Investigación Clínica ISSN: 0535-5133 [email protected] Universidad del Zulia Venezuela Cermeño, Julman; Cermeño, Julmery; Godoy, Gerardo; Hernández, Isabel; Orellán, Yida; Blanco, Ytalia; Penna, Salvador; García, Luily; Mender, Thamara; Gonsálvez, Marisa; López, César; Hernández, Neudys; Longa, Isabel; Gottberg, Esther; Basanta, Amarilys; Castro, Milagros; Millán, Iraida; León, Walesca; Plaz, Flor; Jahouhari, Caroline; Cabello, Ismery Epidemiological study of paracoccidioidomycosis and histoplasmosis in a suburb of San Félix city, Bolívar state, Venezuela. Investigación Clínica, vol. 50, núm. 2, 2009, pp. 213-220 Universidad del Zulia Maracaibo, Venezuela Available in: http://www.redalyc.org/articulo.oa?id=372937676008 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Invest Clin 50(2): 213 - 220, 2009 Epidemiological study of paracoccidioidomycosis and histoplasmosis in a suburb of San Félix city, Bolívar state, Venezuela. Julman Cermeño1, Julmery Cermeño1, Gerardo Godoy1, Isabel Hernández1, Yida Orellán1, Ytalia Blanco1, Salvador Penna1, Luily García2, Thamara Mender1, Marisa Gonsálvez1, César López2, Neudys Hernández2, Isabel Longa2, Esther Gottberg2, Amarilys Basanta2, Milagros Castro2, Iraida Millán2, Walesca León2, Flor Plaz2, Caroline Jahouhari1 and Ismery Cabello1. 1Escuela de Ciencias de la Salud “Dr. Francisco Battistini Casalta”, Universidad de Oriente Núcleo Bolívar, Ciudad Bolívar y 2Hospital “Raúl Leoni”. San Félix, estado Bolívar, Venezuela. Key words: Epidemiology, histoplasmosis, paracoccidioidomycosis, Venezuela. Abstract. Epidemiologic studies of deep mycosis have been scarce in Bolívar state, where paracoccidioidomycosis and histoplasmosis are consid- ered as endemic diseases. The aim of this study was to determine para- coccidioidomycosis and histoplasmosis prevalences in people from a suburb of San Félix, Bolívar state, Venezuela. Three-hundred volunteers agreed to par- ticipate in this study and they were inoculated with paracoccidioidine and histoplasmine. Identification and epidemiologic data were registered. Reading of skin tests after 24 hours was performed in 275 persons. Paracoccidioidine test was positive in 10.2% (n=28). A higher percentage of positive reactions in the age group of 40-50 years old (n=10; 35.7%) was observed. Bricklayers, farmers and miners were positive in 27.3 % (3 out of 11), a higher percentage than in people with other occupations. Histoplasmine test was positive in 7.6% of cases (n= 21). The higher percentage of reactivity was observed in the age group of 40-50 years old (n=9; 42.9%). There was a direct propor- tional relationship between staying time in the locality and H. capsulatum in- fection mainly in persons staying in the area for more than 30 years (p<0.05). These results showed low prevalences of P. brasiliensis and H. capsulatum in- fection in this area. Corresponding author: Julman R Cermeño. Avenida 17 de Diciembre, Centro Comercial Country, piso 1, local 3. Ciudad Bolívar 8001, Venezuela. Tele/Fax: +58-85-6316923 +58-85-65-43291. E-mail: [email protected] 214 Cermeño y col. Estudio epidemiológico de la paracoccidioidomicosis e histoplasmosis en una población suburbana de San Félix, estado Bolívar, Venezuela. Invest Clin 2009; 50(2): 213 - 220 Palabras clave: Epidemiología, histoplasmosis, paracoccidioidomicosis, Vene- zuela. Resumen. El estudio epidemiológico de las micosis profundas ha sido es- caso en el estado Bolívar donde la paracoccidioidomicosis e histoplasmosis son endémicas. El objetivo de este estudio fue determinar la prevalencia de in- fecciones por Paracoccidioides brasiliensis e Histoplasma capsulatum en indi- viduos residenciados en una población suburbana de San Félix, estado Bolívar, Venezuela. Se administró paracoccidioidina e histoplasmina a 300 personas voluntarias. Se realizó lectura de las pruebas a las 24 horas. La paracoccidioi- dina fue positiva en el 10,2% (n=28). Se observó mayor porcentaje de positivi- dad en el grupo de 40-50 años (n=10; 35,7%). Las ocupaciones de riesgo: al- bañiles, agricultores y mineros, presentaron un porcentaje de positividad de 27,3% (3 de 11), mayor que el de los individuos sin riesgo aparente: mecáni- cos, oficios del hogar y estudiantes (25 de 264; 9,5%) (p=0,04). La histoplas- mina fue positiva en el 7,6% (n=21). El mayor porcentaje de intradermorreac- ción positiva se observó entre los 40-50 años (n=9; 42,9%). Hubo relación sig- nificativa entre el tiempo de residencia en la localidad y la infección por H. capsulatum, demostrándose en los individuos con más de 30 años en esa loca- lidad (p<0,05). Estos resultados muestran una prevalencia relativamente baja de infecciones