Current Fungal Infection Reports

, Volume 12, Issue 4, pp 138–143 | Cite as

The Southern Endemic Zone of Paracoccidioidomycosis: Epidemiological Approach in Northeast Argentina

  • Gustavo GiusianoEmail author
  • Florencia Rojas
  • Javier Mussin
  • Liliana Alegre
  • María de los Ángeles Sosa
Clinical Mycology Lab Issues (S Córdoba, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Clinical Mycology Lab Issues


Purpose of Review

Paracoccidioidomycosis (PCM) is one of the most prevalent systemic endemic mycosis in Latin America caused by species of an environmental fungus of the genus Paracoccidioides. In Argentina, the endemic area with the highest incidence is located in the Northeast. This review presents the current aspects of PCM epidemiology influenced by global and particular climatic anomalies.

Recent Findings

An increase of cases with particularly features, in the diagnosis and clinical manifestations, delaying the diagnosis was observed. Two genotypes of Paracoccidioides are circulating and, probably, are related to a considerable percentage of non-reactive serological tests obtained in proven cases of PCM.


The traditional view of the PCM epidemiology in the southern endemic zone area must be reconsidered. A higher level of premonition is now required in Northeast Argentina and, may be, in bordering countries. The particular characteristics both in the clinic and in the diagnosis currently observed suggest a new trend in PCM.


