Puzzling paracoccidioidomycosis: Factors associated with the severity of Paracoccidioides lutzii infections

Author(s)

Nery, Andreia Ferreira ^{[1, 2]} ; de Camargo, Zoilo Pires ^{[3, 4]} ; Rodrigues, Anderson Messias ^{[3, 4]} ; Portela, Tiago Ferreira ^[2] ; Hoffmann-Santos, Hugo Dias ^[5] ; Pinheiro, Breno Goncalves ^[3] ; Possa, Ana Paula ^[3] ; da Silva Cavalcante, Leticia Rossetto ^[2] ; Hagen, Ferry ^{[6, 7]} ; Hahn, Rosane Christine ^{[8, 2]}

Affiliation

^[1] Univ Fed Mato Grosso, Fac Med, Internal Med Dept, Cuiaba, Mato Grosso - Brazil

^[2] Univ Fed Mato Grosso, Julio Muller Univ Hosp, Cuiaba, Mato Grosso - Brazil

^[3] Univ Fed Sao Paulo, Dept Microbiol Immunol & Parasitol, Lab Emerging Fungal Pathogens, Sao Paulo - Brazil

^[4] Univ Fed Sao Paulo, Dept Med, Discipline Infect Dis, Sao Paulo - Brazil

^[5] Univ Ctr Varzea Grande, Varzea Grande, Mato Grosso - Brazil

^[6] Univ Med Ctr Utrecht, Dept Med Microbiol, Utrecht - Netherlands

^[7] Westerdijk Fungal Biodivers Inst, Utrecht - Netherlands

^[8] Univ Fed Mato Grosso, Fac Med, Lab Mycol Res, Cuiaba, Mato Grosso - Brazil

• Document type: Journal article
• Source: INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES; v. 107, p. 284-290, JUN 2021.
• Web of Science Citations: 0

Abstract

Objectives: Historically, the Brazilian Central-West region has had high numbers of paracoccidioidomycosis (PCM) cases caused by the dimorphic fungus Paracoccidioides lutzii. Methods: This epidemiological, observational, analytical, cross-sectional study was performed to investigate the clinical and laboratory data of 44 PCM patients with a culture-proven P. lutzii infection. All patients were referred to the Systemic Mycosis Center, J \& uacute;lio Muller University Hospital, Cuiab \& aacute;, Brazil, during January 2017 to March 2020. The neutrophil to lymphocyte ratio (NLR) was calculated and dichotomized by its median value to include in the identification of factors associated with severity. Results: At admission, 13 (31.7%) patients showed the disseminated multifocal chronic form of PCM and 16 (36.4%) patients met the clinical severity criteria. Treatment prescribed on admission did not follow the recommendations of the Brazilian Guideline for the Clinical Management of Paracoccidioidomycosis in 26% of the severe PCM cases (prevalence ratio 0.26, 95% confidence interval 0.14 \& ndash;0.49; P < 0.0001). Patients with severe PCM had a higher NLR that was greater than the median (>4.11). Conclusions: The NLR biomarker complements the criteria for PCM severity. Applying the low-cost NLR test can greatly increase the diagnostic sensitivity when screening patients for PCM and contribute to better control of the disease, management of complications, and therapeutic strategies. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). (AU)

• FAPESP's process: 17/27265-5 - Molecular epidemiology and genomic perspectives on the evolution and spread of emerging fungal pathogens
• Grantee: Anderson Messias Rodrigues
• Support Opportunities: Research Grants - Young Investigators Grants
• FAPESP's process: 18/21460-3 - Study of different antigenic preparations of Paracoccidioides lutzii for the standardization of the ELISA test as an aid in the diagnosis of paracoccidioidomycosis due to P. lutzii
• Grantee: Zoilo Pires de Camargo
• Support Opportunities: Regular Research Grants