por P. brasiliensis ydeH. capsulatum en el área estudiada. Received: 29-04-2008. Accepted: 16-10-2008. INTRODUCTION high organic content for H. capsulatum) that determine the distribution of these Paracoccidioidomycosis (PCM) and fungi in nature (1, 6-10). histoplasmosis (H) are systemic mycosis PCM is a chronic progressive infection produced by geophilic dimorphic fungi with a geographic distribution limited to Paracoccidioides brasiliensis and Histoplas- the Americas, specifically the Latin Ameri- ma capsulatum, respectively (1-3). These can countries. It is characterized by a pri- mycosis are endemic diseases in the south mary lung infection, frequently unapparent, of Venezuela and are considered as a public which can disseminate, principally present- health problem (4, 5). They are probably re- ing lesions on the mucosae of the upper air- lated to environmental conditions like hu- ways and upper digestive tract and occa- midity, temperature and soil characteristics sionally the gastrointestinal tract. The (10-28°C, pluviometry 500-2500 mm/year, lymph nodes are frequently involved and oc- acid soils with rivers around for P. bra- casionally the disease extends to other or- siliensis and 22-29°C, pluviometry 1200 gans, especially the skin tissue and adrenal mm/year, humidity 67-87 % and soils with glands (11). Investigación Clínica 50(2): 2009 Paracoccidioidomycosis and histoplasmosis in suburb region of Venezuela 215 Histoplasmosis is almost always ac- PATIENTS AND METHODS quired by inhalation of the mycelial frag- ments and microconidia of the organism Geographic characteristics from an environmental source, most com- This study was performed in the com- monly disturbed earth or bird or bat drop- munity “25 de Marzo”, a suburban area pings. The organism is found worldwide and with 46309 inhabitants (19). It is localized it is endemic in parts of the United States, in Caroni county, San Felix city, situated in South America, Southeast Asia, Africa, and the north-east region of Bolívar state in Australia. Usually H presents as a dissemi- south-east of Venezuela. It has a mean an- nated infection with fever and weight loss. nual precipitation of 1000 mm3 and a rela- Respiratory complaints, local or generalized tive humidity of 70% (20). lymphadenopathy, hepatosplenomegaly, co- lonic lesions, and skin and oral ulcers may Samples also be present. Diagnosis is usually made A group of 300 persons voluntarily by culturing the fungus from blood or other agreed to participate in this study. Preg- clinical specimens, or by histopathologic nant women, children under 6 months old, examination of bone marrow aspirate or bi- adults older than 65 years old and people opsy material (9, 12). with a history of systemic mycosis were ex- Intradermic tests like paracoccidioid- cluded. Identification and epidemiologic ine and histoplasmine are often used in data was registered. epidemiologic studies in order to detect PCM and H respectively (6, 13, 14), particu- Clinical and laboratory evaluation larly in cases of asymptomatic infections. In of symptomatic patients these tests, fungus antigens are intrader- All patients with respiratory symptoms mically injected to induce a reaction that is were clinically evaluated and a radiological read 24 and 48 hours later and a positive study of the thorax was made. Sputum sam- reaction is an indurated area of 5 mm or ples were collected in patients with a proba- more. A positive reaction suggests the pres- ble diagnosis of PCM and/or H. All secre- ence of fungus infection (13, 15-17). tions were evaluated with Ziehl Neelsen Epidemiologic studies of deep mycosis stain, KOH 20% and argentic methenamine have been scarce in Bolívar state, even stain. All samples were cultured, by dupli- though PCM and H are considered as en- cate, in glucose agar Sabouraud and demic diseases (5, 18) and, therefore, it is heart-brain agar; they were incubated at necessary a better knowledge of the clinical 37°C during 8 weeks. In addition, antibod- and epidemiologic aspects of these dis- ies against H. capsulatum and P. brasilien- eases. sis in serum samples were determined. Most of cases of PCM and H in children All samples were processed in the Par- that have been diagnosed in “Raúl Leoni” asitology and Microbiology Department, Hospital in San Félix, Bolivar state, came Universidad de Oriente, Núcleo Bolívar. from the “25 de Marzo” community, for that reason this place was chosen to realize Serological study this epidemiologic study in order to deter- Before cutaneous tests were per- mine prevalence of P. brasiliensis and H. formed, blood samples were taken for serol- capsulatum infections in people