Emergence of acute/subacute infant-juvenile paracoccidioidomycosis in Northeast Argentina : effect of climatic and anthropogenic changes?

Abstract

Argentina has two endemic areas of paracoccidioidomycosis (PCM). Bordering Paraguay and Brazil, Northeast Argentina (NEA) comprises the area with the highest incidence

where the chronic adult clinical form has historically been reported. Juvenile form in chil- dren and adolescents is rare in this area since only one case was reported in the last 10

years. Despite this, between 2010 and 2012, several cases of acute/subacute clinical forms in children aged 10 to 16 (median 12) were detected. In the last decade, the NEA region has

been exposed to ecological variations as consequences of certain climatic and anthro- pogenic changes, including El Nino–Southern Oscillation phenomenon during 2009, and ̃

deforestation. The region has also suffered from the significant ecological effects of the construction of one of the biggest hydroelectric dams of South America. This study aims to describe clinical and epidemiological aspects of acute/subacute PCM cases detected in

children from NEA and to discuss climatic and anthropogenic changes as possible con- tributing factors in the emergence of this disease in children. This acute/subacute PCM

cluster was characterized by severe disseminated and aggressive presentations to local- ized form, with a high spectrum of clinical manifestations uncommonly observed. Due

to the lack of experience in acute/subacute PCM in children in the studied area and the atypical clinical manifestations observed, the diagnosis was delayed. In order to avoid misdiagnosis, a higher level of suspicion is now required in NEA and countries bordering the southern part of the endemic area, which are affected by the changes discussed in this article.