Paracoccidioidomycosis and pregnancy: A 40-year single-center cohort study in the endemic area of Rio de Janeiro, Brazil

• Published in: PLoS neglected tropical diseases Vol. 17; no. 9; p. e0011645
• Main Authors: Benko, Lorena Macedo Pestana, Vieira da Silva, Mariana Evangelista de Souza, Falcão, Eduardo Mastrangelo Marinho, Freitas, Dayvison Francis Saraiva, Calvet, Guilherme Amaral, Almeida, Marcos de Abreu, Almeida-Paes, Rodrigo, Zancopé-Oliveira, Rosely Maria, do Valle, Antonio Carlos Francesconi, de Macedo, Priscila Marques
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 14.09.2023; Public Library of Science (PLoS)
• Subjects: Abortion; Analysis; Animal models; Biology and Life Sciences; Birth weight; Body organs; Care and treatment; Case reports; Childbirth; Childbirth & labor; Cohort analysis; Contraceptives; Development and progression; Disease management; Drugs; Epidemiology; Fetuses; Fungal infections; Health aspects; Health risks; Infection; Infectious diseases; Itraconazole; Low birth weight; Medical records; Medical research; Medicine and Health Sciences; Medicine, Experimental; Oral administration; Oral contraceptives; Oral medication; Patients; People and places; Pre-eclampsia; Pregnancy; Pregnancy complications; Premature birth; Public health; South American blastomycosis; Teratogenicity; Toxicity tests; Urban areas; Womens health; Brazil; Rio de Janeiro Brazil
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0011645

The occurrence of acute paracoccidioidomycosis (PCM) in urban areas of the Rio de Janeiro state, Brazil, has emerged in recent years. Therefore, young populations, including pregnant women, are at a higher risk of infection. Furthermore, young women undergoing itraconazole treatment for PCM have increased chances to get pregnant because this medication may reduce the effectiveness of contraceptives. Acute PCM is invasive, reaching abdominal organs, posing a maternal-fetal risk. PCM treatment in pregnant women is also challenging due to the teratogenicity associated with the currently available oral drugs. There are scarce studies on PCM and pregnancy, mainly consisting of case reports and experimental murine models that highlight the severity of this association. We conducted a database research at a PCM reference center in Rio de Janeiro state from 1980 to 2020. We included patients diagnosed with PCM who were pregnant shortly before, at admission, or at any moment of their PCM follow-up care. Data related to pregnancy, childbirth, and the newborn were obtained from the Brazilian official public databases. We also reviewed the epidemiological and clinical features of these patients. During the study period, we identified 18 pregnant patients, with a median age of 26 years (range: 16–38). Among these cases, six (33.3%) were detected in the last 5 years, and 14 (77.8%) presented acute PCM, supporting the recent shift in the epidemiological profile towards acute PCM. Most pregnancies occurred during PCM treatment (n = 11, 61.1%), which led to challenges in the therapeutic management. Maternal-fetal complications occurred in some of these cases, including vaginal bleeding (n = 1), preeclampsia (n = 1), prematurity (n = 2), low birth weight (n = 4), and fetal deaths (n = 2). PCM during pregnancy presents a significant public health concern in the context of the emergence of acute PCM in urban areas.