Fungus in the air

One hundred years ago, Adolpho Lutz published two articles describing a new disease

Published in April 2008

Imagem: Photos archives of the ial memory centerIn the early 20th century, doctor and researcher Adolpho Lutz very carefully studied two patients in São Paulo with different illnesses that caused serious lesions and destroyed the gums’ mucosa, with painful effects upon the ganglia. In April 1908, after almost three years of research, Lutz published two articles in Brazil-Medico – Revista Semanal de Medicina e Cirurgia [Brazil-Medical – Weekly Journal of Medicine and Surgery], in which he qualified the disease as a pseudococcidar mycosis, after identifying the fungus that caused it and describing its typical reproduction system.

“What Lutz did was highly remarkable and rare,” says pharmacist and biochemist Cezar Mendes de Assis, a researcher from the Adolpho Lutz Institute. “He described the disease, observed its agent in clinical material under a microscope, isolated it in cultures, showed that it was dimorphous (had two distinct forms, mildew at 27ºC and yeast at 36ºC), described its characteristics, reproduced the disease in different laboratory animals and re-isolated the agent.” Furthermore, he was worried about claiming that he had discovered a new disease and warned of the difficulty of differentiating it from similar conditions.

The name for the disease since 1971, after a specialists congress held in Colombia, is paracoccidiomycosis, although it has had several names since 1908 – one of them being “Lutz’s disease.” It is a mycosis caused by the fungus Paracoccidiodes brasiliensis, found in rural areas and that most often enters the human body via inhalation. When not diagnosed at the right time it causes skin sores and mouth lesions, may contaminate the lungs, spleen and liver, and may infiltrate the bones, joints and central nervous system. Some of the risk activities are linked to agriculture, gardening and transporting vegetables. Deforestation and preparing the soil for planting increase the number of particles of the fungus in suspension.

As notification is not compulsory, there is a shortage of accurate information about the incidence of this mycosis in Brazil. Health Ministry data show 3,181 deaths from 1980 to 1995 and a mortality rate of 1.45 cases per million inhabitants. ‘Consensus about paracoccidiomycosis’, a technical report published in 2006 by the Revista da Sociedade de Medicina Tropical (Journal of the Society of Tropical Medicine), showed that few people exposed to the fungus develop the disease. When the mycosis manifests itself, however, the public health problem becomes significant because mortality rates are high – those who do not die are frequently disabled and unable to work. For the time being there is no effective vaccine.

After the pioneering articles in 1908, the mycosis continued to be studied. Italian bacteriologist Alfonso Splendore and São Paulo mycologist Floriano Paulo de Almeida added substantially to understanding it. In the same year in which he published his research, Lutz (1855-1940) left the Bacteriological Institute of São Paulo (now the Adolfo Lutz Institute), where he had been director for 15 years, and returned to his hometown, Rio de Janeiro, to work solely as a researcher. A lover of the solitude of laboratory work and field collecting, to the end of his life he remained at the Oswaldo Cruz Institute, where he continued studying topics of medical or purely biological interest.