Epidemiological, clinical, and genomic landscape of coccidioidomycosis in northeastern Brazil

Kelsen Dantas Eulálio, Daniel R. Kollath, Liline Maria Soares Martins, Antonio de Deus Filho, Maria do Amparo Salmito Cavalcanti, Lucas Machado Moreira, Bernardo Guerra Tenório, Lucas Gomes de Brito Alves, Danielle Yamauchi, Ligia Vizeu Barrozo, George R. Thompson, Mathieu Nacher, Jason E. Stajich, Gil Benard, Eduardo Bagagli, Maria Sueli Soares Felipe, Bridget M. Barker, Luciana Trilles and Marcus de Melo Teixeira ()
Additional contact information
Kelsen Dantas Eulálio: Federal University of Piauí-UFPI
Daniel R. Kollath: Northern Arizona University
Liline Maria Soares Martins: Federal University of Piauí-UFPI
Antonio de Deus Filho: Federal University of Piauí-UFPI
Maria do Amparo Salmito Cavalcanti: Federal University of Piauí-UFPI
Lucas Machado Moreira: Fiocruz - RJ
Bernardo Guerra Tenório: University of Brasília
Lucas Gomes de Brito Alves: University of Brasília
Danielle Yamauchi: Universidade Estadual Paulista/UNESP
Ligia Vizeu Barrozo: University of São Paulo
George R. Thompson: Division of Infectious Diseases and Department of Medical Microbiology and Immunology, UC-Davis
Mathieu Nacher: Centre hospitalier de Cayenne – French Guiana
Jason E. Stajich: Department of Microbiology and Plant Pathology University of California-Riverside
Gil Benard: University of São Paulo
Eduardo Bagagli: Universidade Estadual Paulista/UNESP
Maria Sueli Soares Felipe: Universidade Católica de Brasília
Bridget M. Barker: Northern Arizona University
Luciana Trilles: Fiocruz - RJ
Marcus de Melo Teixeira: Northern Arizona University

Nature Communications, 2024, vol. 15, issue 1, 1-11

Abstract: Abstract Coccidioidomycosis, listed as a priority mycosis by the WHO, is endemic in the United States but often overlooked in Central and South America. Employing a multi-institutional approach, we investigate how disease characteristics, pathogen genetic variation, and environmental factors impact coccidioidomycosis epidemiology and outcomes in South America. We identified 292 cases (1978–2021) and 42 outbreaks in Piauí and Maranhão states, Brazil, the largest series outside the US/Mexico epidemic zone. The male-to-female ratio was 57.4:1 and the most common activity was armadillo hunting (91.1%) 4 to 30 days before symptom onset. Most patients (92.8%) exhibited typical acute pulmonary disease, with cough (93%), fever (90%), and chest pain (77%) as predominant symptoms. The case fatality rate was 8%. Our negative binomial regression model indicates that reduced precipitation levels in the current (p = 0.015) and preceding year (p = 0.001) predict heightened incidence. Unlike other hotspots, acidic soil characterizes this region. Brazilian strains differ genomically from other C. posadasii lineages. Northeastern Brazil presents a distinctive coccidioidomycosis profile, with armadillo hunters facing elevated risks. Low annual rainfall emerges as a key factor in increasing cases. A unique C. posadasii lineage in Brazil suggests potential differences in environmental, virulence, and/or pathogenesis traits compared to other Coccidioides genotypes.

Date: 2024
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DOI: 10.1038/s41467-024-47388-0

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