Paracoccidioidomycosis Epidemiology Climatic influence Argentina 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Mendes RP, Cavalcante RS, Marques SA, Marques MEA, Venturini J, Sylvestre TF, et al. Paracoccidioidomycosis: current perspectives from Brazil. Open Microbiol J. 2017;11(1):224–82. Scholar
  2. 2.
    •• Restrepo A, Gómez BL, Tobón A. Paracoccidioidomycosis: Latin America’s own fungal disorder. Curr Fungal Infect Rep. 2012;6(4):303–11. This is a comprehensive review of PCM epidemiology in Latin America. CrossRefGoogle Scholar
  3. 3.
  4. 4.
    Falci R, Queiroz-Telles F, Fahal AH, Falci DR, Caceres DH, Chiller T, et al. Neglected endemic mycoses. Ser Lancet Infect Dis. 2017;17(17):30443–50. Scholar
  5. 5.
    Colombo AL, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol. 2011;49(8):785–98.PubMedGoogle Scholar
  6. 6.
    • Restrepo A, McEwen JG, Castañeda E. The habitat of Paracoccidioides brasiliensis: how far from solving the riddle? Med Mycol. 2001;39(3):233–41. This is a review article about the ecology of Paracoccidioides and its relationship with certain PCM characteristics. CrossRefGoogle Scholar
  7. 7.
    WHO | World Health Organization Department of Control of Neglected Tropical Diseases. Neglected tropical diseases. World Health Organization; 2018 [cited 2018 Jul 13].
  8. 8.
    Martinez R. Paracoccidioidomycosis: the dimension of the problem of a neglected disease. Rev Soc Bras Med Trop. 2010;43(4):480. Scholar
  9. 9.
    •• Negroni R. Paracoccidioidomycosis (South American blastomycosis, Lutz’s mycosis). Int J Dermatol. 1993;(12):847–59. This article is a review about epidemiology, pathogenesis and clinical aspects of PCM. Google Scholar
  10. 10.
    Travassos LR, Taborda CP, Colombo AL. Treatment options for paracoccidioidomycosis and new strategies investigated. Expert Rev Anti-Infect Ther. 2008;6(2):251–62.CrossRefGoogle Scholar
  11. 11.
    Teixeira Mde M, Theodoro RC, Oliveira FF, Machado GC, Hahn RC, Bagagli E, et al. Paracoccidioides lutzii sp. nov.: biological and clinical implications. Med Mycol. 2014;52(1):19–28.PubMedGoogle Scholar
  12. 12.
    Matute DR, McEwen JG, Puccia R, B a M, San-Blas G, Bagagli E, et al. Cryptic speciation and recombination in the fungus Paracoccidioides brasiliensis as revealed by gene genealogies. Mol Biol Evol. 2006;23(1):65–73. Scholar
  13. 13.
    Teixeira MM, Theodoro RC, Nino-Vega G, Bagagli E, Felipe MSS. Paracoccidioides species complex: ecology, phylogeny, sexual reproduction, and virulence. PLoS Pathog. 2014;10(10):e1004397. Scholar
  14. 14.
    • Muñoz JF, Farrer RA, Desjardins CA, Gallo JE, Sykes S, Sakthikumar S, et al. Genome diversity, recombination, and virulence across the major lineages of Paracoccidioides. mSphere. 2016;1(5):e00213–6. This article summarizes the phylogeny and current taxonomy of Paracoccidioides genus. CrossRefGoogle Scholar
  15. 15.
    Turissini DA, Gomez OM, Teixeira MM, McEwen JG, Matute DR. Species boundaries in the human pathogen Paracoccidioides. Fungal Genet Biol. 2017;106:9–25. Scholar
  16. 16.
    Giusiano G, Cattana ME, Tracogna MF, Sosa MA, Rojas F, Fernández MS, et al. Re-emerging paracoccidioidomycosis in Argentina with peculiarities in the diagnosis and clinical manifestations. Mycoses. 2015;58(Suppl4):124–5.Google Scholar
  17. 17.
    Shankar J, Restrepo A, Clemons KV, Stevens D a. Hormones and the resistance of women to paracoccidioidomycosis. Clin Microbiol Rev. 2011;24(2):296–313.CrossRefGoogle Scholar
  18. 18.
    de Deus Vieira G, da Cunha Alves T, de Lima SMD, Camargo LMA, de Sousa CM. Paracoccidioidomycosis in a western Brazilian Amazon state: clinical-epidemiologic profile and spatial distribution of the disease. Rev Soc Bras Med Trop. 2014;47(1):63–8. Scholar
  19. 19.
    Dutra LM, Silva THM, Falqueto A, Peçanha PM, Souza LRM, Gonçalves SS, et al. Oral paracoccidioidomycosis in a single-center retrospective analysis from a Brazilian southeastern population. J Infect Public Health. 2018;11(4):530–3. Scholar
  20. 20.
    Negroni P, Negroni R. Paracoccidioidomicosis. In: Negroni P, Negroni R, editors. Micosis cutáneas y viscerales. 9th ed. Buenos Aires: Lopez Libreros Editores; 1991. p. 156–64.Google Scholar
  21. 21.
    López-Martínez R, Hernández-Hernández F, Méndez-Tovar L, Manzano-Gayosso P, Bonifaz A, Arenas R, et al. Paracoccidioidomycosis in Mexico: clinical and epidemiological data from 93 new cases (1972–2012). Mycoses. 2014;57(9):525–30. Scholar
  22. 22.
    Blotta MH, Mamoni RL, Oliveira SJ, Nouér SA, Papaiordanou PM, Goveia A, et al. Endemic regions of paracoccidioidomycosis in Brazil: a clinical and epidemiologic study of 584 cases in the southeast region. Am J Trop Med Hyg. 1999;61(3):390–4.CrossRefGoogle Scholar
  23. 23.
    Mangiaterra M, Alonso J, Galvan M, Giusiano G, Gorodner J. Histoplasmin and paracoccidioidin skin reactivity in infantile population of northern Argentina. Rev Inst Med Trop Sao Paulo. 1996;38(5):349–53.CrossRefGoogle Scholar
  24. 24.
    Mangiaterra ML, Giusiano GE, Alonso JM, Gorodner JO. Paracoccidioides brasiliensis infection in a subtropical region with important environmental changes. Bull Soc Pathol Exot. 1999;92(3):173–6.PubMedGoogle Scholar
