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de Brito TGN, Taborda M, Provenci B, Costa AN, Benard G. A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited. J Fungi (Basel) 2021; 7:jof7080655. [PMID: 34436194 PMCID: PMC8398402 DOI: 10.3390/jof7080655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/01/2022] Open
Abstract
Clinical observations have long suggested that women are protected against paracoccidioidomycosis. 17β-estradiol, the main female estrogen, inhibits conidia-to-yeast transformation (C-to-Y), which is required for the infection establishment. However, experiments in murine models have yielded conflicting results, suggesting that C-to-Y inhibition, alone, fails to explain the female-associated protection and that sexual hormones may also act by modulating the host’s immune responses. Therefore, this issue remains unsolved. Strikingly, no studies have compared the severity of paracoccidioidomycosis between men and women. This retrospective case-control study compared 36 women with 72 age-matched men for clinical–demographic, laboratory, and chest imaging findings. Overall, paracoccidioidomycosis in women presented the main features described in the acute/subacute and chronic forms seen in men. Women also showed similar demographic features and clinical–laboratory and imaging severity scores as men. We additionally reviewed 58 paracoccidioidin skin test surveys undertaken by volunteers from endemic areas. Data accumulated from 10.873 tests showed that females and males are infected with similar magnitudes (21.9% vs. 25.2%) and that reactivity steadily increased with age, peaking after the age of 60. We discuss the paradox of similar infection rates but much lower disease prevalence in women, considering the current pathogenetic views of paracoccidioidomycosis, and we raise alternative hypotheses to account for this paradox.
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Affiliation(s)
- Tereza Graciano Nascimento de Brito
- Laboratorio de Investigacao em Imunologia e Dermatologia (LIM56), Departamento de Dermatologia and Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 470, São Paulo 05403-000, Brazil;
| | - Mariane Taborda
- Divisao de Doenças Infecciosas, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 255, São Paulo 05403-000, Brazil;
| | - Bruna Provenci
- Divisao de Pneumologia, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 44, São Paulo 05403-900, Brazil; (B.P.); (A.N.C.)
| | - André Nathan Costa
- Divisao de Pneumologia, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 44, São Paulo 05403-900, Brazil; (B.P.); (A.N.C.)
| | - Gil Benard
- Laboratorio de Investigacao em Imunologia e Dermatologia (LIM56), Departamento de Dermatologia and Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 470, São Paulo 05403-000, Brazil;
- Laboratorio de Micologia Medica (LIM53), Departamento de Dermatologia and Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 470, São Paulo 05403-000, Brazil
- Correspondence:
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Lenhard-Vidal A, Bender FR, Assolini JP, Maruo AEM, Vieira LT, Pereira EC, Ono MA, Sano A, Itano EN. IgG reactivity profile to Paracoccidioides spp. antigens in people with asymptomatic Paracoccidioidomycosis. J Med Microbiol 2021; 70. [PMID: 33258768 DOI: 10.1099/jmm.0.001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Paracoccidioidomycosis (PCM) is a systemic mycosis caused by Paracoccidioides spp. As the disease is known to affect mostly men over 40 years old who previously worked handling soil, some cities of agricultural economy in endemic regions may have more cases of paracoccidioidal infection.Gap statement. The true frequency of PCM cannot be established in Brazil because it is not a disease of mandatory reporting. The detection of paracoccidioidal infection may assist in the planning of health services, in order to provide early detection of the disease and to prevent its worsening or even progression to death. In addition, little is described about sera reactivity with antigens from different species of Paracoccidiodes, especially P. lutzii.Aim. Current research was conducted in an inland municipality of southern Brazil, in order to assess infection rate within this endemic region of PCM disease.Methodology. ELISA was employed to evaluate 359 sera from random volunteers from Guarapuava, Paraná, Brazil, to detect IgG against cell-free antigens (CFA) from P. restrepiensis B339, P. americana LDR3 and P. lutzii LDR2. Confirmatory ELISA employed gp43 from B339. Reduction of cross-reactions was sought by treatment with sodium metaperiodate (SMP-CFA, SMP-gp43). Immunoblot was performed with 37 selected sera among those reactive in ELISA. Epidemiological profile was assessed by questionnaire.Results. ELISA reactivity was: CFA/SMP-CFA in general 37.3/17.8 %, B339 25.3/14.5 %, LDR3 24.5/1.4 %, LDR2 8.3/5.8 %; gp43/SMP-gp43 7.2/4.7 %. There were sera reactive with multiple CFAs. In immunoblot, five sera showed the same reaction profile with P. lutzii's antigens as PCM disease sera. Rural residence and soil-related professions were risk factors for paracoccidioidal infection.Conclusion. The low prevalence is in accordance with previous reports of lower PCM disease endemicity in Guarapuava than in other areas of Paraná. Although P. brasiliensis seems to be the prevalent strain of the region, 21 sera from people who only lived in Guarapuava reacted with P. lutzii LDR2. CFA-ELISA with whole antigens seems a good option for serological screening in epidemiological surveys.
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Affiliation(s)
- Adriane Lenhard-Vidal
- State University of Londrina, Londrina, Brazil.,University Center Campo Real, Guarapuava, Brazil
| | | | | | | | | | | | | | - Ayako Sano
- Department of Animal Sciences, University of the Ryukyus, Okinawa, Japan
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