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

TY - JOUR

T1 - Paracoccidioidomycosis due to P. lutzii

T2 - the importance of neutrophil/lymphocyte ratio in the symptomatic and asymptomatic phases in severe cases

AU - Nery, Andreia Ferreira

AU - de Camargo, Zoilo Pires

AU - Rodrigues, Anderson Messias

AU - Portela, Tiago Ferreira

AU - Hoffmann-Santos, Hugo Dias

AU - Dambros, Pedro Vitor Krüger

AU - de Souza, Jânio Felipe Ribeiro

AU - Garcia, Alexandre Carvalho

AU - Santos, Carolina Araújo Damasio

AU - Hagen, Ferry

AU - Hahn, Rosane Christine

N1 - This article is protected by copyright. All rights reserved.

PY - 2021/4/8

Y1 - 2021/4/8

N2 - 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.

AB - 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.

U2 - 10.1111/myc.13282

DO - 10.1111/myc.13282

M3 - Article

C2 - 33829534

SN - 0933-7407

JO - Mycoses

JF - Mycoses

ER -