Epidemiology of Endemic Mycosis in Children

  • Alexandro BonifazEmail author
  • Yessica Estrada-Caraveo
  • Andrés Tirado-Sánchez
Pediatric Fungal Infections (D Corzo-Leon, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Fungal Infections


Purpose of the Review

This review is aimed to overview clinical and epidemiological aspects, as well as the diagnosis and management of four endemic mycosis in children.

Recent Findings

The studies available in the specialized literature concerning endemic mycosis in children are scarce and have great variation due to the characteristic heterogeneity of diseases.


The clinical image of these diseases shows clear differences as well as their expression in immunocompromised patients. An understanding of the geographic range, typical manifestations, diagnostic methods, and treatment of the endemic mycoses is key in assessing patients presenting with atypical infections who may have traveled to endemic areas.


Endemic mycosis Children Sporotrichosis Histoplasmosis Coccidiodomycosis Paracoccidiodomycosis 


Compliance with Ethical Standards

Conflict of Interest

Alexandro Bonifaz, Yessica Estrada-Caraveo and Andres Tirado-Sanchez declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Yeoh DK, Butters C, Curtis N. Endemic Mycoses in Children. Pediatr Infect Dis J. 2019;38:S52–9. Extensive review of systemic endemic mycosis worldwide, focusing on diagnosis and treatment. Scholar
  2. 2.
    Queiroz-Telles F, Fahal AH, Falci DR, Caceres DH, Chiller T, Pasqualotto AC. Neglected endemic mycoses. Lancet Infect Dis. 2017;17:e367–77. Scholar
  3. 3.
    •• Bonifaz A, Vázquez-González D, Perusquía-Ortiz AM. Endemic systemic mycoses: coccidioidomycosis, histoplasmosis, paracoccidioidomycosis and blastomycosis. J Dtsch Dermatol Ges. 2011;9:705–14. Extensive review of endemic mycosis, focusing in diagnosis. Scholar
  4. 4.
    Corzo-León DE, Armstrong-James D, Denning DW. Burden of serious fungal infections in Mexico. Mycoses. 2015;58(Suppl 5):34–44. Scholar
  5. 5.
    • Sifuentes-Osornio J, Corzo-León DE. Ponce-de-León LA. Epidemiology of invasive fungal infections in Latin America. Curr Fungal Infect Rep. 2012;6(1):23–34. The study provides an approach to the worldwide epidemiology of invasive fungal diseases. Scholar
  6. 6.
    Canteros CE. Paracoccidioidomycosis: chronicle of a neglected disease. Medicina (B Aires). 2018;78:180–4 PMID: 29940544.Google Scholar
  7. 7.
    de Macedo PM, Almeida-Paes R, Freitas DF, Varon AG, Paixão AG, Romão AR, et al. Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro. Brazil PLoS Negl Trop Dis. 2017;11:e0005500. Scholar
  8. 8.
    de Arruda JAA, Schuch LF, Abreu LG, Silva LVO, Mosconi C, Monteiro JLGC, et al. A multicentre study of oral paracoccidioidomycosis: Analysis of 320 cases and literature review. Oral Dis. 2018;24:1492–502. Scholar
  9. 9.
    Brummer E, Castaneda E, Restrepo A. Paracoccidiodomycosis: An update. Clin Microbiol Rev. 1993;6:89–117.4. Scholar
  10. 10.
    Giusiano G, Aguirre C, Vratnica C, Rojas F, Corallo T, Cattana ME, et al. Emergence of acute/subacute infant-juvenile paracoccidioidomycosis in Northeast Argentina: Effect of climatic and anthropogenic changes? Med Mycol. 2019;57:30–7. Scholar
  11. 11.
