Name: HOSANA EWALD OLIVEIRA

Publication date: 23/08/2021
Advisor:

Name	Role
ALOÍSIO FALQUETO	Co-advisor *
CREUZA RACHEL VICENTE	Advisor *

Examining board:

Name	Role
ALOÍSIO FALQUETO	Co advisor *
CREUZA RACHEL VICENTE	Advisor *
CRISPIM CERUTTI JUNIOR	Internal Examiner *

Summary: Introduction: Paracoccidioidomycosis is a fungal disease endemic in Brazil that can affect any organ and present relapse. Objective: Identify risk factors for relapse of paracoccidioidomycosis. Methods: A paired-control case study was carried out based on data from medical records of patients with paracoccidioidomycosis treated at the Cassiano Antônio Moraes University Hospital (HUCAM) between 1978 and 2018. For each identified case, four controls were drawn, considering the matching by sex, age (ranging from ten years below to ten years above that of the case), and time from diagnosis ranging around two years of that of the case. The following variables were
evaluated: age, sex, occupation, city and state of residence, city and state WHERE the infection was acquired, clinical form of the disease, smoking and alcoholism, organs more affected, time of disease evolution, results of the diagnostic tests, medications used for treatment, duration of and adherence to treatment, and relapse. Data analysis included descriptive analysis, setting of the Kaplan Meier Curve, and Simple Conditional Logistic Regression. Significant variables were analyzed using multivariate conditional logistic regression by stepwise forward method (P <0.20) with Akaike criteria. For measure of effect, paired Odds Ratio was applied (paired OR), with a significance level of 5%. Data were analyzed using the R software (version 4.0.2). Results: We evaluated 788 medical records of patients with paracoccidioidomycosis and identified 22 cases of relapse, 21 in men with a mean age of 44 years. Of the patients with relapse, 20 had a history of smoking and 17 a history of alcoholism, while in the group without relapse these frequencies were 49
and 28, respectively. Smoking history (p-value = 0.0146) and alcoholism (p-value =0.00115) showed a statistically significant difference between the groups, and the risk of relapse between smokers and alcoholics was 6.66 (ORp 95% CI = 1.45 –30.54) and 6.40 (ORp 95% CI = 2.09 – 19.58) times higher than that on those without these habits, respectively. The frequencies of the other variables analyzed did not show a statistically significant difference between the groups (p-value > 0.05). Conclusion: The study sought to verify the existence of an association between relapse and the history of smoking and alcoholism, treatment adherence, type of treatment, presence of comorbidities and affected organs. The influence of smoking, alcoholism, the presence of skin lesions, and more than three organs affected by the disease with the occurrence of relapse of paracoccidioidomycosis were observed.

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