Dados do Trabalho

Título

IRON METABOLISM DISORDERS IN PATIENTS WITH CHRONIC FORM OF PARACOCCIDIOIDOMYCOSIS

Introdução

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by fungi of the genus Paracoccidioides spp.. During infection, some host’s immune mechanisms limit the availability of iron to the fungus, reducing its reproduction. But Paracoccidioides spp. can evade the immune defense and, even in limited iron conditions, it manages to use this mineral for its growth and dissemination.

Objetivo(s)

The objective of this study was to evaluate the iron metabolism in different iron compartments in patients with chronic PCM, before treatment and after clinical cure.

Material e Métodos

Thirty-nine patients with chronic PCM diagnosed from 2013 to 2021, treated at a University Hospital in Midwest Brazil were studied. Three iron compartments (storage, transport and functional) were analyzed at two moments, before treatment (BT) and at clinical cure (CC).

Resultados e Conclusão

Patients had mean age of 54.5 (SD 6.7) years, and most of them were men (97.4%), rural workers (92.1%), smokers (84.6%) and with moderate severity disease (66.7%). The storage compartment was evaluated by serum ferritin. Although before treatment ferritin levels were within the normal range, the median levels reduced after treatment, at the clinical cure. The transport compartment was evaluated by total iron binding capacity (TIBC) and transferrin saturation (TSAT). Before treatment, patients had median values of both parameters slightly below normal, but no change after treatment was observed. The functional compartment was analyzed by the following parameters: red blood cells (RBC), hemoglobin (Hb), hematocrit (HCT), soluble transferrin receptor (sTfR) and sTfR/logFerritin index. Central measures of these parameters were little or not changed before treatment. Even so, it is possible to infer that PCM interferes in the functional compartment, since there was an improvement in the parameters after treatment as well as an association with the severity of the disease. Furthermore, a moderate correlation was found between Hb, RBC, HCT and iron with C-reactive protein (CRP). In conclusion, PCM interferes with iron metabolism by transferring iron from the functional to the storage compartment revealed by anemia, low iron levels with normal levels of TSAT, TIBC, sTfR and sTfR/logFerritin index and normal or slightly increased ferritin levels. Alterations in iron metabolism in PCM can lead to anemia of inflammation, that it would be differentiated of the iron deficiency anemia by a careful investigation of the parameters of the iron compartments.

Palavras-chave

iron
PCM
anemia