    Taicz M, Rosanova MT, Bes D, Lisdero ML, Iglesias V, Santos P, et al. Paracoccidioidomicosis en pediatría: descripción de 4 casos. Rev Iberoam Micol. 2014;31:141–4. Scholar
  12. 12.
    Bellissimo-Rodrigues F, Machado A, Martínez R. Paracoccidioidomycosis epide-miological features of a 1,000-cases series from a hyperendemic area on the southeast of Brazil. Am J Trop Med Hyg. 2011;85:546–50. Scholar
  13. 13.
    Trindade AH, Meira HC, Pereira IF, de Lacerda JCT, de Mesquita RA, Santos VR. Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients. Mycoses. 2017;60:521–5. Scholar
  14. 14.
    de Macedo PM, Almeida-Paes R, Freitas DF, Varon AG, Paixão AG, Romão AR, et al. Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro. Brazil PLoS Negl Trop Dis. 2017;11:e0005500. Scholar
  15. 15.
    Salzer HJF, Stoney RJ, Angelo KM, Rolling T, Grobusch MP, Libman M, et al. Epidemiological aspects of travel-related systemic endemic mycoses: a GeoSentinel analysis, 1997-2017. J Travel Med. 2018;25.
  16. 16.
    Riera FO, Caeiro JP, Denning DW. Burden of Serious Fungal Infections in Argentina. J Fungi (Basel). 2018;4. pii: E51. DOI: CrossRefGoogle Scholar
  17. 17.
    do Valle ACF, Marques de Macedo P, Almeida-Paes R, Romão AR, Lazéra MDS, Wanke B. Paracoccidioidomycosis after Highway Construction, Rio de Janeiro, Brazil. Emerg Infect Dis. 2017;23:1917–9. Scholar
  18. 18.
    Peçanha PM, Batista Ferreira ME, Massaroni Peçanha MA, Schmidt EB, Lamas de Araújo M, Zanotti RL, et al. Paracoccidioidomycosis: Epidemiological and Clinical Aspects in 546 Cases Studied in the State of Espírito Santo, Brazil. Am J Trop Med Hyg. 2017;97:836–44. Scholar
  19. 19.
    Nogueira MG, Andrade GM, Tonelli E. Clinical evolution of paracoccidioidomycosis in 38 children and teenagers. Mycopathologia. 2006;161:73–81. Scholar
  20. 20.
    Pereira RM, Bucaretchi F, Barison Ede M, Hessel G, Tresoldi AT. Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome. Rev Inst Med Trop Sao Paulo. 2004;46:127–31. Scholar
  21. 21.
    Schimke LF, Hibbard J, Martinez-Barricarte R, Khan TA, de Souza CR, Borges de Oliveira Junior E, et al. Paracoccidioidomycosis Associated With a Heterozygous STAT4 Mutation and Impaired IFN-γ Immunity. J Infect Dis. 2017;216:1623–34. Scholar
  22. 22.
    Alves ABRM, David MA, de Castro LF, da Silva RM, Longhi LNA, Blotta MHSL, et al. Differential production of interleukin-1 family cytokines (IL-1β, IL-18, IL-33 and IL-37) in patients with paracoccidioidomycosis: correlation with clinical form and antifungal therapy. Med Mycol. 2018;56:332–43. Scholar
  23. 23.
    Carvalho FM, Busser FD, Freitas VL, Furucho CR, Sadahiro A, Kono AS, et al. Polymorphisms on IFNG, IL12B and IL12RB1 genes and paracoccidioidomycosis in the Brazilian population. Infect Genet Evol. 2016;43:245–51. Scholar
  24. 24.
    Braga FG, Ruas LP, Pereira RM, Lima XT, Antunes E, Mamoni RL, et al. Functional and phenotypic evaluation of eosinophils from patients with the acute form of paracoccidioidomycosis. PLoS Negl Trop Dis. 2017;11:e0005601. Scholar
  25. 25.
    de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F, et al. Paracoccidioides-host interaction: an overview on recent advances in the paracoccidioidomycosis. Front Microbiol. 2015;6:1319.