  25. 25.
    Taicz M, Rosanova MT, Bes D, Lisdero ML, Iglesias V, Santos P, et al. Paracoccidioidomycosis in pediatric patients: a description of 4 cases. Rev Iberoam Micol. 2014;31(2):141–4.CrossRefGoogle Scholar
  26. 26.
    •• Giusiano G, Aguirre C, Vratnica C, Rojas F, Corallo T, Cattana ME, et al. Emergence of acute/subacute infant-juvenile paracoccidioidomycosis in Northeast Argentina: effect of climatic and anthropogenic changes? Med Mycol. 2018. This study conducted in Northeast Argentina provides information about the emergence of a cluster of PCM in children influenced by climatic anomalies.
  27. 27.
    Carneiro Rda C, Miranda BG, Camilo Neto C, Tsukumo MK, Fonseca CL, Mendonca JS. Juvenile paracoccidioidomycosis in urban area: report of two cases. Braz Infect Dis. 2010;14:77–80.CrossRefGoogle Scholar
  28. 28.
    Ballesteros A, Beltrán S, Patiño J, Bernal C, Orduz R. Paracoccidioidomicosis juvenil diseminada diagnosticada en una niña en área urbana. Biomedica. 2014;34:21–8.CrossRefGoogle Scholar
  29. 29.
    de Macedo PM, Almeida-Paes R, Freitas DFS, Varon AG, Gomes Paixao AG, Rocha Romao AR, et al. Acute juvenile Paracoccidioidomycosis: a 9-year cohort study in the endemic area of Rio de Janeiro, Brazil. PLoS Negl Trop Dis. 2017;11(3):e0005500.CrossRefGoogle Scholar
  30. 30.
    • Martinez R. New trends in Paracoccidioidomycosis epidemiology. J Fungi. 2017;3(1):1 This article evaluates PCM data in Latin America and the possible causes of epidemiological modification. CrossRefGoogle Scholar
  31. 31.
    • Shikanai-Yasuda MA, Mendes RP, Colombo AL, De Q-t F, Satie A, Kono G, et al. Brazilian guidelines for the clinical management of paracoccidioidomycosis. Rev Soc Bras Med Trop. 2017;50(5):715–40. This article summarizes the current recommendations for the management of PCM according to the Brazilian Society of Infectious Diseases. CrossRefGoogle Scholar
  32. 32.
    Batista J Jr, de Camargo ZP, Fernandes GF, Vicentini AP, Fontes CJF, Hahn RC. Is the geographical origin of a Paracoccidioides brasiliensis isolate important for antigen production for regional diagnosis of paracoccidioidomycosis? Mycoses. 2010;53(2):176–80. Scholar
  33. 33.
    • Machado GC, Moris DV, Arantes TD, LRF S, Theodoro RC, Mendes RP, et al. Cryptic species of Paracoccidioides brasiliensis: impact on paracoccidioidomycosis immunodiagnosis. Mem Inst Oswaldo Cruz. 2013;108(5):637–43. This work evaluates the implications of cryptic species in P. brasiliensis in the immunodiagnosis. CrossRefGoogle Scholar
  34. 34.
    •• Martinez R. Epidemiology of paracoccidioidomycosis. Rev Inst Med Trop Sao Paulo. 2015;57(suppl 19):11–20 This article review clinical and epidemiological aspects of PCM and the geographic distribution in Latin America. CrossRefGoogle Scholar
  35. 35.
    • Barrozo LV, Mendes RP, Marques SA, Benard G, Siqueira Silva ME, Bagagli E. Climate and acute/subacute paracoccidioidomycosis in a hyper-endemic area in Brazil. Int J Epidemiol. 2009;38(6):1642–9. This work help to clarify the conditions that favor Paracoccidioides survival and growth in the environment and enhance human exposure. CrossRefGoogle Scholar
  36. 36.
    Simões LB, Marques SA, Bagagli E. Distribution of paracoccidioidomycosis: determination of ecologic correlates through spatial analyses. Med Mycol. 2004;42(6):517–23.CrossRefGoogle Scholar
  37. 37.
    Loth EA, De CSV, Da SJR, Gandra RF. Occurrence of 102 cases of paracoccidioidomycosis in 18 months in the Itaipu Lake region, Western Paraná. Rev Soc Bras Med Trop. 2011;44(5):636–7.CrossRefGoogle Scholar
  38. 38.
    Coimbra Júnior CE, Wanke B, Santos RV, do Valle AC, Costa RL, Zancopé-Oliveira RM. Paracoccidioidin and histoplasmin sensitivity in Tupí-Mondé Amerindian populations from Brazilian Amazonia. Ann Trop Med Parasitol. 1994;88(2):197–207 Scholar
  39. 39.
    • Barrozo LV, Benard G, Silva MES, Bagagli E, Marques SA, Mendes RP. First description of a cluster of acute/subacute paracoccidioidomycosis cases and its association with a climatic anomaly. PLoS Negl Trop Dis. 2010;4(3):e643. This article describe the relationship between clusters of PCM cases with the climatic anomaly caused by El Niño Southern Oscillation. CrossRefGoogle Scholar
  40. 40.
    Null J. El Niño and La Niña years and intensities based on Oceanic Niño Index (ONI). 2017. [cited 2018 Jul 15]. Available from:
  41. 41.
    Cattana ME, Teixeira MDM, Litvintseva A, Tracogna MF, Arechavala A, Negroni R, et al. Whole genome sequencing of P. brasiliensis isolates of endemic areas in Argentina and Paraguay. Med Mycol. 2018;56(suppl2):S1–159. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Gustavo Giusiano
    • 1
    Email author
  • Florencia Rojas
    • 1
  • Javier Mussin
    • 1
  • Liliana Alegre
    • 1
  • María de los Ángeles Sosa
    • 1
    • 2
  1. 1.Departamento de Micología, Instituto de Medicina Regional, CONICETUniversidad Nacional del NordesteResistenciaArgentina
  2. 2.Laboratorio Central de Salud PúblicaCorrientesArgentina

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