COVID-19 in patients with paracoccidioidomycosis

Author summaryParacoccidioidomycosis (PCM) is a severe invasive mycosis, affecting the lungs and other important organs of patients in Latin America, notably Brazil. Paracoccidioides is the causative agent of PCM and it was recently included in the World Health Organization (WHO) fungal priority pathogens list to guide research, development and public health action. Since the beginning of COVID-19 pandemic, only one case of concomitant PCM and COVID-19 has been reported. Our work aims to investigate the occurrence of COVID-19 in patients with PCM followed at a reference center for infectious diseases in a Brazilian endemic region for PCM. Between March 2020 and September 2022, we identified six individuals with COVID-19 among the 117 patients with PCM evaluated. Although we found a high range of disease severity in the cases analyzed, concomitant disease also represented a severe association. As COVID-19 and PCM may share similar clinical aspects and PCM is neglected, it is probable that COVID-19 has been hampering simultaneous PCM diagnosis, which can explain the absence of new co-infection reports. Our findings call for more attention by health professionals to identify co-infections with Paracoccidioides. IntroductionIn 2020, we reported the first patient with concomitant COVID-19 and paracoccidioidomycosis (PCM). Since then, no other cases have been recorded in the literature. We aim to update information on the occurrence of COVID-19 in patients with PCM followed at a reference center for infectious diseases at Rio de Janeiro, Brazil. MethodsWe reviewed the medical records from patients diagnosed with PCM who presented with clinical symptoms, radiological findings, and/or laboratory diagnosis of COVID-19 at any time during their acute or follow-up care. The clinical profiles of these patients were described. ResultsBetween March 2020 and September 2022, we identified six individuals with COVID-19 among the 117 patients with PCM evaluated. The median age was 38 years and the male to female ratio 2:1. Most patients (n = 5) presented for evaluation due to acute PCM. The severity of COVID-19 ranged from mild to severe in acute PCM and only the single patient with chronic PCM died. ConclusionsThere is a range of disease severity in COVID-19 and PCM co-infection and concomitant disease may represent a severe association, especially in the chronic type of the mycosis with pulmonary involvement. As COVID-19 and chronic PCM share similar clinical aspects and PCM is neglected, it is probable that COVID-19 has been hampering simultaneous PCM diagnosis, which can explain the absence of new co-infection reports. With the continued persistence of COVID-19 globally, these findings further suggest that more attention by providers is necessary to identify co-infections with Paracoccidioides.