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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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Autores principales: de Brito, Tereza Graciano Nascimento, Taborda, Mariane, Provenci, Bruna, Costa, André Nathan, Benard, Gil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8398402/
https://www.ncbi.nlm.nih.gov/pubmed/34436194
http://dx.doi.org/10.3390/jof7080655
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author de Brito, Tereza Graciano Nascimento
Taborda, Mariane
Provenci, Bruna
Costa, André Nathan
Benard, Gil
author_facet de Brito, Tereza Graciano Nascimento
Taborda, Mariane
Provenci, Bruna
Costa, André Nathan
Benard, Gil
author_sort de Brito, Tereza Graciano Nascimento
collection PubMed
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.
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spelling pubmed-83984022021-08-29 A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited de Brito, Tereza Graciano Nascimento Taborda, Mariane Provenci, Bruna Costa, André Nathan Benard, Gil J Fungi (Basel) Article 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. MDPI 2021-08-13 /pmc/articles/PMC8398402/ /pubmed/34436194 http://dx.doi.org/10.3390/jof7080655 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
de Brito, Tereza Graciano Nascimento
Taborda, Mariane
Provenci, Bruna
Costa, André Nathan
Benard, Gil
A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited
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 Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8398402/
https://www.ncbi.nlm.nih.gov/pubmed/34436194
http://dx.doi.org/10.3390/jof7080655
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