Evaluation of adrenal impairment in patients with paracoccidioidomycosis

• Grant number: 12/21349-9
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: February 01, 2013
• End date: January 31, 2014
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Rinaldo Poncio Mendes
• Grantee: Joyce Godoy Farat
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

The paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by the fungus Paracoccidioides brasiliensis. It is the most common systemic mycosis in South America, especially in the Southern and Southeastern regions of Brazil. The clinical form of PCM varies from a self-limited infection to a severe, progressive, and sometimes fatal disease, which involves pulmonary and extra pulmonary tissues. The acute form is characterized by systemic lymphoadenopathy, hepatosplenomegaly, bone marrow dysfunction, and a great impairment of patient's general condition, especially in young persons. The chronic form presents progressive pulmonary or extra pulmonary (mucocutaneous, lymph nodes, adrenal glands, intestine, bone, etc) manifestations. Previous studies found impairment of adrenal function in a high percentage (10 to 44%) of patients with PCM. The adrenal impairement by Paracoccidioides brasiliensis is an important factor of gravity and can lead the patient to die quickly, especially when subjected to stress. The immediate clinical identification of Addison's Syndrome is essential for a successful treatment, with full recovery of the patients' vital functions. The hormone replacement therapy is usually maintained throughout life, and the situations that cause stress are common triggers of acute Addison's crisis, which is often fatal. The present study aims to assess the general prevalence of chronic adrenal insufficiency (CAI) in patients with paracoccidioidomycosis (PCM) and analyze clinical, laboratorial and imaging aspects of Addison's disease in patients with PCM. A retrospective study will be conduced with patients accompanied by Paracoccidioidomycosis Ambulatory, linked to the Infectology Service from Hospital of Botucatu's Medical School Hospital/ UNESP. After reviewing the records of 400 patients with clinical forms acute / subacute or chronic PCM, treated between 1981 and 2012, will be selected patient charts that present chronic adrenal insufficiency. For each patient will be filled in a standardized form containing patient name, sex, age, number of record at the Hospital das Clinicas, date of admission to the service, date of installation of chronic adrenal insufficiency (or involvement after initial introduction of antifungal), presence or absence of signs and symptoms suggestive of adrenal insufficiency. The comparison of frequencies will be made by the Ç2 test (chi square) or the Fisher exact test. The medians will be analized using the Wilcoxon test for correlated samples, or by Mann-Whitney test for the independent. The rejection of the null hypothesis would be bound to an error type alpha equal to or less than 0.05.