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Giusiano G, Tracogna F, Messina F, Sosa V, Rojas F, Chacón Y, Vásquez A, de Los Ángeles Sosa M, Formosa P, Fernández M, Cattana ME, Mussin J, Fernández N, Piedrabuena M, Romero M, Miranda C, Posse G, Davalos F, Valdez R, Acuña A, Aguilera A, Andreni M, Serrano J, Álvarez C, Aguirre D, Pineda G, Effron GG, Santiso G. Impact of COVID-19 on paracoccidioidomycosis. Which was the most influential: The pandemic or the virus? Mycoses 2024; 67:e13761. [PMID: 38946016 DOI: 10.1111/myc.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/02/2024]
Abstract
The impact of COVID-19 on paracoccidioidomycosis (PCM) in Argentina and the consequences generated by the pandemic are discussed. From 2018 to 3 years after the pandemic declaration, 285 proven PCM patients were registered. No association between both diseases was documented. PCM frequency decreased to extremely low levels in 2020. Mandatory social isolation and the emotional and psychological effects generated under pandemic circumstances led to delays in diagnosis, severe disseminated cases, and other challenges for diagnosis in subsequent years. Probable underdiagnosis should be considered due to the overlap of clinical manifestations, the low index of suspicion and the lack of sensitive diagnostic tools.
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Affiliation(s)
- Gustavo Giusiano
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia, Chaco, Argentina
- Hospital Pediátrico Juan Pablo II, Corrientes, Argentina
| | | | - Fernando Messina
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
| | - Vanesa Sosa
- Servicio de Micología, Hospital Ramon Madariaga, Posadas, Misiones, Argentina
| | - Florencia Rojas
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia, Chaco, Argentina
| | - Yone Chacón
- Hospital Señor del Milagro, Salta, Argentina
| | - Andrea Vásquez
- Servicio de Microbiología, Hospital 4 de Junio Ramón Carrillo, Presidencia Roque Sáenz Peña, Chaco, Argentina
| | - Maria de Los Ángeles Sosa
- Laboratorio Central de Redes y Programas, Facultad de Ciencias Exactas y Naturales y Agrimensura, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Corrientes, Argentina
| | - Patricia Formosa
- Hospital de Alta Complejidad Pte. J. D. Perón, Formosa, Argentina
| | | | | | - Javier Mussin
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia, Chaco, Argentina
| | - Norma Fernández
- Laboratorio de Micología, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina
| | - Milagros Piedrabuena
- Laboratorio de Microbiología, Hospital San Martín, Paraná, Entre Ríos, Argentina
| | - Mercedes Romero
- CEMAR Microbiología, Dir. Bioquímica, Secretaría de Salud Pública, Rosario, Argentina
| | | | - Gladys Posse
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | | | - Ruth Valdez
- Hospital Señor del Milagro, Salta, Argentina
| | | | | | - Mariana Andreni
- Sección Microbiología, Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina
| | - Julian Serrano
- Sección Micología, Hospital Independencia, Santiago del Estero, Argentina
| | - Christian Álvarez
- División Micología-Laboratorio de Salud Pública de Tucumán, Tucumán, Argentina
| | - Diana Aguirre
- Hospital Pediátrico Avelino Castelán, Resistencia, Chaco, Argentina
| | - Gloria Pineda
- Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
- Hospital de Pediatría S.A.M.I.C. Juan P. Garraham, Buenos Aires, Argentina
| | - Guillermo Garcia Effron
- Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, CONICET, Santa Fe, Argentina
| | - Gabriela Santiso
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
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de Souza CAT, Ponce CC, Klautau GB, Costa AN, Queiroz W, Patzina RA, Benard G, Lindoso JAL. Can COVID-19 impact the natural history of paracoccidioidomycosis? Insights from an atypical chronic form of the mycosis. Rev Inst Med Trop Sao Paulo 2023; 65:e57. [PMID: 38055375 PMCID: PMC10691805 DOI: 10.1590/s1678-9946202365057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 12/08/2023] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It can occur as an acute/subacute form (A/SAF), a chronic form (CF) and rarely as a mixed form combining the features of the two aforementioned forms in an immunocompromised patient. Here, we report a 56-year-old male patient with CF-PCM who presented with atypical manifestations, including the development of an initial esophageal ulcer, followed by central nervous system (CNS) lesions and cervical and abdominal lymphatic involvement concomitant with severe SARS-CoV-2 infection. He was HIV-negative and had no other signs of previous immunodeficiency. Biopsy of the ulcer confirmed its mycotic etiology. He was hospitalized for treatment of COVID-19 and required supplemental oxygen in the intensive unit. The patient recovered without the need for invasive ventilatory support. Investigation of the extent of disease during hospitalization revealed severe lymphatic involvement typical of A/SAF, although the patient`s long history of high-risk exposure to PCM, and lung involvement typical of the CF. Esophageal involvement is rare in non-immunosuppressed PCM patients. CNS involvement is also rare. We suggest that the immunological imbalance caused by the severe COVID-19 infection may have contributed to the patient developing atypical severe CF, which resembles the PCM mixed form of immunosuppressed patients. Severe COVID-19 infection is known to impair the cell-mediated immune response, including the antiviral response, through T-lymphopenia, decreased NK cell counts and T-cell exhaustion. We hypothesize that these alterations would also impair antifungal defenses. Our case highlights the potential influence of COVID-19 on the course of PCM. Fortunately, the patient was timely treated for both diseases, evolving favorably.
