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Standardization and Prevalence of the Booster Phenomenon: Evaluation Using a Two-Step Skin Test with 43 kDa Glycoprotein in Individuals from an Endemic Region of Paracoccidioidomycosis

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Abstract

Background

We estimated the occurrence rate of the booster phenomenon by using an intradermal test with 43 kDa glycoprotein in an endemic area of paracoccidioidomycosis in the central-west region of Brazil.

Methods

Individuals who had a negative result on a survey performed by using an intradermal test with 43 kDa glycoprotein in an endemic area of paracoccidioidomycosis underwent a second intradermal test after 10–15 days to determine the presence or absence of the booster phenomenon. Statistical analyses were performed using the Chi-square test, Chi-square for linear trend test, Student’s t test, and binomial test; p < 0.05 was considered significant.

Results

For the first time, we reported the occurrence of the booster phenomenon to an intradermal reaction caused by 43 kDa glycoprotein at a rate of 5.8–8.4%, depending on the test’s cutoff point. This suggests that a cutoff point should be considered for the booster phenomenon in intradermal tests with 43 kDa glycoprotein: a difference of 6–7 mm between readings according to the first and second tests, depending on the purpose of the evaluation.

Conclusion

The results indicate that the prevalence of paracoccidioidal infection in endemic areas is underestimated, as the booster phenomenon has not been considered in epidemiological surveys for this infection.

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Acknowledgements

We thank the Health Department of the Municipality of Jaraguari (Mato Grosso do Sul, Brazil), Post-Graduation Program for Health and Development of the Central-West Region Brazil, and Professor Antonio Ruffino Netto for providing assistance and financial support. We also thank Editage (www.editage.com.br) for English language editing.

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Authors and Affiliations

  1. Faculty of Medicine, Federal University of Mato Grosso do Sul, Cidade Universitária s/n, Campo Grande, 79070-900, Brazil

    Ana Paula C. Marques, Sandra Maria V. L. Oliveira, Grazielli R. Rezende, Dayane A. Melo, Sonia M. Fernandes-Fitts, Elenir Rose J. C. Pontes & Anamaria M. M. Paniago

  2. Laboratory of Immunology and Immunogenetics, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, 21040-360, Brazil

    Maria da Glória Bonecini-Almeida

  3. Laboratory of Medical Mycology, Clinical Hospital, Faculty of Medicine, Federal University of São Paulo, São Paulo, 04023-062, Brazil

    Zoilo P. Camargo

  4. Tropical Disease Department, Faculty of Medicine of Botucatu, Paulista State University, Botucatu, Brazil

    Rinaldo P. Mendes

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  1. Ana Paula C. Marques
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  2. Sandra Maria V. L. Oliveira
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  3. Grazielli R. Rezende
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Correspondence to Ana Paula C. Marques.

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Marques, A.P.C., Oliveira, S.M.V.L., Rezende, G.R. et al. Standardization and Prevalence of the Booster Phenomenon: Evaluation Using a Two-Step Skin Test with 43 kDa Glycoprotein in Individuals from an Endemic Region of Paracoccidioidomycosis. Mycopathologia 182, 809–817 (2017). https://doi.org/10.1007/s11046-017-0159-z

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