Paracoccidioidomycosis due to P lutzii: The importance of neutrophil/lymphocyte ratio in the symptomatic and asymptomatic phases in severe cases

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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] ; Kruger Dambros, Pedro Vitor ^[6] ; Ribeiro de Souza, Janio Felipe ^[7] ; Garcia, Alexandre Carvalho ^[7] ; Damasio Santos, Carolina Araujo ^[7] ; Hagen, Ferry ^{[8, 9, 10]} ; Hahn, Rosane Christine ^{[2, 11]}

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

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

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

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

^[5] Univ Ctr Varzea Grande, Varzea Grande, MT - Brazil

^[6] Univ Cuiaba UNIC, Cuiaba, MT - Brazil

^[7] Fac Ciencias Biomed Cacoal, Cacoal, RO - Brazil

^[8] Univ Med Ctr Utrecht, Dept Med Microbiol, Utrecht - Netherlands

^[9] Westerdijk Fungal Biodivers Inst, Utrecht - Netherlands

^[10] Jining 1 Peoples Hosp, Lab Med Mycol, Jining - Peoples R China

^[11] Univ Fed Mato Grosso, Fac Med, Lab Mycol Res, Cuiaba, MT - Brazil

• Tipo de documento: Artigo Científico
• Fonte: MYCOSES; v. 64, n. 8, p. 874-881, AUG 2021.
• Citações Web of Science: 0

Resumo

Background PCM is a neglected systemic mycosis endemic in Brazil. The middle-west region of Brazil has shown the highest number of PCM by Paracoccidioides lutzii (P lutzii) cases. Differentiating cases of severe PCM from non-severe ones should be a concern at the bedside. Diagnosis of severe PCM by P lutzii is based on the subjectivity of clinical manifestations, which can result in a delay in starting its treatment and, consequently evolution to severe sequelae. There is not laboratory biomarker available to support the early diagnosis of severe PCM that is feasible for all the realities that coexist in Brazil. Objectives The aim of this study was to investigate the usefulness of laboratory biomarkers as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the diagnosis of severe PCM. Patients/Methods ESR, CRP and NLR were analysed for 44 patients with PCM by P lutzii and a Receiver Operation Characteristic (ROC) curve were generated to identify the NLR cut-off point and point out the presence of severe PCM. Results Sixteen (36.4%) had severe PCM and 28 (63.6%) had non-severe PCM. The mean NLR was higher and statistically significant among patients with severe PCM than among those with non-severe PCM. The area under the ROC curve was 0.859 for the diagnosis of severe PCM. The cut-off point for NLR for the diagnosis of severe PCM was 3.318 (sensitivity of 100%, specificity of 77%). Conclusions According to results, it is plausible to conclude that NLR represents a potential biomarker for the diagnosis of severe PCM. (AU)

• Processo FAPESP: 17/27265-5 - Epidemiologia molecular e perspectivas genômicas na evolução e propagação de patógenos fúngicos emergentes
• Beneficiário: Anderson Messias Rodrigues
• Modalidade de apoio: Auxílio à Pesquisa - Jovens Pesquisadores
• Processo FAPESP: 18/21460-3 - Estudo de diferentes preparações antigênicas de Paracoccidioides lutzii para a padronização do teste de ELISA como auxílio no diagnóstico da paracoccidioidomicose por P. lutzii
• Beneficiário: Zoilo Pires de Camargo
• Modalidade de apoio: Auxílio à Pesquisa - Regular