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Affiliation(s)
| | - Cesar Cilento Ponce
- Instituto de Infectologia Emilio Ribas, São Paulo, São Paulo,
Brazil
- Instituto Adolfo Lutz, São Paulo, São Paulo, Brazil
| | - Gisele Burlamaqui Klautau
- Instituto de Infectologia Emilio Ribas, São Paulo, São Paulo,
Brazil
- Santa Casa de São Paulo, Faculdade de Medicina, São Paulo, São
Paulo, Brazil
| | - André Nathan Costa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de
Cardio-Pneumologia, São Paulo, São Paulo, Brazil
| | - Wladimir Queiroz
- Instituto de Infectologia Emilio Ribas, São Paulo, São Paulo,
Brazil
| | | | - Gil Benard
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Micologia Médica (LIM-53), São Paulo,
São Paulo, Brazil
| | - José Angelo Lauletta Lindoso
- Instituto de Infectologia Emilio Ribas, São Paulo, São Paulo,
Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, Laboratório de Protozoologia (LIM-49), São Paulo,
São Paulo, Brazil
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Benko LMP, Vieira da Silva MEDS, Falcão EMM, Freitas DFS, Calvet GA, Almeida MDA, Almeida-Paes R, Zancopé-Oliveira RM, do Valle ACF, de Macedo PM. Paracoccidioidomycosis and pregnancy: A 40-year single-center cohort study in the endemic area of Rio de Janeiro, Brazil. PLoS Negl Trop Dis 2023; 17:e0011645. [PMID: 37708219 PMCID: PMC10522026 DOI: 10.1371/journal.pntd.0011645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/26/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
The occurrence of acute paracoccidioidomycosis (PCM) in urban areas of the Rio de Janeiro state, Brazil, has emerged in recent years. Therefore, young populations, including pregnant women, are at a higher risk of infection. Furthermore, young women undergoing itraconazole treatment for PCM have increased chances to get pregnant because this medication may reduce the effectiveness of contraceptives. Acute PCM is invasive, reaching abdominal organs, posing a maternal-fetal risk. PCM treatment in pregnant women is also challenging due to the teratogenicity associated with the currently available oral drugs. There are scarce studies on PCM and pregnancy, mainly consisting of case reports and experimental murine models that highlight the severity of this association. We conducted a database research at a PCM reference center in Rio de Janeiro state from 1980 to 2020. We included patients diagnosed with PCM who were pregnant shortly before, at admission, or at any moment of their PCM follow-up care. Data related to pregnancy, childbirth, and the newborn were obtained from the Brazilian official public databases. We also reviewed the epidemiological and clinical features of these patients. During the study period, we identified 18 pregnant patients, with a median age of 26 years (range: 16-38). Among these cases, six (33.3%) were detected in the last 5 years, and 14 (77.8%) presented acute PCM, supporting the recent shift in the epidemiological profile towards acute PCM. Most pregnancies occurred during PCM treatment (n = 11, 61.1%), which led to challenges in the therapeutic management. Maternal-fetal complications occurred in some of these cases, including vaginal bleeding (n = 1), preeclampsia (n = 1), prematurity (n = 2), low birth weight (n = 4), and fetal deaths (n = 2). PCM during pregnancy presents a significant public health concern in the context of the emergence of acute PCM in urban areas.
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Affiliation(s)
- Lorena Macedo Pestana Benko
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | | - Eduardo Mastrangelo Marinho Falcão
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Dayvison Francis Saraiva Freitas
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Guilherme Amaral Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Marcos de Abreu Almeida
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | | | - Antonio Carlos Francesconi do Valle
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
| | - Priscila Marques de Macedo
- Laboratory of Clinical Research on Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil
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