Puzzling paracoccidioidomycosis - Factors associated with the severity of Paracoccidioides lutzii infections

Andreia Ferreira Nery, Zoilo Pires de Camargo, Anderson Messias Rodrigues, Tiago Ferreira Portela, Hugo Dias Hoffmann-Santos, Breno Gonçalves Pinheiro, Ana Paula Possa, Letícia Rossetto da Silva Cavalcante, Ferry Hagen, Rosane Christine Hahn

Research output: Contribution to journal/periodicalArticleScientificpeer-review

6 Citations (Scopus)


OBJECTIVES: Historically, the Brazilian midwestern region has had a high number of paracoccidioidomycosis (PCM) cases caused by the dimorphic fungus Paracoccidioides lutzii.

METHODS: We investigated by an epidemiological, observational, analytical cross-sectional study the clinical and laboratory data of 44 PCM patients with a culture-proven P. lutzii infection. All patients were referred to the Systemic Mycosis Center, Júlio Muller University Hospital, Cuiabá, Brazil, during January 2017-March 2020. The neutrophil to lymphocyte ratio (RNL) was calculated and dichotomized by its median to include in the identification of factors associated with severity.

RESULTS: At admission 13 (31.7%) patients showed the disseminated multifocal chronic PCM form and 16 (36.4%) patients met clinical severity criteria. Treatment prescribed on admission did not followed the 'Brazilian Guideline for the Clinical Management of Paracoccidioidomycosis' recommendations in 26% (PR: 0.26; 95% CI: 0.14-0.49; p < 0.0001) of the severe PCM cases. Patients with severe PCM had a higher neutrophil/lymphocyte ratio (NLR) that was greater than the median (≥4.11).

CONCLUSIONS: The NLR biomarker complements the criteria of PCM severity. Applying the low-cost NLR test can greatly increase the diagnostic sensitivity when screening patients for PCM and contribute to a better control the disease, complications and therapeutic strategies.

Original languageEnglish
JournalInternational Journal of Infectious Diseases
Publication statusPublished - Jun 2021


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