{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:52:04Z","timestamp":1787028724338,"version":"build-2736575974"},"reference-count":70,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Clinical observations have long suggested that women are protected against paracoccidioidomycosis. 17\u03b2-estradiol, the main female estrogen, inhibits conidia-to-yeast transformation (C-to-Y), which is required for the infection establishment. However, experiments in murine models have yielded conflicting results, suggesting that C-to-Y inhibition, alone, fails to explain the female-associated protection and that sexual hormones may also act by modulating the host\u2019s immune responses. Therefore, this issue remains unsolved. Strikingly, no studies have compared the severity of paracoccidioidomycosis between men and women. This retrospective case-control study compared 36 women with 72 age-matched men for clinical\u2013demographic, laboratory, and chest imaging findings. Overall, paracoccidioidomycosis in women presented the main features described in the acute\/subacute and chronic forms seen in men. Women also showed similar demographic features and clinical\u2013laboratory and imaging severity scores as men. We additionally reviewed 58 paracoccidioidin skin test surveys undertaken by volunteers from endemic areas. Data accumulated from 10.873 tests showed that females and males are infected with similar magnitudes (21.9% vs. 25.2%) and that reactivity steadily increased with age, peaking after the age of 60. We discuss the paradox of similar infection rates but much lower disease prevalence in women, considering the current pathogenetic views of paracoccidioidomycosis, and we raise alternative hypotheses to account for this paradox.<\/jats:p>","DOI":"10.3390\/jof7080655","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T09:22:38Z","timestamp":1628846558000},"page":"655","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A Case-Control Study of Paracoccidioidomycosis in Women: The Hormonal Protection Revisited"],"prefix":"10.3390","volume":"7","author":[{"given":"Tereza Graciano Nascimento de","family":"Brito","sequence":"first","affiliation":[{"name":"Laboratorio de Investigacao em Imunologia e Dermatologia (LIM56), Departamento de Dermatologia and Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. En\u00e9as de Carvalho Aguiar 470, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariane","family":"Taborda","sequence":"additional","affiliation":[{"name":"Divisao de Doen\u00e7as Infecciosas, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. En\u00e9as de Carvalho Aguiar 255, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna","family":"Provenci","sequence":"additional","affiliation":[{"name":"Divisao de Pneumologia, Instituto do Cora\u00e7\u00e3o, Hospital das Clinicas, Faculdade de Medicina, Universidade Sao Paulo, SP, R. Dr. En\u00e9as de Carvalho Aguiar 44, S\u00e3o Paulo 05403-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8025-6940","authenticated-orcid":false,"given":"Andr\u00e9 Nathan","family":"Costa","sequence":"additional","affiliation":[{"name":"Divisao de Pneumologia, Instituto do Cora\u00e7\u00e3o, Hospital das Clinicas, Faculdade de Medicina, Universidade Sao Paulo, SP, R. Dr. En\u00e9as de Carvalho Aguiar 44, S\u00e3o Paulo 05403-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5469-3602","authenticated-orcid":false,"given":"Gil","family":"Benard","sequence":"additional","affiliation":[{"name":"Laboratorio de Investigacao em Imunologia e Dermatologia (LIM56), Departamento de Dermatologia and Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. En\u00e9as de Carvalho Aguiar 470, S\u00e3o Paulo 05403-000, Brazil"},{"name":"Laboratorio de Micologia Medica (LIM53), Departamento de Dermatologia and Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de Sao Paulo, SP, R. Dr. En\u00e9as de Carvalho Aguiar 470, S\u00e3o Paulo 05403-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"ref_1","first-page":"654","article-title":"Paracoccidioidomycosis","volume":"Volume 1","author":"Nosanchuk","year":"2021","journal-title":"Encyclopedia of Mycology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1590\/S0037-86821987000200012","article-title":"Paracoccidioidomycosis: A recently proposed classification of its clinical forms","volume":"20","author":"Franco","year":"1987","journal-title":"Rev. Soc. Bras. Med. 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