ]. The confounders of overlapping clinical manifestations may explain in part the absence of new case reports of PCM and COVID-19 co-infection.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 in patients with paracoccidioidomycosis

et al. 2023

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Introduction In 2020, we reported the first patient with concomitant COVID-19 and paracoccidioidomycosis (PCM). Since then, no other cases have been recorded in the literature. We aim to update information on the occurrence of COVID-19 in patients with PCM followed at a reference center for infectious diseases at Rio de Janeiro, Brazil. Methods We reviewed the medical records from patients diagnosed with PCM who presented with clinical symptoms, radiological findings, and/or laboratory diagnosis of COVID-19 at any time during their acute or follow-up care. The clinical profiles of these patients were described. Results Between March 2020 and September 2022, we identified six individuals with COVID-19 among the 117 patients with PCM evaluated. The median age was 38 years and the male to female ratio 2:1. Most patients (n = 5) presented for evaluation due to acute PCM. The severity of COVID-19 ranged from mild to severe in acute PCM and only the single patient with chronic PCM died. Conclusions There is a range of disease severity in COVID-19 and PCM co-infection and concomitant disease may represent a severe association, especially in the chronic type of the mycosis with pulmonary involvement. As COVID-19 and chronic PCM share similar clinical aspects and PCM is neglected, it is probable that COVID-19 has been hampering simultaneous PCM diagnosis, which can explain the absence of new co-infection reports. With the continued persistence of COVID-19 globally, these findings further suggest that more attention by providers is necessary to identify co-infections with Paracoccidioides.

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