Paracoccidioidomycosis Diagnosed in Europe-A Systematic Literature Review.

Gernot Wagner,Casey Zachariah,Birgit Willinger,Verena Mayr,Irma Klerings,Miriam Van Den Nest,Anna Glechner,Deddo Moertl,Gerald Gartlehner

doi:10.3390/jof7020157

Abstract

Paracoccidioidomycosis is a systemic mycosis that is endemic in geographical regions of Central and South America. Cases that occur in nonendemic regions of the world are imported through migration and travel. Due to the limited number of cases in Europe, most physicians are not familiar with paracoccidioidomycosis and its close clinical and histopathological resemblance to other infectious and noninfectious disease. To increase awareness of this insidious mycosis, we conducted a systematic review to summarize the evidence on cases diagnosed and reported in Europe. We searched PubMed and Embase to identify cases of paracoccidioidomycosis diagnosed in European countries. In addition, we used Scopus for citation tracking and manually screened bibliographies of relevant articles. We conducted dual abstract and full-text screening of references yielded by our searches. To identify publications published prior to 1985, we used the previously published review by Ajello et al. Overall, we identified 83 cases of paracoccidioidomycosis diagnosed in 11 European countries, published in 68 articles. Age of patients ranged from 24 to 77 years; the majority were male. Time from leaving the endemic region and first occurrence of symptoms considerably varied. Our review illustrates the challenges of considering systemic mycosis in the differential diagnosis of people returning or immigrating to Europe from endemic areas. Travel history is important for diagnostic-workup, though it might be difficult to obtain due to possible long latency period of the disease.

Highlights

IntroductionParacoccidioidomycosis, known as South American blastomycosis, is a systemic fungal infection [1] caused by the thermally dimorphic fungi of the species Paracoccidioides brasiliensis and the related species P. americana, P. restrepiensis, P. venezuelensis, and
We identified 83 case reports from 11 European countries, published in
Our systematic review summarizes the evidence on published case reports of imported paracoccidioidomycosis diagnosed in Europe

Summary

Introduction

Paracoccidioidomycosis, known as South American blastomycosis, is a systemic fungal infection [1] caused by the thermally dimorphic fungi of the species Paracoccidioides brasiliensis and the related species P. americana, P. restrepiensis, P. venezuelensis, and. P. lutzii [2,3]. These fungi are endemic to certain geographic regions of Central and South. Most of the cases of paracoccidioidomycosis are reported in Brazil, followed by Colombia, Venezuela, Ecuador, and Argentina [5]. Based on estimates from epidemiological data, the number of cases of paracoccidioidomycosis in Brazil ranges from 3360 to 5600 per year [5]. The incidence of cases considerably varies among regions with low, 4.0/)

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