title: Paracoccidioidomycosis in the state of Maranhão, Brazil: geographical and clinical aspects.
abstract: BACKGROUND
  The study aimed to show the situation of paracoccidioidomycosis in the state of Maranhão, Brazil.
  
  
  METHODS
  This study is a descriptive case series developed in two stages. First, a survey of cases originating from the state of Maranhão at the Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP) from 1997 to 2007, and second, the clinical description of 29 cases diagnosed in the Centro de Referências em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP) from 2004 to 2010.
  
  
  RESULTS
  Two hundred and sixteen cases have been cataloged at the IDTNP. West, east, and central regions of the state of Maranhão recorded 90.3% of cases proving to be important areas for study. The western region, with a prevalence of 10.8/100,000 inhabitants, has a significantly higher proportion of cases than the northern, southern, and eastern regions (p < 0.05). The occurrence was higher in men with 89.3% of cases, and the male-to-female ratio was 8.4:1. The majority of patients were older than 20 years, lived in rural areas, and had farming or soil management as main occupation (73.8%). At CREDIP, 29 cases were diagnosed, of which 26 (89.6%) had multifocal manifestations. Mucous tissues were involved more (75.8%) frequently, followed by lymph nodes, skin, and lungs with 65.5%, 39% and 37.9 %, respectively. The diagnosis was made by combining direct examination, culture, and histopathology.
  
  
  CONCLUSIONS
  The study shows the geographical distribution and the epidemiological and clinical aspects of paracoccidioidomycosis, revealing the significance of the disease to the state of Maranhão.
authors: Departamento de Patologia, Universidade Federal do Maranhão, São Luis, MA, Brasil.
authors: Wilma Batista de
authors: WB
authors: Matos
authors: Gisele Maria Campelo
authors: GM
authors: Dos Santos
authors: Vitor Emmanuel Bouças da
authors: VE
authors: Silva
authors: Eloísada Graça do
authors: EG
authors: Rosário Gonçalves
authors: Antonio Rafael da
authors: AR
authors: Silva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D062306:Geography, Medical; D006801:Humans; D008297:Male; D008875:Middle Aged; D010229:Paracoccidioidomycosis / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D055815:Young Adult