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However, <jats:italic>Paracoccidioides<\/jats:italic> spp. can evade the immune defense and, even under limited iron conditions, use this mineral for growth and dissemination. This study evaluated the iron metabolism of 39 patients who were diagnosed with chronic PCM from 2013 to 2021. The forms of iron before treatment and at the time of clinical cure were evaluated based on the following: serum ferritin levels (storage iron); total iron-binding capacity (TIBC) and transferrin saturation (TSAT) level (transport iron); red blood cell (RBC), hemoglobin (Hb), hematocrit (HCT), and soluble transferrin receptor (sTfR) levels; and sTfR\/log ferritin ratio (functional iron). The mean age of the patients was 54.5 years (\u00b16.7 years). Most patients were men (97.4%), rural workers (92.1%), and smokers (84.6%); furthermore, most had moderate disease severity (66.7%). After achieving clinical cure, we observed that serum ferritin levels decreased, and parameters of functional iron increased. The extent of alteration in these parameters were more pronounced in severe cases than in to mild or moderate cases. Furthermore, moderate correlations were observed between C-reactive protein and the Hb (r = -0.500; p = 0.002), RBC (r = -0.461; p = 0.005), HCT (r = -0.514; p = 0.001), and iron levels (r = -0.491; p = 0.002). However, it is possible to infer that PCM interferes with functional and storage iron because improvements in these parameters after treatment as well as associations with disease severity were observed. PCM can lead to anemia of inflammation, which can be differentiated from iron deficiency anemia by a careful investigation of the iron form parameters.<\/jats:p>","DOI":"10.1371\/journal.pone.0282218","type":"journal-article","created":{"date-parts":[[2023,6,23]],"date-time":"2023-06-23T13:36:28Z","timestamp":1687527388000},"page":"e0282218","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Iron metabolism disorders of patients with chronic paracoccidioidomycosis"],"prefix":"10.1371","volume":"18","author":[{"given":"Eliana da Costa Alvarenga","family":"de Brito","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5627-206X","authenticated-orcid":true,"given":"Igor Valadares","family":"Siqueira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Venturini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vin\u00edcius Lopes Teodoro","family":"F\u00e9lix","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alana Oswaldina Gavioli Meira","family":"dos Santos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rinaldo Poncio","family":"Mendes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4181-142X","authenticated-orcid":true,"given":"Simone Schneider","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8925-7712","authenticated-orcid":true,"given":"Anamaria Mello Miranda","family":"Paniago","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"key":"pone.0282218.ref001","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1590\/S0102-311X2002000500037","article-title":"Paracoccidioidomycosis mortality in Brazil (1980\u20131995)","volume":"18","author":"ZF Coutinho","year":"2002","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"pone.0282218.ref002","doi-asserted-by":"crossref","first-page":"224","DOI":"10.2174\/1874285801711010224","article-title":"Paracoccidioidomycosis: Current perspectives from Brazil","volume":"11","author":"RP Mendes","year":"2017","journal-title":"TOMICROJ"},{"key":"pone.0282218.ref003","doi-asserted-by":"crossref","first-page":"ofaa624","DOI":"10.1093\/ofid\/ofaa624","article-title":"Pathogenesis and classification of Paracocidioidomycosis: New Insights From Old Good Stuff.","volume":"8","author":"G Benard","year":"2021","journal-title":"Open Forum Infectious Diseases"},{"key":"pone.0282218.ref004","first-page":"821","article-title":"Paracoccidioides spp. ferrous and ferric iron assimilation pathways","volume":"6","author":"EFLC Bail\u00e3o","year":"2015","journal-title":"Front Microbiol"},{"key":"pone.0282218.ref005","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/j.1572-0241.2005.30252.x","article-title":"Iron-Deficiency Anemia and Helicobacter pylori Infection: A Review of the Evidence.","volume":"100","author":"S DuBois","year":"2005","journal-title":"Am J Gastroenterology"},{"key":"pone.0282218.ref006","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1007\/s13238-014-0083-7","article-title":"Essential functions of iron-requiring proteins in DNA replication, repair and cell cycle control","volume":"5","author":"C. 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