Paracoccidioidomycosis due to P lutzii: The importance of neutrophil/lymphocyte ratio in the symptomatic and asymptomatic phases in severe cases

• Published in: Mycoses 2021-08, Vol.64 (8), p.874-881
• Main Authors: Nery, Andreia Ferreira, de Camargo, Zoilo Pires, Rodrigues, Anderson Messias, Portela, Tiago Ferreira, Hoffmann‐Santos, Hugo Dias, Dambros, Pedro Vitor Krüger, de Souza, Jânio Felipe Ribeiro, Garcia, Alexandre Carvalho, Santos, Carolina Araújo Damasio, Hagen, Ferry, Hahn, Rosane Christine
• Format: Article
• Language: English
• Subjects: biomarker; Biomarkers; Complications; Diagnosis; Erythrocyte sedimentation rate; Laboratories; Leukocytes (neutrophilic); Lymphocytes; Mycosis; neutrophil ‐lymphocyte ratio; Neutrophils; P lutzii; Paracoccidioidomycosis; Patients; PCM severity criteria; receiver operating characteristic curve; South American blastomycosis; Statistical analysis
• ISSN: 0933-7407; 1439-0507
• DOI: 10.1111/myc.13282

Background PCM is a neglected systemic mycosis endemic in Brazil. The middle‐west region of Brazil has shown the highest number of PCM by Paracoccidioides lutzii (P lutzii) cases. Differentiating cases of severe PCM from non‐severe ones should be a concern at the bedside. Diagnosis of severe PCM by P lutzii is based on the subjectivity of clinical manifestations, which can result in a delay in starting its treatment and, consequently evolution to severe sequelae. There is not laboratory biomarker available to support the early diagnosis of severe PCM that is feasible for all the realities that coexist in Brazil. Objectives The aim of this study was to investigate the usefulness of laboratory biomarkers as erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the diagnosis of severe PCM. Patients/Methods ESR, CRP and NLR were analysed for 44 patients with PCM by P lutzii and a Receiver Operation Characteristic (ROC) curve were generated to identify the NLR cut‐off point and point out the presence of severe PCM. Results Sixteen (36.4%) had severe PCM and 28 (63.6%) had non‐severe PCM. The mean NLR was higher and statistically significant among patients with severe PCM than among those with non‐severe PCM. The area under the ROC curve was 0.859 for the diagnosis of severe PCM. The cut‐off point for NLR for the diagnosis of severe PCM was 3.318 (sensitivity of 100%, specificity of 77%). Conclusions According to results, it is plausible to conclude that NLR represents a potential biomarker for the diagnosis of severe PCM.