  26. 26.
    Benard G, Orii NM, Marques HH, Mendonca M, Aquino MZ, Campeas AE, et al. Severe acute paracoccidioidomycosis in children. Pediatr Infect Dis J. 1994;13:510–5 PMID: 8078739.PubMedGoogle Scholar
  27. 27.
    Sylvestre TF, Cavalcante RS, da Silva JF, Paniago AMM, Weber SS, Pauletti BA, et al. Serological proteomic biomarkers to identify Paracoccidioides species and risk of relapse. PLoS One. 2018;13:e0202804. Scholar
  28. 28.
    • Sylvestre TF, Franciscone Silva LR, Cavalcante Rde S, Moris DV, Venturini J, Vicentini AP, et al. Prevalence and serological diagnosis of relapse in paracoccidioidomycosis patients. PLoS Negl Trop Dis. 2014;8:e2834. An important study reporting an extensive frame about paracoccidioidomycosis. Scholar
  29. 29.
    Shikanai-Yasuda MA. PARACOCCIDIOIDOMYCOSIS TREATMENT. Rev Inst Med Trop Sao Paulo. 2015;57:31–7. Scholar
  30. 30.
    Borges SR, Silva GM, Chambela Mda C, Oliveira Rde V, Costa RL, Wanke B, et al. Itraconazole vs. trimethoprim-sulfamethoxazole: A comparative cohort study of 200 patients with paracoccidioidomycosis. Med Mycol. 2014;52:303–10. Scholar
  31. 31.
    Peçanha PM, de Souza S, Falqueto A, Grão-Veloso TR, Lírio LV, Ferreira CU Jr, et al. Amphotericin B lipid complex in the treatment of severe paracoccidioidomycosis: a case series. Int J Antimicrob Agents. 2016;48:428–30. Scholar
  32. 32.
    Marques SA. Paracoccidioidomycosis. Clin Dermatol. 2012;30:610–5. Scholar
  33. 33.
    Queiroz-Telles F, Goldani LZ, Schlamm HT, Goodrich JM, Espinel-Ingroff A, Shikanai-Yasuda MA. An open-label comparative pilot study of oral voriconazole and itraconazole for long-term treatment of paracoccidioidomycosis. Clin Infect Dis. 2007;45:1462–9. Scholar
  34. 34.
    Maxwell CS, Sepulveda VE, Turissini DA, Goldman WE, Matute DR. Recent admixture between species of the fungal pathogen Histoplasma. Evol Lett. 2018;2:210–20. Scholar
  35. 35.
    Wheat LJ, Azar MM, Bahr NC, Spec A, Relich RF, Hage C. Histoplasmosis. Infect Dis Clin N Am. 2016;30:207–27. Scholar
  36. 36.
    Fischer GB, Mocelin H, Severo CB, Oliveira Fde M, Xavier MO, Severo LC. Histoplasmosis in children. Paediatr Respir Rev. 2009;10:172–7. Scholar
  37. 37.
    López LF, Valencia Y, Tobón ÁM, Velásquez O, Santa CD, Cáceres DH, et al. Childhood histoplasmosis in Colombia: Clinical and laboratory observations of 45 patients. Med Mycol. 2016;54:677–83. Scholar
  38. 38.
    Evrard S, Caprasse P, Gavage P, Vasbien M, Radermacher J, Hayette MP, et al. Disseminated histoplasmosis: case report and review of the literature. Acta Clin Belg. 2018;73:356–63. Scholar
  39. 39.
    • Newman SL, Lemen W, Smulian AG. Dendritic cells restrict the transformation of Histoplasma capsulatum conidia into yeasts. Med Mycol. 2011;49:356–64. A study reporting new insights about Histoplasma cell infection. Scholar
  40. 40.
    Newman SL. Interaction of Histoplasma capsulatum with human macrophages, dendritic cells, and neutrophils. Methods Mol Med. 2005;118:181–91. Scholar
  41. 41.
    Hage CA, Wheat LJ, Loyd J, Allen SD, Blue D, Knox KS. Pulmonary histoplasmosis. Semin Respir Crit Care Med. 2008;29:151–65. Scholar
  42. 42.
