Paracoccidioidomycosis and pregnancy: A 40-year single-center cohort study in the endemic area of Rio de Janeiro, Brazil

The occurrence of acute paracoccidioidomycosis (PCM) in urban areas of the Rio de Janeiro state, Brazil, has emerged in recent years. Therefore, young populations, including pregnant women, are at a higher risk of infection. Furthermore, young women undergoing itraconazole treatment for PCM have increased chances to get pregnant because this medication may reduce the effectiveness of contraceptives. Acute PCM is invasive, reaching abdominal organs, posing a maternal-fetal risk. PCM treatment in pregnant women is also challenging due to the teratogenicity associated with the currently available oral drugs. There are scarce studies on PCM and pregnancy, mainly consisting of case reports and experimental murine models that highlight the severity of this association. We conducted a database research at a PCM reference center in Rio de Janeiro state from 1980 to 2020. We included patients diagnosed with PCM who were pregnant shortly before, at admission, or at any moment of their PCM follow-up care. Data related to pregnancy, childbirth, and the newborn were obtained from the Brazilian official public databases. We also reviewed the epidemiological and clinical features of these patients. During the study period, we identified 18 pregnant patients, with a median age of 26 years (range: 16-38). Among these cases, six (33.3%) were detected in the last 5 years, and 14 (77.8%) presented acute PCM, supporting the recent shift in the epidemiological profile towards acute PCM. Most pregnancies occurred during PCM treatment (n = 11, 61.1%), which led to challenges in the therapeutic management. Maternal-fetal complications occurred in some of these cases, including vaginal bleeding (n = 1), preeclampsia (n = 1), prematurity (n = 2), low birth weight (n = 4), and fetal deaths (n = 2). PCM during pregnancy presents a significant public health concern in the context of the emergence of acute PCM in urban areas. Paracoccidioidomycosis (PCM) is a fungal infection that is common in Brazil and other parts of Latin America. There are two clinical forms: the chronic, which affects rural workers and the acute, which is usually more severe and tends to affect young people. The Rio de Janeiro state, Brazil, is endemic for PCM, and juvenile cases have increased in the recent years. This is concerning for pregnant women since they could also be affected. In addition, young women could get pregnant during the PCM treatment because itraconazole, the main medication to treat PCM, may reduce the effectiveness of contraceptives. This could represent a risk to both mother and fetus because acute PCM is more invasive, reaching abdominal organs. PCM treatment in pregnant women is a challenge because the available oral drugs to treat this mycosis can be harmful to the fetus. There is little information about this important issue in the literature. Therefore, we investigated cases of PCM in pregnancy performing a search in the databases of a PCM specialized center in Rio de Janeiro state. We found 18 pregnant patients in the period of 1980-2020, most of them presenting acute PCM (n = 14, 77.8%) with a moderate to severe clinical profile. Most pregnancies occurred during PCM treatment (n = 11, 61.1%), which created difficulties in the management of both conditions. Some of these cases experienced complications, including prematurity, low birth weight, and two fetal deaths. PCM in pregnancy is an important public health issue and the authors hope to contribute with the knowledge of this subject, to improve care for this vulnerable population.