{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:30:25Z","timestamp":1784543425183,"version":"3.55.0"},"reference-count":42,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T00:00:00Z","timestamp":1657670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Dean of Research and Graduate Studies (PROPESP) at Federal University of Par\u00e1-UFPA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>The Brazilian Amazon has a specific epidemiological profile for cryptococcosis, considering its social and economic inequality, health reality, and low access to health services. Furthermore, Brazil and Colombia have the highest cryptococcosis incidence rates in Latin America. In this study, we identified the areas of risk for cryptococcosis in the state of Par\u00e1 in the Brazilian Amazon. This was an ecological study of patients admitted to a referral hospital from 2008 to 2018, aged 13 years or older, and of both sexes. The spatial distribution was determined using ArcGis 10.3.1 software. Cryptococcosis was confirmed in 272 cases. The incidence rate was 3.41 cases\/100,000 inhabitants. Spatial distribution was concentrated in the Metropolitana de Bel\u00e9m, Nordeste Paraense, and Maraj\u00f3 mesoregions. The sociodemographic profile consisted of 62% men, aged between 24 and 34 years (36%), without completed secondary education (64.7%), and with occupations varying between agricultural activities (13.8%) and household activities (22%). The mean hospitalization time was 39 days; the prevalent clinical form was neurological (89.7%). The mortality rate among patients with cryptococcosis was up to 40%. Knowledge of the real magnitude of the disease in the Brazilian Amazon makes it possible to identify areas with the greatest risks and to propose control and epidemiological surveillance programs.<\/jats:p>","DOI":"10.3390\/microorganisms10071411","type":"journal-article","created":{"date-parts":[[2022,7,14]],"date-time":"2022-07-14T00:12:40Z","timestamp":1657757560000},"page":"1411","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cryptococcosis: Identification of Risk Areas in the Brazilian Amazon"],"prefix":"10.3390","volume":"10","author":[{"given":"Danielle Saraiva Tuma","family":"dos Reis","sequence":"first","affiliation":[{"name":"Faculty of Nursing, Federal University of Par\u00e1 (UFPA), Bel\u00e9m 66075-110, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8165-8629","authenticated-orcid":false,"given":"Mioni Thieli Figueiredo Magalh\u00e3es","family":"de Brito","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Federal University of Par\u00e1 (UFPA), Bel\u00e9m 66075-110, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5767-4765","authenticated-orcid":false,"given":"Ricardo Jos\u00e9 de Paula Souza","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Geoprocessing Laboratory, Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6267-9966","authenticated-orcid":false,"given":"Juarez Ant\u00f4nio Sim\u00f5es","family":"Quaresma","sequence":"additional","affiliation":[{"name":"Juarez Ant\u00f4nio Sim\u00f5es Quaresma Tropical Medicine Center, Federal University of Par\u00e1 (UFPA), Bel\u00e9m 66075-110, PA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,13]]},"reference":[{"key":"ref_1","unstructured":"Brazil (2022, July 07). ONU: Crise Econ\u00f4mica Emperra Desenvolvimento Humano No Brasil. Ag\u00eancia Brasil. Available online: https:\/\/agenciabrasil.ebc.com.br\/direitos-humanos\/noticia\/2017-03\/crise-economica-emperra-desenvolvimento-humano-no-brasil."},{"key":"ref_2","unstructured":"IBGE (2022, May 08). Cities and States, Available online: https:\/\/www.ibge.gov.br\/cidades-e-estados\/pa\/."},{"key":"ref_3","unstructured":"Ebserh (2021, January 12). Brazilian Hospital Services Company. Strategic Master Plan 2021\u20132023. UFPA University Hospital Complex\u2014HUJBB\/HUBFS. v.02.1-12\/17\/2020, Available online: https:\/\/www.gov.br\/ebserh\/pt-br\/hospitais-universitarios\/regiao-norte\/chu-ufpa\/governanca\/plano-diretor-estrategico."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1590\/0037-8682-0169-2021","article-title":"Cryptococcosis by Cryptococcus neoformans\/Cryptococcus gattii Species Complexes in non-HIV-Infected Patients in Southeastern Brazil","volume":"54","author":"Nascimento","year":"2021","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_5","first-page":"49","article-title":"Comparison of clinical and survival characteristics between HIV-positive and HIV-negative patients with meningeal cryptococcosis in a third-level hospital","volume":"37","author":"Lizarazo","year":"2012","journal-title":"Acta Med. Colomb. Bogota"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-021-06752-x","article-title":"Clinical features of cryptococcosis in patients with different immune statuses: A multicenter study in Jiangsu Province\u2013China","volume":"21","author":"Wang","year":"2021","journal-title":"BMC Infect. Dis."