title: Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro, Brazil.
abstract: Paracoccidioidomycosis (PCM) is a systemic mycosis caused by pathogenic dimorphic fungi of the genus Paracoccidioides. It is the most important systemic mycosis in Latin America and the leading cause of hospitalizations and death among them in Brazil. Acute PCM is less frequent but relevant because vulnerable young patients are affected and the severity is usually higher than that of the chronic type.
  
  
  
  The authors performed a retrospective cohort study from 2001 to 2009 including acute juvenile PCM patients from a reference center in Rio de Janeiro, Brazil. Clinical, epidemiological, diagnostic, therapeutic, and prognostic data were reported.
  
  
  
  Twenty-nine patients were included. The average age was 23 years old and the male to female ratio was 1:1.07. All cases were referred from 3 of 9 existing health areas in the state of Rio de Janeiro, predominantly from urban areas (96.5%). Lymph nodes were the most affected organs (100%), followed by the skin and the spleen (31% each). Twenty-eight patients completed treatment (median 25 months) and progressed to clinical and serological cure; 1 death occurred. Twenty-four patients completed 48-month median follow-up. Four patients abandoned follow-up after the end of treatment. The most frequent sequela was low adrenal reserve. Paracoccidioides brasiliensis S1 was identified by partial sequencing of the arf and gp43 genes from 4 patients who presented a viable fungal culture.
  
  
  
  Acute juvenile PCM is a severe disease with a high rate of complications. There are few cohort clinical studies of acute PCM in the literature. More studies should be developed to promote improvement in patients' healthcare.
authors.affiliation: Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Priscila Marques
authors.identifier: 0000-0002-6900-9703
authors.initials: PM
authors.lastname: de Macedo
authors.affiliation: Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Almeida-Paes
authors.affiliation: Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Dayvison Francis Saraiva
authors.initials: DF
authors.lastname: Freitas
authors.affiliation: Department of Inpatient Health Care, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Andréa Gina
authors.initials: AG
authors.lastname: Varon
authors.affiliation: Department of Inpatient Health Care, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Ariane Gomes
authors.initials: AG
authors.lastname: Paixão
authors.affiliation: Geoprocessing Laboratory, Institute of Scientific and Technological Communication and Information in Health, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Anselmo Rocha
authors.initials: AR
authors.lastname: Romão
authors.affiliation: Sergio Arouca National School of Public Health, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Ziadir Francisco
authors.initials: ZF
authors.lastname: Coutinho
authors.affiliation: Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Claudia Vera
authors.initials: CV
authors.lastname: Pizzini
authors.affiliation: Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Rosely Maria
authors.initials: RM
authors.lastname: Zancopé-Oliveira
authors.affiliation: Infectious Dermatology Clinical Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Francesconi do Valle
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D019353:Endemic Diseases; D005260:Female; D005656:Fungal Proteins / Q000235:genetics; D005838:Genotype; D006801:Humans; D008297:Male; D010228:Paracoccidioides / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D010229:Paracoccidioidomycosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D005656:Fungal Proteins