Avaliação dos exames micológicos no diagnóstico de pacientes com paracoccidioidomicose
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Data
2020-02-28
Autores
Fiorini, Mateus Henrique Bosqueto
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução. A paracoccidioidomicose (PCM) é micose endêmica na América Latina causada por fungos do gênero Paracoccidioides. O exame micológico do escarro é um método rápido, barato e de simples execução que permite diagnosticar a doença. Poucos estudos têm avaliado a sensibilidade deste método diagnóstico bem como a quantificação do fungo no escarro e sua relação com a gravidade do paciente. Este estudo teve por objetivo avaliar estes parâmetros no escarro de pacientes com PCM no momento do diagnóstico. Métodos. Foi realizado um estudo transversal em 24 pacientes com a forma crônica da PCM atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP entre janeiro de 2018 a julho de 2019. Eles coletaram uma ou mais amostras de escarro no momento do diagnóstico para a realização de exame micológico direto (MD) e homogeneizado (MH), exame citopatológico (CP) e cultura. Nas amostras positivas para MH foi realizada a quantificação do fungo. Para comparação de sensibilidade dos métodos foi utilizado o teste Q de Cochran. Foi utilizado teste de Qui- quadrado ou Exato de Fisher para variáveis categóricas e teste de Mann-Whitney para as contínuas independentes e correlação pelo teste de Spearman. Análise de correspondência múltipla foi utilizada para avaliação multivariada. Foi considerado significativo valores de p menores que 0,05. Resultados. A sensibilidade geral do MH foi superior ao do MD (78,1 vs 34,1%; p<0,01). Na comparação geral entre os métodos, o MH (80,0%) teve sensibilidade maior que MD (40,0%) e CP (46,7) e não diferiu da Imunodifusão dupla – IDD (53,3%) [p<0,01]. MD, CP e IDD não diferiram entre si. Houve associação entre a positividade do MD e IDD, presença de lesões cutâneas e padrão misto de lesões na radiografia de tórax. A positividade do MH se associou com valores elevados da velocidade de hemossedimentação e padrão alveolar de lesões na radiografia de tórax. Maior carga fúngica no escarro se associou com idade acima de 65 anos, hemoptise e presença de nódulos maiores que 0,6 cm e cavidades no raio-x de tórax. Conclusões. Este estudo demonstra a vantagem de se realizar o exame MH de escarro como método padrão para diagnóstico de PCM, em especial na primeira amostra coletada.
Introduction. Paracoccidioidomycosis (PCM) is endemic mycosis in Latin America caused by fungi of the genus Paracoccidioides. Sputum mycological examination is fast, inexpensive and simple method that allows the diagnosis of the disease. Few studies have evaluated the sensitivity of this method as well as the fungal quantification of the sputum and its relationship with the severity of the patient. This study aimed to evaluate these parameters in the sputum of PCM patients at the time of diagnosis. Methods. A cross- sectional study was carried out on 24 patients with the chronic form of PCM treated at the University Hospital – Botucatu Medical School – UNESP between January 2018 to July 2019. They collected one or more sputum samples at the time of diagnosis for the performing direct (DM) and homogenized (HM) mycological exam, cytopathological (CP) exam and culture. In samples positive for HM, the fungus was quantified. To compare the sensitivity of the methods, the Cochran's Q test was used. Chi-square test or Fisher's Exact test was used for categorical variables and Mann-Whitney test for continuous and correlation by Spearman test. Multiple correspondence analysis was used for multivariate evaluation. P values less than 0.05 were considered significant. Results. The sensitivity of HM was higher than that of DM (78.1 vs 34.1%; p<0.01). In the comparison among the methods, HM (80.0%) had a higher sensitivity than DM (40.0%) and CP (46.7) and did not differ from Double Immunodiffusion - DID (53.3%) [p<0.01]. MD, CP and DID did not differ. There was an association between DM and DID positivity, presence of skin lesions and a mixed pattern of lesions on chest radiography. HM positivity was associated with high values of erythrocyte sedimentation rate and alveolar pattern of lesions on chest radiography. Higher fungal load in sputum was associated with age over 65 years, hemoptysis and the presence of nodules larger than 0.6 cm and cavities in the chest x-ray. Conclusions. This study demonstrates the advantage of performing the sputum MH exam as a standard method for diagnosing PCM, especially in the first sample collected.
Introduction. Paracoccidioidomycosis (PCM) is endemic mycosis in Latin America caused by fungi of the genus Paracoccidioides. Sputum mycological examination is fast, inexpensive and simple method that allows the diagnosis of the disease. Few studies have evaluated the sensitivity of this method as well as the fungal quantification of the sputum and its relationship with the severity of the patient. This study aimed to evaluate these parameters in the sputum of PCM patients at the time of diagnosis. Methods. A cross- sectional study was carried out on 24 patients with the chronic form of PCM treated at the University Hospital – Botucatu Medical School – UNESP between January 2018 to July 2019. They collected one or more sputum samples at the time of diagnosis for the performing direct (DM) and homogenized (HM) mycological exam, cytopathological (CP) exam and culture. In samples positive for HM, the fungus was quantified. To compare the sensitivity of the methods, the Cochran's Q test was used. Chi-square test or Fisher's Exact test was used for categorical variables and Mann-Whitney test for continuous and correlation by Spearman test. Multiple correspondence analysis was used for multivariate evaluation. P values less than 0.05 were considered significant. Results. The sensitivity of HM was higher than that of DM (78.1 vs 34.1%; p<0.01). In the comparison among the methods, HM (80.0%) had a higher sensitivity than DM (40.0%) and CP (46.7) and did not differ from Double Immunodiffusion - DID (53.3%) [p<0.01]. MD, CP and DID did not differ. There was an association between DM and DID positivity, presence of skin lesions and a mixed pattern of lesions on chest radiography. HM positivity was associated with high values of erythrocyte sedimentation rate and alveolar pattern of lesions on chest radiography. Higher fungal load in sputum was associated with age over 65 years, hemoptysis and the presence of nodules larger than 0.6 cm and cavities in the chest x-ray. Conclusions. This study demonstrates the advantage of performing the sputum MH exam as a standard method for diagnosing PCM, especially in the first sample collected.
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Carga fúngica, Diagnóstico, Micológico direto, Micológico homogeneizado, Paracoccidioidomicose, Paracoccidioidomycosis, Direct mycological, Homogenized mycological, Cytopathological, Diagnosis