},{"key":"ref_7","first-page":"55","article-title":"Cryptococcus spp. in HIV\/AIDS patients: Literature review","volume":"18","author":"Almeida","year":"2014","journal-title":"Essays Sci. Biol. Agric. Health Sci. Campo Gd."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"30243","DOI":"10.1016\/S1473-3099(17)30243-8","article-title":"Global burden of disease of HIV-associated cryptococcal meningitis: An updated analysis","volume":"17","author":"Rajasingham","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_9","first-page":"1","article-title":"Global molecular epidemiology of Cryptococcus neoformans and Cryptococcus gattii: An atlas of the molecular types","volume":"1","author":"Cogliati","year":"2013","journal-title":"Hindawi Publ. Corp. Sci."},{"key":"ref_10","first-page":"e170554","article-title":"The status of cryptococcosis in Latin America","volume":"113","author":"Firacative","year":"2018","journal-title":"Mem\u00f3rias Do Inst. Oswaldo Cruz"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Soares, E.A., dos Santos Lazera, M., Wanke, B., de Faria Ferreira, M., de Oliveira, R.V.C., Oliveira, A.G., and Coutinho, Z.F. (2019). Mortality by cryptococcosis in Brazil from 2000 to 2012: A descriptive epidemiological study. PLoS Negl. Trop. Dis., 13.","DOI":"10.1371\/journal.pntd.0007569"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"251","DOI":"10.3201\/eid1602.090900","article-title":"Epidemiology of Cryptococcocus gattii, British Columbia, Canada, 1999\u20132007","volume":"16","author":"Galanis","year":"2010","journal-title":"Emerg. Infect. Dis."},{"key":"ref_13","first-page":"565","article-title":"Use of time series analysis in epidemiological studies","volume":"24","author":"Antunes","year":"2015","journal-title":"Epidemiol. Health Serv."},{"key":"ref_14","unstructured":"Brazil Ministry of Health, Health Surveillance Secretariat, and Oswaldo Cruz Foundation (2006). Spatial Approaches in Public Health."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s42489-019-00026-y","article-title":"Empirical Studies on the Visual Perception of Spatial Patterns in Choropleth Maps","volume":"69","author":"Schiewe","year":"2019","journal-title":"KN J. Cartogr. Geogr. Inf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s42489-020-00057-w","article-title":"Trustworthy COVID-19 Mapping: Geo-spatial Data Literacy Aspects of Choropleth Maps","volume":"70","author":"Juergens","year":"2020","journal-title":"KN J. Cartogr. Geogr. Inf."},{"key":"ref_17","unstructured":"(2019, October 01). National Health Council. Resolution CNS No. 466, of December 12, 2012. Bras\u00edlia, DF, Available online: http:\/\/conselho.saude.gov.br\/resolucoes\/2012\/Reso466.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s42770-020-00383-1","article-title":"Cryptococcal meningitis in non-HIV patients in the State of Amazonas, Northern Brazil","volume":"52","author":"Pinheiro","year":"2020","journal-title":"Braz. J. Microbiol."},{"key":"ref_19","first-page":"1","article-title":"Epidemiological and therapeutic profile of patients with cryptococcosis treated at a teaching hospital in Santa Maria\/RS","volume":"44","author":"Ianiski","year":"2018","journal-title":"Health"},{"key":"ref_20","first-page":"1","article-title":"The epidemiology of cryptococcosis and the characterization of Cryptococcus neoformans isolated in a Brazilian University Hospital","volume":"59","author":"Pedroso","year":"2017","journal-title":"J. Inst. Trop. Med."},{"key":"ref_21","unstructured":"WHO (2019, January 21). Guidelines for the Diagnosis, Prevention and Management of Cryptococcal Disease in HIV-Infected Adults, Adolescents and Children. Available online: http:\/\/www.who.int\/hiv\/pub\/guidelines\/cryptococcal-disease\/en\/."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e01238-18","DOI":"10.1128\/JCM.01238-18","article-title":"Cryptococcal Meningitis Diagnostics and Screening in the Era of Point-of-Care Laboratory Testing","volume":"57","author":"Rajasingham","year":"2019","journal-title":"J. Clin. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1093\/cid\/ciy817","article-title":"Symptomatic cryptococcal antigenemia presenting as early cryptococcal meningitis with negative cerebral spinal fluid analysis","volume":"68","author":"Sebambulidde","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1056\/NEJMoa1710922","article-title":"Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa","volume":"378","author":"Molloy","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"7224","DOI":"10.1128\/AAC.01698-15","article-title":"Toxicity of Amphotericin B Deoxycholate-Based Induction Therapy in Patients with HIV-Associated Cryptococcal Meningitis","volume":"59","author":"Bicanic","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"65","DOI":"10.4322\/2357-9730.56021","article-title":"Amphotericin B: A review of its different formulations, adverse effects and toxicity","volume":"35","author":"Falci","year":"2015","journal-title":"Clin. Biomed. