Definition of paracoccidioidomycosis endemic areas in Colombia

Abstract

An endemic disease is one that is constantly present within a geographical area or population group; the definition of endemia also encompasses the usual prevalence of a disease within a defined area or a determined group. The aim of this work was to establish the endemicity of paracoccidioidomycosis in the 32 Colombian departments (political divisions) and to associate it with certain geographical characteristics such as altitude. A retrospective study was carried out from 1949 to 1999. The data collected referred to the year of diagnosis and patients' residence locality, while the information was derived from four different mycology laboratories, two pathology services and the Colombian publications on the disease. The incidence rate for department was obtained from three individual censuses. 1973, 1985 and 1993. as well as from projections for 1990 and 1995. Definition of endemic areas was based on the distribution of case frequencies by place and time. Statistical rneasurements used were the median and the quartiles. In the 50-year period 1,191 cases had been recorded and were analyzed here. Based on the total number of cases diagnosed for department, 9 were classified as endemic, having reported more than 32 cases per year; 8 of them belonged to the Andean region and 1 to the Sierra Nevada of Santa Marta. Eighteen departments were catalogued as low endemic regions, as they had reported only 2-27 cases, while the remaining 5 reported 1 or no cases and were considered non-endemic. In the period from 1980 to 1998, 8 departments diagnosed the disease regularly for 13-19 years, and they were classified as endernic. Fifteen departments were considered of low endemicity as they informed the rnycosisfor only 2-12 years. while 10 were regarded as non-endemic because they informed cases for less than 1 year Both analyses agreed in cataloguing 8 departments as endemic. The higher national incidence was obtained in 1980 with 2.4 patients/1'000.000 inhabitants. The incidence rate of the disease was found to be an inadequate pararneter to define endemicity. The findings corroborate that the distribution of paracoccidioidomycosis in Colombia is heterogeneous, and, additionally, offer an alternative way to study the habitat of the etiological agent.