Epidemiological, clinical, and genomic landscape of coccidioidomycosis in northeastern Brazil.

Coccidioidomycosis, listed as a priority mycosis by the WHO, is endemic in the United States but often overlooked in Central and South America. Employing a multi-institutional approach, we investigate how disease characteristics, pathogen genetic variation, and environmental factors impact coccidioidomycosis epidemiology and outcomes in South America. We identified 292 cases (1978-2021) and 42 outbreaks in Piauí and Maranhão states, Brazil, the largest series outside the US/Mexico epidemic zone. The male-to-female ratio was 57.4:1 and the most common activity was armadillo hunting (91.1%) 4 to 30 days before symptom onset. Most patients (92.8%) exhibited typical acute pulmonary disease, with cough (93%), fever (90%), and chest pain (77%) as predominant symptoms. The case fatality rate was 8%. Our negative binomial regression model indicates that reduced precipitation levels in the current (p = 0.015) and preceding year (p = 0.001) predict heightened incidence. Unlike other hotspots, acidic soil characterizes this region. Brazilian strains differ genomically from other C. posadasii lineages. Northeastern Brazil presents a distinctive coccidioidomycosis profile, with armadillo hunters facing elevated risks. Low annual rainfall emerges as a key factor in increasing cases. A unique C. posadasii lineage in Brazil suggests potential differences in environmental, virulence, and/or pathogenesis traits compared to other Coccidioides genotypes.

Genotypes of Cryptococcus neoformans and Cryptococcus gattii as agents of endemic cryptococcosis in Teresina, Piauí (northeastern Brazil).

Throughout Brazil, Cryptococcus neoformans is the cause of cryptococcosis, whereas Cryptococcus gattii is endemic to the northern and northeastern states. In this study, the molecular types of 63 cryptococcal isolates recovered from the cerebrospinal fluid of meningitis patients diagnosed between 2008-2010 in Teresina, Piauí, Brazil, were analysed. Out of the 63 patients, 37 (58.7%) were human immunodeficiency virus (HIV)-positive and 26 (41.3%) were HIV-negative. URA5-restriction fragment length polymorphism analysis identified 37/63 (58.7%) isolates as the C. neoformans VNI genotype, predominantly in HIV-positive patients (32/37, 86.5%), and 24/63 (38.1%) as the C. gattii VGII genotype, mostly in HIV-negative patients (21/26, 80.8%). The occurrence of C. gattii VGII in six apparently healthy children and in seven adolescents/young adults in this region reaffirms the endemic occurrence of C. gattii VGII-induced primary cryptococcosis and early cryptococcal infection. Lethality occurred in 18/37 (48.6%) of the HIV-positive subjects and in 13/26 (50%) of the HIV-negative patients. Our results provide new information on the molecular epidemiology of C. neoformans and C. gattii in Brazilian endemic areas.

Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis.

OBJECTIVE: To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP) in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. RESULTS: Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001). The direction of this relationship was maintained in subsequent punctures. CONCLUSION: The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis.

Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis / Potenciais evocados visuais mostram correlação positiva forte com a pressão intracraniana em pacientes com meningite criptocócica

Objective : To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP) in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. Results : Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001). The direction of this relationship was maintained in subsequent punctures. Conclusion : The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis. .

Objetivo : Verificar a relação entre pressão intracraniana e potencial evocado visual por flash (PEV-F) em pacientes com meningite criptocócica. Método A amostra incluiu pacientes admitidos em um hospital de referência para doenças infecciosas. Realizou-se PEV-F antes de cada punção lombar. Calculou-se o coeficiente de correlação de Pearson e a equação de regressão linear entre as variáveis latência N2 e pressão intracraniana inferida através de raquimanometria. Resultados Dezoito pacientes foram submetidos a um total de 69 punções lombares. A latência N2 mostrou correlação positiva forte com a pressão de abertura verificada na primeira punção lombar a que cada paciente foi submetido (r = 0,83; IC = 0,60 – 0,94; p < 0,0001). A positividade da correlação foi mantida nas aferições subsequentes. Conclusão Houve associação positiva forte entre a latência N2 do PEV-F e pressão intracraniana em pacientes com meningite criptocócica. .

