A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited
Clinical observations have long suggested that women are protected against paracoccidioidomycosis. 17β-estradiol, the main female estrogen, inhibits conidia-to-yeast transformation (C-to-Y), which is required for the infection establishment. However, experiments in murine models have yielded conflic...
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| Format: | Article |
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MDPI AG
2021-08-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/7/8/655 |
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| author | Tereza Graciano Nascimento de Brito Mariane Taborda Bruna Provenci André Nathan Costa Gil Benard |
| author_facet | Tereza Graciano Nascimento de Brito Mariane Taborda Bruna Provenci André Nathan Costa Gil Benard |
| author_sort | Tereza Graciano Nascimento de Brito |
| collection | DOAJ |
| description | Clinical observations have long suggested that women are protected against paracoccidioidomycosis. 17β-estradiol, the main female estrogen, inhibits conidia-to-yeast transformation (C-to-Y), which is required for the infection establishment. However, experiments in murine models have yielded conflicting results, suggesting that C-to-Y inhibition, alone, fails to explain the female-associated protection and that sexual hormones may also act by modulating the host’s immune responses. Therefore, this issue remains unsolved. Strikingly, no studies have compared the severity of paracoccidioidomycosis between men and women. This retrospective case-control study compared 36 women with 72 age-matched men for clinical–demographic, laboratory, and chest imaging findings. Overall, paracoccidioidomycosis in women presented the main features described in the acute/subacute and chronic forms seen in men. Women also showed similar demographic features and clinical–laboratory and imaging severity scores as men. We additionally reviewed 58 paracoccidioidin skin test surveys undertaken by volunteers from endemic areas. Data accumulated from 10.873 tests showed that females and males are infected with similar magnitudes (21.9% vs. 25.2%) and that reactivity steadily increased with age, peaking after the age of 60. We discuss the paradox of similar infection rates but much lower disease prevalence in women, considering the current pathogenetic views of paracoccidioidomycosis, and we raise alternative hypotheses to account for this paradox. |
| first_indexed | 2024-03-10T08:41:13Z |
| format | Article |
| id | doaj.art-a7205c7857f14e81806a581ec98ef37e |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-10T08:41:13Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-a7205c7857f14e81806a581ec98ef37e2023-11-22T08:17:24ZengMDPI AGJournal of Fungi2309-608X2021-08-017865510.3390/jof7080655A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection RevisitedTereza Graciano Nascimento de Brito0Mariane Taborda1Bruna Provenci2André Nathan Costa3Gil Benard4Laboratorio de Investigacao em Imunologia e Dermatologia (LIM56), Departamento de Dermatologia and Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 470, São Paulo 05403-000, BrazilDivisao de Doenças Infecciosas, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 255, São Paulo 05403-000, BrazilDivisao de Pneumologia, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 44, São Paulo 05403-900, BrazilDivisao de Pneumologia, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 44, São Paulo 05403-900, BrazilLaboratorio de Investigacao em Imunologia e Dermatologia (LIM56), Departamento de Dermatologia and Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. Enéas de Carvalho Aguiar 470, São Paulo 05403-000, BrazilClinical observations have long suggested that women are protected against paracoccidioidomycosis. 17β-estradiol, the main female estrogen, inhibits conidia-to-yeast transformation (C-to-Y), which is required for the infection establishment. However, experiments in murine models have yielded conflicting results, suggesting that C-to-Y inhibition, alone, fails to explain the female-associated protection and that sexual hormones may also act by modulating the host’s immune responses. Therefore, this issue remains unsolved. Strikingly, no studies have compared the severity of paracoccidioidomycosis between men and women. This retrospective case-control study compared 36 women with 72 age-matched men for clinical–demographic, laboratory, and chest imaging findings. Overall, paracoccidioidomycosis in women presented the main features described in the acute/subacute and chronic forms seen in men. Women also showed similar demographic features and clinical–laboratory and imaging severity scores as men. We additionally reviewed 58 paracoccidioidin skin test surveys undertaken by volunteers from endemic areas. Data accumulated from 10.873 tests showed that females and males are infected with similar magnitudes (21.9% vs. 25.2%) and that reactivity steadily increased with age, peaking after the age of 60. We discuss the paradox of similar infection rates but much lower disease prevalence in women, considering the current pathogenetic views of paracoccidioidomycosis, and we raise alternative hypotheses to account for this paradox.https://www.mdpi.com/2309-608X/7/8/655paracoccidioidomycosisestrogensfemalesusceptibilityskin test |
| spellingShingle | Tereza Graciano Nascimento de Brito Mariane Taborda Bruna Provenci André Nathan Costa Gil Benard A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited Journal of Fungi paracoccidioidomycosis estrogens female susceptibility skin test |
| title | A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited |
| title_full | A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited |
| title_fullStr | A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited |
| title_full_unstemmed | A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited |
| title_short | A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited |
| title_sort | case control study of paracoccidioidomycosis in women the hormonal protection revisited |
| topic | paracoccidioidomycosis estrogens female susceptibility skin test |
| url | https://www.mdpi.com/2309-608X/7/8/655 |
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