1. Epidemiological, clinical, and genomic landscape of coccidioidomycosis in northeastern Brazil.
- Author
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Eulálio, Kelsen, Kollath, Daniel, Martins, Liline, Filho, Antonio, Cavalcanti, Maria, Moreira, Lucas, Tenório, Bernardo, Alves, Lucas, Yamauchi, Danielle, Barrozo, Ligia, Thompson Iii, George, Nacher, Mathieu, Benard, Gil, Bagagli, Eduardo, Felipe, Maria, Barker, Bridget, Trilles, Luciana, Teixeira, Marcus, and Stajich, Jason
- Subjects
Humans ,Female ,Male ,Animals ,Brazil ,Coccidioidomycosis ,Armadillos ,Genomics ,Genotype - Abstract
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.
- Published
- 2024