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Acute-subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non-survival predictor.
Mycoses 2019M

Abstract

The acute-subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute-subacute PCM, to determine a mortality risk factor and to propose a test for non-survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15 years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P < .05). Through a period of 38 years, 141 children and adolescents were diagnosed with acute-subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole-trimethoprim (SMX-TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut-off for serum albumin was 2.18 g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute-subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage ≤ 2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard.

Authors+Show Affiliations

The State University of Campinas - Unicamp, Campinas, SP, Brasil.The State University of Campinas - Unicamp, Campinas, SP, Brasil.The State University of Campinas - Unicamp, Campinas, SP, Brasil.The State University of Campinas - Unicamp, Campinas, SP, Brasil.The State University of Campinas - Unicamp, Campinas, SP, Brasil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31408548

Citation

Romaneli, Mariana Tresoldi das Neves, et al. "Acute-subacute Paracoccidioidomycosis: a Paediatric Cohort of 141 Patients, Exploring Clinical Characteristics, Laboratorial Analysis and Developing a Non-survival Predictor." Mycoses, 2019.
Romaneli MTDN, Tardelli NR, Tresoldi AT, et al. Acute-subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non-survival predictor. Mycoses. 2019.
Romaneli, M. T. D. N., Tardelli, N. R., Tresoldi, A. T., Morcillo, A. M., & Pereira, R. M. (2019). Acute-subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non-survival predictor. Mycoses, doi:10.1111/myc.12984.
Romaneli MTDN, et al. Acute-subacute Paracoccidioidomycosis: a Paediatric Cohort of 141 Patients, Exploring Clinical Characteristics, Laboratorial Analysis and Developing a Non-survival Predictor. Mycoses. 2019 Aug 13; PubMed PMID: 31408548.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute-subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non-survival predictor. AU - Romaneli,Mariana Tresoldi das Neves, AU - Tardelli,Natália Rocha, AU - Tresoldi,Antonia Teresinha, AU - Morcillo,André Moreno, AU - Pereira,Ricardo Mendes, Y1 - 2019/08/13/ PY - 2019/05/01/received PY - 2019/08/02/revised PY - 2019/08/07/accepted PY - 2019/8/14/pubmed PY - 2019/8/14/medline PY - 2019/8/14/entrez KW - Paracoccidioides brasiliensis KW - antifungal agents KW - deep fungal infection KW - epidemiology KW - lymphadenitis KW - paracoccidioidomycosis JF - Mycoses JO - Mycoses N2 - The acute-subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute-subacute PCM, to determine a mortality risk factor and to propose a test for non-survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15 years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P < .05). Through a period of 38 years, 141 children and adolescents were diagnosed with acute-subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole-trimethoprim (SMX-TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut-off for serum albumin was 2.18 g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute-subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage ≤ 2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard. SN - 1439-0507 UR - https://www.unboundmedicine.com/medline/citation/31408548/Acute-subacute_paracoccidioidomycosis:_a_pediatric_cohort_of_141_patients,_exploring_clinical_characteristics,_laboratorial_analysis,_and_developing_a_non-survival_predictor L2 - https://doi.org/10.1111/myc.12984 DB - PRIME DP - Unbound Medicine ER -