Paracoccidioidomycosis Epidemiological Features of a 1,000-Cases Series from a Hyperendemic Area on the Southeast of Brazil

Abstract

Paracoccidioidomycosis has been known for over 100 years, and until now, there were only few estimates of the disease's incidence. We aim to analyze 1,000 cases treated between 1960 and 1999 at Ribeirão Preto city, São Paulo, Brazil, where the disease's incidence range detected was 1.6 to 3.7 cases per 100,000 habitants per year (mean = 2.7 cases/year). We observed a male to female ratio of 6:1 and an age distribution from 3 to 85 years. The acute/subacute form of the disease accounted for 25.4% of cases. Most of the patients (93.5%) had lived or worked in rural areas before the disease development. Smoking and alcoholism were reported by 64.7% and 37.2% of patients, respectively. Comorbidities identified included tuberculosis (8.3%), Chagas' disease (8.6%), and human immunodeficiency virus/acquired immunodeficiency syndrome (4.2%). The present study revealed an area in Brazil where paracoccidioidomycosis is hyperendemic (has the highest reported incidence of this disease); this endemic area is probably caused by geological and climatic conditions as well as intensive agriculture.

Histoplasmosis in immunocompetent individuals living in an endemic area in the Brazilian Southeast

“…Compared to the 95 cases of active disease, 1,219 cases of paracoccidioidomycosis affecting immunocompetent individuals occurred in the same geographic area over an approximately equal period of time 16 . This result suggests that the incidence of histoplasmosis-disease is approximately 13 times lower than that of paracoccidioidomycosis, whose mean incidence in the Ribeirão Preto region has been estimated at 2.7 cases/100,000 inhabitants/ year 17 . However, this ratio needs careful interpretation because the patients with chronic pulmonary and chronic disseminated histoplasmosis did not know the places or times of the fungal infections.…”

Pulmonary Paracoccidioidomycosis: Clinical, Immunological and Histopathological Aspects

“…(Bellissimo- Rodrigues et al, 2011;Paniago et al, 2003;Shankar et al, 2011). Clinically manifested PCM occurs, consequently, more often (>80%) in adult patients 30-60 years old with the fourth decade of life presenting the largest number of cases (Colombo et al, 2011;Nucci et al, 2009;Paniago et al, 2003).…”

“…The predominance of adult patients is reflected in higher mortality rates for those within this age group (Bittencourt et al, 2005;Coutinho et al, 2002;Prado et al, 2009;Santo, 2008). Although co-existence of the mycosis with HIV infection is relatively uncommon, 4%-5% according to data in the two largest series of cases published in Brazil (Belissimo- Rodrigues et al, 2011;Morejon et al, 2009), this dual infection has introduced a significant change in age distribution as these patients are younger (mean, 34 years of age) than the PCM non-AIDS cases (mean, 45 years of age).…”

“…Santo (2008) reviewed 1,950 PCM death certificates finding that the largest number of deaths had occurred in men in the older age groups and among rural workers. The largest series of cases ever published (Bellissimo- Rodrigues et al, 2011) analyzed 1,000 Brazilian PCM patients and indicated that in the 1980-1999 period, the incidence rates for the Riberão Preto district in São Paulo State were equivalent to a mean of 2.70 cases per 100,000 inhabitants. Colombian estimates show a much lower incidence rate, with the highest being 0.24 per 100,000 inhabitants.…”

“…Colombian estimates show a much lower incidence rate, with the highest being 0.24 per 100,000 inhabitants. Since these were annual mean mortality rates calculated on the basis of 7,482 deaths reported to be caused by PCM, the figures varied from 1.45 to 3.48 per one million inhabitants (Bellissimo- Rodrigues et al, 2011). The importance of this mycosis can be inferred by the high burden of deaths occurring among the working population in individuals aged 30-60 years, mostly men engaged in agriculture (Bellissimo-Rodrigues et al, 2011).…”