de Macedo Priscila Marques, Almeida-Paes Rodrigo, Freitas Dayvison Francis Saraiva, Varon Andréa Gina, Paixão Ariane Gomes, Romão Anselmo Rocha, Coutinho Ziadir Francisco, Pizzini Claudia Vera, Zancopé-Oliveira Rosely Maria, Francesconi do Valle Antonio Carlos
Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
PLoS Negl Trop Dis. 2017 Mar 29;11(3):e0005500. doi: 10.1371/journal.pntd.0005500. eCollection 2017 Mar.
Paracoccidioidomycosis (PCM) is a systemic mycosis caused by pathogenic dimorphic fungi of the genus Paracoccidioides. It is the most important systemic mycosis in Latin America and the leading cause of hospitalizations and death among them in Brazil. Acute PCM is less frequent but relevant because vulnerable young patients are affected and the severity is usually higher than that of the chronic type.
The authors performed a retrospective cohort study from 2001 to 2009 including acute juvenile PCM patients from a reference center in Rio de Janeiro, Brazil. Clinical, epidemiological, diagnostic, therapeutic, and prognostic data were reported.
Twenty-nine patients were included. The average age was 23 years old and the male to female ratio was 1:1.07. All cases were referred from 3 of 9 existing health areas in the state of Rio de Janeiro, predominantly from urban areas (96.5%). Lymph nodes were the most affected organs (100%), followed by the skin and the spleen (31% each). Twenty-eight patients completed treatment (median 25 months) and progressed to clinical and serological cure; 1 death occurred. Twenty-four patients completed 48-month median follow-up. Four patients abandoned follow-up after the end of treatment. The most frequent sequela was low adrenal reserve. Paracoccidioides brasiliensis S1 was identified by partial sequencing of the arf and gp43 genes from 4 patients who presented a viable fungal culture.
Acute juvenile PCM is a severe disease with a high rate of complications. There are few cohort clinical studies of acute PCM in the literature. More studies should be developed to promote improvement in patients' healthcare.
副球孢子菌病（PCM）是一种由副球孢子菌属致病性双相真菌引起的系统性真菌病。它是拉丁美洲最重要的系统性真菌病，也是巴西住院和死亡的主要原因。急性PCM较少见但很重要，因为易感染的年轻患者会受到影响，且严重程度通常高于慢性类型。
作者进行了一项回顾性队列研究，研究对象为2001年至2009年来自巴西里约热内卢一个参考中心的急性青少年PCM患者。报告了临床、流行病学、诊断、治疗和预后数据。
纳入29例患者。平均年龄为23岁，男女比例为1:1.07。所有病例均来自里约热内卢州9个现有卫生区域中的3个，主要来自城市地区（96.5%）。淋巴结是受影响最严重的器官（100%），其次是皮肤和脾脏（各占31%）。28例患者完成治疗（中位时间25个月），病情进展至临床和血清学治愈；1例死亡。24例患者完成了中位时间为48个月的随访。4例患者在治疗结束后放弃随访。最常见的后遗症是肾上腺储备功能低下。通过对4例真菌培养存活患者的arf和gp43基因进行部分测序，鉴定出巴西副球孢子菌S1型。
急性青少年PCM是一种严重疾病，并发症发生率高。文献中关于急性PCM的队列临床研究较少。应开展更多研究以促进患者医疗保健的改善。
