Prognostic factors for mortality in patients with Paracoccidioidomycosis

Abstract

Paracoccidioidomycosis (PCM) is a systemic mycosis, endemic in Latin America, caused by thermo-dimorphic fungi of the genus Paracoccidioides, which mainly affect individuals with previous or current contact with the soil, especially rural workers. It has two main clinical forms: the acute/subacute form, which occurs more frequently in children, adolescents and young adults and compromises organs rich in mononuclear phagocytic system; the chronic form, more observed in individuals aged over 35 years and is characterized by compromising lungs, skin and mucous membranes of the upper aero-digestive tract.Treated patients may evolve with the residual form or sequelae, such as fibrosis and pulmonary emphysema and adrenal insufficiency. Since it is not a notifiable disease, epidemiological data about PCM is imprecise. In Brazil, there is an estimated overall mortality rate of 1.45 deaths / 1 million inhabitants, with variations between regions, being the eighth cause of mortality due to predominantly chronic infectious diseases among infectious diseases and parasites. The state of São Paulo has an estimated rate of 2.66 deaths / 1 million inhabitants.In Botucatu, located in the countryside, where there is hyper endemicity of PCM, mortality rate is quite high, with 8.73 deaths / 1 million inhabitants. Considering this condition, this study aims to evaluate deaths occurring in patients with PCM to identify their causes and predictive factors in the Botucatu region. In order to do so, a retrospective cohort will be evaluated, composed of patients with PCM treated at the infectology service of the Hospital das Clínicas da Faculdade of Medicine of Botucatu - UNESP between 2012 and 2022. The clinical, epidemiological and laboratory data will be obtained from the medical record, including autopsy data, when performed. Patients will be evaluated for the outcome of death occurring at the moment of diagnosis of PCM, during treatment and up to two years after the end of antifungal therapy. All cases that evolved to death will be considered in the study and will be classified whether or not related to PCM. In this cohort, "cases" will be defined as those patients who evolved to death and "non-cases" those who survived and will be compared to each other. Continuous variables will be analyzed using the Mann-Whitney test, while the categorical variables, by the Ç2 test or Fisher's exact test for independent variables. To evaluate predictive factors of death, a multiple analysis will be performed by Cox proportional hazards regression. P values lower than 0.05 will be considered significant.