Genotypes of Cryptococcus neoformans and Cryptococcus gattii as agents of endemic cryptococcosis in Teresina, Piauí (northeastern Brazil)

Throughout Brazil, Cryptococcus neoformans is the cause of cryptococcosis, whereas Cryptococcus gattii is endemic to the northern and northeastern states. In this study, the molecular types of 63 cryptococcal isolates recovered from the cerebrospinal fluid of meningitis patients diagnosed between 2008-2010 in Teresina, Piauí, Brazil, were analysed. Out of the 63 patients, 37 (58.7 percent) were human immunodeficiency virus (HIV)-positive and 26 (41.3 percent) were HIV-negative. URA5-restriction fragment length polymorphism analysis identified 37/63 (58.7 percent) isolates as the C. neoformans VNI genotype, predominantly in HIV-positive patients (32/37, 86.5 percent), and 24/63 (38.1 percent) as the C. gattii VGII genotype, mostly in HIV-negative patients (21/26, 80.8 percent). The occurrence of C. gattii VGII in six apparently healthy children and in seven adolescents/young adults in this region reaffirms the endemic occurrence of C. gattii VGII-induced primary cryptococcosis and early cryptococcal infection. Lethality occurred in 18/37 (48.6 percent) of the HIV-positive subjects and in 13/26 (50 percent) of the HIV-negative patients. Our results provide new information on the molecular epidemiology of C. neoformans and C. gattii in Brazilian endemic areas.

Criptococose sistêmica endêmica pela variedade gattii no meio norte do Brasil

Estudamos 124 pacientes com criptococose da regiäo Meio Norte, Piauí e Maranhäo, no período de 10 anos bem como amostras de solo, poeira e madeira em decomposiçäo do domicílio e peridomicílio de 39 destes pacientes. Também estudamos ocos de árvores vivas, localizadas na praça Joäo Luis Ferreira, em Teresina, e restos de folha, flores e madeira de Eucalyptus camldulensis, no campo de experimentaçäo da EMBRAPA, na periferia de Teresina. Os pacientes apresentavam quadro de Meningoencefalite, com cefaléia, vômitos, rigidez de nuca, febre e adinamia. As complicaçöes foram diminuiçäo da visäo ou perda completa (amaurose), surdez, hidrocefalia e recidiva que ocorreu em 16 por cento dos casos. O diagnóstico em 98 por cento dos casos foi feito através do exame microscópico direto do Líquor com tinta da China e a cultura em meio de Saouraud à temperatura ambiente. A dosagem de proteinas estava elevada e a glicose baixa. Nos pacientes com criptococose associada à AIDS, o líquor apresentou-se claro, com celularidade de <50 cel/mmd elementos leveduriformes. (...) Em Teresina foram coletados amostras de 23 ocos de árvores vivas e na praça Joäo Luis Ferreira, se obteve isolamentos de C. neoformans gattii de oitis (Moquilea tormentosa), cássia (Cassia grandis) e figueira (Vicus microcarpa). Foi também isolada a variedade neoformans de Cassia granadis. No campo da EMBRAPA isolou-se a variedade gatti de restos de madeira, flores e folha de Eycalyptus camaldulensis. (AU)

Criptococose sistêmica endêmica pela variedade gattii no meio norte do Brasil

Estudamos 124 pacientes com criptococose da regiäo Meio Norte, Piauí e Maranhäo, no período de 10 anos bem como amostras de solo, poeira e madeira em decomposiçäo do domicílio e peridomicílio de 39 destes pacientes. Também estudamos ocos de árvores vivas, localizadas na praça Joäo Luis Ferreira, em Teresina, e restos de folha, flores e madeira de Eucalyptus camldulensis, no campo de experimentaçäo da EMBRAPA, na periferia de Teresina. Os pacientes apresentavam quadro de Meningoencefalite, com cefaléia, vômitos, rigidez de nuca, febre e adinamia. As complicaçöes foram diminuiçäo da visäo ou perda completa (amaurose), surdez, hidrocefalia e recidiva que ocorreu em 16 por cento dos casos. O diagnóstico em 98 por cento dos casos foi feito através do exame microscópico direto do Líquor com tinta da China e a cultura em meio de Saouraud à temperatura ambiente. A dosagem de proteinas estava elevada e a glicose baixa. Nos pacientes com criptococose associada à AIDS, o líquor apresentou-se claro, com celularidade de <50 cel/mmd elementos leveduriformes. A incidência nos 10 anos de estudo variou de 0,14º/0000a 1,24º/0000 habitantes, e a prevalência de 0,14º/0000 a 1,24º/0000 habitantes. Em Teresina foram coletados amostras de 23 ocos de árvores vivas e na praça Joäo Luis Ferreira, se obteve isolamentos de C. neoformans gattii de oitis (Moquilea tormentosa), cássia (Cassia grandis) e figueira (Vicus microcarpa). Foi também isolada a variedade neoformans de Cassia granadis. No campo da EMBRAPA isolou-se a variedade gatti de restos de madeira, flores e folha de Eycalyptus camaldulensis. (AU)