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1093\/cid\/cix613","article-title":"Inadequacy of High-Dose Fluconazole Monotherapy Among Cerebrospinal Fluid Cryptococcal Antigen (CrAg)\u2013Positive Human Immunodeficiency Virus-Infected Persons in an Ethiopian CrAg Screening Program","volume":"65","author":"Beyene","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","unstructured":"Oliveira, A.S. (2018). Cryptococcosis: Mortality Patterns in Brazil and Morbidity and Mortality in a Reference Hospital in Cear\u00e1. [Master\u2019s Thesis, Federal University of Cear\u00e1]."},{"key":"ref_29","unstructured":"Brazil Ministry of Health, Secretary of Health Surveillance, and Department of Surveillance, Prevention and Control of Sexually Transmitted Infections (2018). HIV\/AIDS and Viral Hepatitis. Epidemiol. Bull. HIV Aids, 49, 2018."},{"key":"ref_30","unstructured":"(2019, July 21). Signature. Confirmed Cases, Deaths, Incidence (Per 100,000 Inhabitants) and Lethality (%) by Type of Meningitis. Brazil, 2010 to 2018. Bras\u00edlia, DF, Available online: https:\/\/portalarquivos2.saude.gov.br\/images\/pdf\/2019\/abril\/25\/tabela-dados-2010-2018-site.pdf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2582","DOI":"10.1590\/S0102-311X2008001100013","article-title":"Cryptococcal meningitis in Rio de Janeiro State, Brazil, 1994\u20132004","volume":"24","author":"Leimann","year":"2008","journal-title":"Cad. De Sa\u00fade P\u00fablica"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/myc.12427","article-title":"The burden of serious human fungal infections in Brazil. Mycoses, Berlin","volume":"59","author":"Giacomazzi","year":"2015","journal-title":"Mycoses"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"105023","DOI":"10.1016\/j.actatropica.2019.05.014","article-title":"Cryptococcosis in the Amazon: A current overview and future perspectives","volume":"197","author":"Pinheiro","year":"2019","journal-title":"Acta Trop."},{"key":"ref_34","first-page":"1","article-title":"Regional history and social participation in the Mesoregions of Par\u00e1","volume":"226","author":"Silva","year":"2008","journal-title":"NAEA Pap. Bel\u00e9m"},{"key":"ref_35","unstructured":"Andrade, S.S. (2019). Public Policies in the Marajoara Amazon: Socioeconomic Development Indices in the Region. N. Amaz. Mag., Available online: https:\/\/periodicos.ufpa.br\/index.php\/nra\/article\/download\/6981\/5469."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"59","DOI":"10.5654\/actageo2008.0103.0005","article-title":"The territorial formation of the Par\u00e1 space: From forts to the creation of municipalities","volume":"3","author":"Tavares","year":"2008","journal-title":"ACTA Geogr. Mag."},{"key":"ref_37","unstructured":"Barbosa, M.J.S., Reis, A.A., and Andrade, W.D.C. (2011). Northeast Par\u00e1 Territory: Sustainable Development and Strategic Management of Rural Territories in the State of Par\u00e1, Federal University of Par\u00e1, Institute of Applied Social Sciences. Analytical Report."},{"key":"ref_38","unstructured":"Rodrigues, T.E., Santos, P.L., Silva, J.M.L., Valente, M.A., Santos, E.S., and Rolim, P.A.M. (2019, October 01). Characterization and Classification of Soils in the Municipality of Bujaru, State of Par\u00e1, Available online: https:\/\/ainfo.cnptia.embrapa.br\/digital\/bitstream\/item\/63748\/1\/Oriental-Doc165.PDF."},{"key":"ref_39","unstructured":"Lamb, I.M.C.C., Rangel-Vasconcelos, L.G.T., Schwartz, G., and Oliveira, F.A. (2017). Northeast Par\u00e1: Overview and Sustainable Use of Secondary Forests, EDUFRA."},{"key":"ref_40","unstructured":"INPE (2015, May 05). PRODES: Disclosure of the Estimated Rate of Deforestation in the Legal Amazon for the 2013\u20132014 Period. Available online: http:\/\/www.obt.inpe.br\/prodes\/taxas\/Prodes_Taxa2014_estimativa.pdf."},{"key":"ref_41","unstructured":"Bueno, R.S., and Villela, R. (2016, January 17\u201326). The expansion of deforestation in the state of Par\u00e1: Population, territorial dynamics and scales of analysis. Proceedings of the VII Congreso de la Asociaci\u00f3n LatinoAmericana de Poblaci\u00f3n and the XX National Meeting of Population Studies, Foz do Igua\u00e7u, Brazil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3389\/fvets.2018.00014","article-title":"The One Health Concept: 10 Years Old and a Long Road Ahead","volume":"5","author":"Mavingui","year":"2018","journal-title":"Front. Veter. Sci."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/10\/7\/1411\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:49:34Z","timestamp":1760140174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/10\/7\/1411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,13]]},"references-count":42,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["microorganisms10071411"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms10071411","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,13]]}}}