    Pamnani R, Rajab JA, Githang'a J, Kasmani R. Disseminated histoplasmosis diagnosed on bone marrow aspirate cytology: report of four cases. East Afr Med J. 2009;86:S102–5 PMID: 21591519.PubMedGoogle Scholar
  43. 43.
    Zhang Y, Su X, Li Y, He R, Hu C, Pan P. Clinical comparative analysis for pulmonary histoplasmosis and progressive disseminated histoplasmosis. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2016;41:1345–51. Scholar
  44. 44.
    Butler JC, Heller R, Wright PF. Histoplasmosis during childhood. South Med J. 1994;87:476–80. Scholar
  45. 45.
    • López LF, Valencia Y, Tobón ÁM, Velásquez O, Santa CD, Cáceres DH, et al. Childhood histoplasmosis in Colombia: Clinical and laboratory observations of 45 patients. Med Mycol. 2016;54:677–83. This study showed a myriad of clinical manifestations of histoplasmosis in children. Scholar
  46. 46.
    Fischer GB, Mocelin H, Severo CB, Oliveira Fde M, Xavier MO, Severo LC. Histoplasmosis in children. Paediatr Respir Rev. 2009;10:172–7. Scholar
  47. 47.
    Esteban I, Minces P, De Cristofano AM, Negroni R, Orqueda R, Canteros C. Central nervous system histoplasmosis in an immunocompetent pediatric patient. Arch Argent Pediatr. 2016;114:e171–4. Scholar
  48. 48.
    Mata-Essayag S, Colella MT, Roselló A, de Capriles CH, Landaeta ME, de Salazar CP, et al. Histoplasmosis: a study of 158 cases in Venezuela, 2000-2005. Medicine (Baltimore). 2008;87:193–202. Scholar
  49. 49.
    Falci DR, Hoffmann ER, Paskulin DD, Pasqualotto AC. Progressive disseminated histoplasmosis: a systematic review on the performance of non-culture-based diagnostic tests. Braz J Infect Dis. 2017;21:7–11. Scholar
  50. 50.
    Miller R, Assi M. AST Infectious Diseases Community of Practice. Endemic fungal infections in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transpl. 2019:e13553.
  51. 51.
    Azar MM, Hage CA. Clinical Perspectives in the Diagnosis and Management of Histoplasmosis. Clin Chest Med. 2017;38:403–15. Scholar
  52. 52.
    Sanguinetti M, Posteraro B, Beigelman-Aubry C, Lamoth F, Dunet V, Slavin M, et al. Diagnosis and treatment of invasive fungal infections: looking ahead. J Antimicrob Chemother. 2019;74:ii27–37. Scholar
  53. 53.
    Stockamp NW, Thompson GR 3rd. Coccidioidomycosis. Infect Dis Clin N Am. 2016;30:229–46. Scholar
  54. 54.
    Martinez-Del-Campo E, Kalb S, Rangel-Castilla L, Moon K, Moran A, Gonzalez O, et al. Spinal Coccidioidomycosis: A Current Review of Diagnosis and Management. World Neurosurg. 2017;108:69–75. Scholar
  55. 55.
    Ramanathan D, Sahasrabudhe N, Kim E. Disseminated Coccidioidomycosis to the Spine-Case Series and Review of Literature. Brain Sci. 2019;9. pii: E160. DOI: CrossRefGoogle Scholar
  56. 56.
    Fisher BT, Chiller TM, Prasad PA, Beveridge M, Walsh TJ, Zaoutis TE. Hospitalizations for coccidioidomycosis at forty-one children's hospitals in the United States. Pediatr Infect Dis J. 2010;29:243–7. Scholar
  57. 57.
    Tsukadaira A, Okubo Y, Sato E, Kubo K. Chronic coccidioidomycosis. Lancet. 2002;360:977. Scholar
  58. 58.
    Dimitrova D, Ross L. Coccidioidomycosis: Experience From a Children's Hospital in an Area of Endemicity. J Pediatric Infect Dis Soc. 2016;5:89–92. Scholar
  59. 59.
    Bried JM, Galgiani JN. Coccidioides immitis infections in bones and joints. Clin Orthop. 1986;211:235–43 PMID: 3769263.Google Scholar
