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PARACOCCIDIOIDOMYCOSIS: AN EPIDEMIOLOGIC SURVEY IN A PEDIATRIC POPULATION FROM THE BRAZILIAN AMAZON USING SKIN TESTS

Since Paracoccidioides brasiliensis and Histoplasma capsulatum are known to be present in similar environments, there have been many epidemiologic investigations regarding the prevalences of these two organisms. However, cross-reactivity can occur in paracoccidioidin and histoplasmin skin tests, and this usually results in the overestimation of the prevalence of P. brasiliensis.The prevalence of infection with P. brasiliensis was evaluated in a cross-sectional study of 298 asymptomatic school children in the Brazilian Amazon region (Mato Grosso State). In this investigation, the reactivity of children to two different P. brasiliensis antigen preparations, paracoccidioidin and a purified 43-kD glycoprotein (gp43), was compared with or without the co-administration of histoplasmin. In the group of individuals receiving paracoccidioidin who had a positive histoplasmin skin test result, the prevalence of exposure to P. brasiliensis was 44% (16 of 36). This reactivity to P. brasiliensis was significantly higher than that observed in other groups, which ranged from 4% to 6% (P < 5 x 10^–4 for each). Overall prevalence was 4.6% (95% confidence interval = 2.5–7.7%). These data suggest that gp43 provides a better estimate of exposure to P. brasiliensis when the co-administration of histoplasmin is desired.

Received October 3, 2002. Accepted for publication October 17, 2003.

Acknowledgments: We thank the Health Department of the Municipality of Peixoto de Azevedo (Mato Grosso, Brazil) for their assistance, Dr. Rui Rafael Durlacher for field support, Dr. Crispim Cerutti, Jr. for helpful suggestions, and Dr. Gil Benard for critically reviewing the manuscript. This work was presented in part at the Eighth International Congress of Infectious Diseases, Boston, MA, May 15–18, 1998.

Financial support: This work was supported by the Centro de Estudos Walter Leser, Fundação Faculdade de Medicina.

Authors’ addresses: E. M. N. Kalmar and F. E. C. Alencar, Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. F. P. Alves, Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de Sao Paulo, Sao, Paulo, Brazil. L. W. Pang, United States Army Medical Research Unit-Brazil, Rio de Janeiro, Brazil. G. M. B. Del Negro Laboratório de Micologia Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas Carvalho Aguiar, 500 Térreo, Sala 4, CEP 05403-000, Sao Paulo, SP, Brazil. Z. P. Camargo, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. M. A. Shikanai-Yasuda, Laboratório de Imunologia Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.

Reprint requests: M. A. Shikanai-Yasuda, Laboratório de Imunologia Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas Carvalho Aguiar, 500 Térreo, Sala 4, CEP 05403-000, Sao Paulo, SP, Brazil, Telephone: 55-11-3069-6530, Fax: 55-11-3085-1755, E-mail: dmip.secr{at}hcnet.usp.br.