Abstract
Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America and more prevalent in South America. The disease is caused by the dimorphic fungus Paracoccidioides spp. whose major hosts are humans and armadillos. The fungus grows in soil and its infection is associated with exposure to the rural environment and to agricultural activities, with a higher risk in coffee and tobacco plantations. Population studies assessing the reactivity to Paracoccidioides spp. antigens by intradermal reaction or serological tests have detected previous subclinical infections in a significant proportion of healthy individuals living in various endemic countries. Paracoccidioidomycosis-disease is manifested by a small minority of infected individuals. The risk of developing the disease and its type of clinical form are related to the personal and life style characteristics of infected individuals, including genetic background, age, sex, ethnicity, smoking habit, alcohol drinking, and eventual cellular immunosuppression. Brazil, Colombia, Venezuela, Argentina, and Ecuador have endemic areas that had already been defined in the 20th century. The incidence of paracoccidioidomycosis can be altered by climate phenomena and mainly by human migration and occupation of poorly explored territories. In Brazil, the endemy tends to expand towards the North and Center-West around the Amazon Region.
Highlights
Paracoccidioidomycosis is an endemic fungal infection occurring on the American continent from 23◦ N to 23◦ S, with higher prevalence in South America
Genotypic studies revealed variations of P. brasiliensis, which was assigned to the cryptic species PS1, PS2, PS3, and PS4 [2]
This fact may be attributed in part to the hormonal and immunity changes that occur during pregnancy, which has been associated with the onset or reactivation of paracoccidioidomycosis [43]
Summary
Paracoccidioidomycosis is an endemic fungal infection occurring on the American continent from 23◦ N to 23◦ S, with higher prevalence in South America. All information about the eco-epidemiology, infection, and disease concerning to Paracoccidioides spp. has been obtained in studies that did not distinguish between the species involved. More recent studies have reported that Paracoccidioides spp. infection and disease occur in areas of agricultural crops [6,7] and that armadillos infected with the fungus live in territories with sandy and acidic soil, disturbed natural vegetation, and the presence of rivers [8]. The disease develops a few weeks or months after exposure to Paracoccidioides spp., permitting the identification of areas of acquisition of this fungal infection. By assuming that the lethality rate of this fungal disease is 3% to 5%, the number of cases of paracoccidioidomycosis in Brazil is estimated to range from 3360 to 5600 per year. In a hyperendemic area more recently installed in the state of Rondônia, West Amazon Region, the mean incidence reached 9.4/100,000 inhabitants/year and some municipalities in the Southeastern part of this state had an incidence close to 40 cases/100,000 inhabitants/year [14]
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