Paracoccidioidomycosis due to P. lutzii: the importance of neutrophil/lymphocyte ratio in the symptomatic and asymptomatic phases in severe cases

Andreia Ferreira Nery, Zoilo Pires de Camargo, Anderson Messias Rodrigues, Tiago Ferreira Portela, Hugo Dias Hoffmann-Santos, Pedro Vitor Krüger Dambros, Jânio Felipe Ribeiro de Souza, Alexandre Carvalho Garcia, Carolina Araújo Damasio Santos, Ferry Hagen, Rosane Christine Hahn

Research output: Contribution to journal/periodicalArticleScientificpeer-review

3 Citations (Scopus)


BACKGROUND: PCM is a neglected systemic mycosis endemic in Brazil. The middle-west region of Brazil has shown the highest number of PCM by P. lutzii cases. Differentiating cases of severe PCM from non-severe ones should be a concern at the bedside. Diagnosis of severe PCM by P. lutzii is based on the subjectivity of clinical manifestations, which can result in a delay in starting its treatment and, consequently evolution to severe sequelae. There isn't laboratory biomarker available to support the early diagnosis of severe PCM that is feasible for all the realities that coexist in Brazil.

OBJECTIVES: The aim of this study was to investigate the usefulness of laboratory biomarkers as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and neutrophil/lymphocyte ratio (NLR) in the diagnosis of severe PCM.

PATIENTS/METHODS: ESR, CRP, and NLR were analyzed for 44 patients with PCM by P.lutzii and a Receiver Operation Characteristic (ROC) curve were generated to identify the NLR cut-off point and point out the presence of severe PCM.

RESULTS: Sixteen (36.4%) had severe PCM and 28 (63.6%) had non-severe PCM. The mean NLR was higher and statistically significant among patients with severe PCM than among those with non-severe PCM. The area under the ROC curve was 0.859 for the diagnosis of severe PCM. The cut-off point for NLR for the diagnosis of severe PCM was 3.318 (sensitivity of 100%, specificity of 77%).

CONCLUSIONS: According to results, it is plausible to conclude that NLR represents a potential biomarker for the diagnosis of severe PCM.

Original languageEnglish
Publication statusE-pub ahead of print - 08 Apr 2021


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