  60. 60.
    Lee JM, Graciano AL, Dabrowski L, Kuzmic B, Tablizo MA. Coccidioidomycosis in infants: A retrospective case series. Pediatr Pulmonol. 2016;51:858–62. Scholar
  61. 61.
    Rojas-García OC, Moreno-Treviño MG, González-Salazar F, Salas-Alanis JC. Primary cutaneous coccidioidomycosis in an infant. Gac Med Mex. 2014;150:175–6 PMID: 24603999.PubMedGoogle Scholar
  62. 62.
    Queiroz-Telles F, Fahal AH, Falci DR, Caceres DH, Chiller T, Pasqualotto AC. Neglected endemic mycoses. Lancet Infect Dis. 2017;17:e367–77. Scholar
  63. 63.
    Orofino-Costa R, Macedo PM, Rodrigues AM, Bernardes-Engemann AR. Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics. An Bras Dermatol. 2017;92:606–20. Scholar
  64. 64.
    • Ramírez Soto MC. Sporotrichosis among children of a hyperendemic area in Peru: an 8-year retrospective study. Int J Dermatol. 2017;56:868–72. This study showed the characteristics of sporotrichosis in children in an endemic area. Scholar
  65. 65.
    Lyon GM, Zurita S, Casquero J, Holgado W, Guevara J, Brandt ME, et al. Sporotrichosis in Peru Investigation Team. Population-based surveillance and a case-control study of risk factors for endemic lymphocutaneous sporotrichosis in Peru. Clin Infect Dis. 2003;36:34–9. Scholar
  66. 66.
    Ramírez Soto MC. Sporotrichosis: The Story of an Endemic Region in Peru over 28 Years (1985 to 2012). PLoS One. 2015;10:e0127924. Scholar
  67. 67.
    Estrada-Castañón R, Chávez-López G, Estrada-Chávez G, Bonifaz A. Report of 73 cases of cutaneous sporotrichosis in Mexico. An Bras Dermatol. 2018;93(6):907–9. Scholar
  68. 68.
    Barraza LL, Tolomelli JB, Cunha CG, Bernardes Filho F, Towersey L, Hay R, et al. Facial Cutaneous Sporotrichosis in a Boy. J Emerg Med. 2019;56:222–3. Scholar
  69. 69.
    Barros MB, Costa DL, Schubach TM, do Valle AC, Lorenzi NP, Texeira JL, et al. Endemic of zoonotic sporotrichosis: profile of cases in children. Pediatr Infect Dis J. 2008;27:246–50. Scholar
  70. 70.
    Bonifaz A, Saúl A, Paredes-Solis V, Fierro L, Rosales A, Palacios C, et al. Sporotrichosis in childhood: clinical and therapeutic experience in 25 patients. Pediatr Dermatol. 2007;24:369–72. Scholar
  71. 71.
    Camacho E, León-Navarro I, Rodríguez-Brito S, Mendoza M, Niño-Vega GA. Molecular epidemiology of human sporotrichosis in Venezuela reveals high frequency of Sporothrix globosa. BMC Infect Dis. 2015;15:94–10. Scholar
  72. 72.
    Oliveira MM, Almeida-Paes R, Gutierrez-Galhardo MC, Zancope-Oliveira RM. Molecular identification of the Sporothrix schenckii complex. Rev Iberoam Micol. 2014;31:2–6. Scholar
  73. 73.
    Macedo PM, Lopes-Bezerra LM, Bernardes-Engemann AR, Orofino-Costa R. New posology of potassium iodide for the treatment of cutaneous sporotrichosis: study of efficacy and safety in 102 patients. J Eur Acad Dermatol Venereol. 2015;29:719–24. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Alexandro Bonifaz
    • 1
    Email author
  • Yessica Estrada-Caraveo
    • 1
  • Andrés Tirado-Sánchez
    • 2
  1. 1.Dermatology DepartmentHospital General de MéxicoDeleg. CuauhtémocMéxico
  2. 2.Dermatology DepartmentInstituto Mexicano del Seguro SocialMexico CityMexico

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