Geographical evaluation of Neuroparacoccidioidomycosis and Paracoccidioidomycosis in Southern Brazil

Abstract

Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis among immunocompetent patients in Latin America. This study aimed to describe the expansion over time and the geographical distribution of confirmed Neuroparacoccidioidomycosis (NPCM) and PCM cases, and relate it to environmental characteristics such as climate, soil types and coffee crops. This was a retrospective study of autopsy and biopsy reports between 1951 and 2014 from the Medical Pathology Section of the Hospital de Clinicas, Universidade Federal do Paraná (UFPR), Curitiba, Southern Brazil. PCM was predominant in male agricultural workers. PCM cases predominated in areas with subtropical climate with hot summers in North West Parana state. NPCM cases were distributed statewide more frequent in rural than metropolitan area. There was no association with climate, soil type, or coffee crop culture. Most of the PCM cases were in the metropolitan area of the capital, chiefly due to migration fluxes. Even though the history is predominantly agricultural, PCM cases were distributed mainly in the metropolitan area of the state capital, there was no association with climate and soil. NPCM cases were numerically more frequent in rural than metropolitan area.

Multifocal Pseudotumorous Form of Neuroparacoccidioidomycosis in an Immunocompetent Patient: A Clinicopathological Review Based on a Case Report

“…In Brazil, PDM is an endemic disease. 1,[7][8][9] Most compromised patients are over 30 years of age, and males are more frequently affected. The lungs are primarily involved, and symptoms of PDM often develop many years after transmission.…”

“…Central nervous system (CNS) mycoses have assumed greater importance as the number of immunocompromised patients has increased over the past few decades. [1][2][3] Fungal infections in the CNS have also been increasing, because of the growing use of complex surgical procedures, invasive medical devices, and long-term broad-spectrum antibiotics. Considerable progress has been made in our understanding of fungal pathobiology, in special due to the sequencing of fungal genomes and the employment of animal models to determine the different components of fungal virulence.…”

“…The fungi grow as thick-walled yeast with round to oval bodies, which are 10 µm to 20 µm in diameter and give rise to single or multiple thin-necked buds. 1,5,6 These fungi probably live in the vegetation or soil. Usually, PDM is a granulomatous disease that initially compromises the lungs and the oral mucosa, and then spreads to the lymph nodes, the adrenal glands, and, rarely, to the CNS.…”

“…Usually, PDM is a granulomatous disease that initially compromises the lungs and the oral mucosa, and then spreads to the lymph nodes, the adrenal glands, and, rarely, to the CNS. 1,3,5,6 Herein, the authors compromising the lung and brain was considered. A biopsy of the mediastinal lymph node showed epithelioid granulomas, which exhibited round, thin-walled fungal structures in Grocott silver stain.…”

Re-drawing the Maps for Endemic Mycoses

“…Because these data are inferred from case reports and retrospective studies of hospitalized patients, incidence rates are postulated to be higher [ 34 , 155 , 238 , 239 , 248 , 253 , 257 ]. Furthermore, climate change, human migration, the expansion of agricultural activities, and highway construction have affected the epidemiology of Paracoccidioides , which is now expanding from the south and southeast to the central-west and north regions of Brazil [ 238 , 249 , 259 ]. All cases of P. brasiliensis reported outside of endemic regions were acquired via travel to endemic areas [ 101 , 238 , 256 , 260 – 263 ] (Table 3 ).…”