Clinical and epidemiological features of paracoccidioidomycosis due to Paracoccidioides lutzii

Abstract

Background

The fungus Paracoccidioides lutzii was recently included as a new causative species of paracoccidioidomycosis (PCM) and most cases have been reported from Brazil. According to available epidemiological information, P. lutzii is concentrated in the Middle-West region in Brazil, mainly in the state of Mato Grosso. However, clinical and laboratorial data available on patients infected with P. lutzii remain extremely limited.

Methodology/Main findings

This work describes the clinical manifestations of 34 patients suffering from PCM caused by P. lutzii, treated along 5 years (2011–2017) at a reference service center for systemic mycoses in Mato Grosso, Brazil. Adult rural workers (men), aged between 28 and 67 predominated. All patients had the chronic form of the disease, and the oral mucosa (n = 19; 55.9%), lymph nodes (n = 23; 67.7%), skin (n = 16; 47.1%) and lung (n = 28; 82.4%) were the most affected sites. Alcohol intake (n = 19; 55.9%) and smoking (n = 29; 85.3%) were frequent habits among the patients. No patient suffered from any other life-threatening disease, such as tuberculosis, cancer or other inflammatory or infectious parasitic diseases. The positivity in culture examination (97.1%) was higher than that found for the direct mycological examination (88.2%). Particularly, one patient presented fungemia at diagnosis, which lead to his death. The time elapsed between the initial symptoms and the initiation of treatment of PCM caused by P. lutzii was 19.7 (31.5) months, with most patients diagnosed 7 months after the symptoms’ onset.

Conclusions/Significance

Compared with the classical clinical-epidemiological profile of PCM caused by P. brasiliensis, the results of this descriptive study did not show significant clinical or epidemiological differences that could be attributed to the species P. lutzii. Future studies may confirm or refute the existence of clinical differences between the two fungal species.

Author summary

Paracoccidioidomycosis (PCM) is an endemic mycosis in Latin America with high incidence in Brazil. The fungi Paracoccidioides brasiliensis (including genetic groups S1, PS2, PS3 and PS4) and Paracoccidioides lutzii are the etiological agents, but little is known about the clinical manifestations of PCM caused by P. lutzii. Regarding eco-epidemiological aspects, the habitat is believed to be the soil due to the predominance of the disease among rural workers and other individuals who work in contact with the land. Paracoccidioides spp. has been isolated from aerosol samples, armadillos and dog food, but more data are needed to better understand the ecology of this fungus. The Middle-West region of Brazil presents the highest number of cases of P. lutzii infection. It is important to note that this species presents particularities regarding the serological diagnosis in patients. Thus, this study aims to verify possible clinical-epidemiological differences in 34 patients from this geographical region. Our results do not point out significant clinical or epidemiological differences between the two species causing PCM. In Brazil, the Ministry of Health has made an effort to include this disease in the list of compulsory notification diseases in order to implement a health policy aimed at an early detection, diagnosis and treatment.