Regional Heterogeneity and Temporal Trends of Infant-Juvenile Paracoccidioidomycosis in Argentina: A 15-Year Comparative Study.

Paracoccidioidomycosis (PCM) is a neglected systemic mycosis in Latin America. This study aims to characterize the epidemiology and clinical profiles of infant PCM cases (0 to 14 years old) over a 15-year period (2008-2023) in the two primary endemic regions of Argentina, the northeast (NEA) and the northwest (NWA) areas. Results reveal striking regional heterogeneity. Distribution showed clear disparities, 71.1% of cases were recorded in NWA, while 28.9% in the NEA area. The NWA region exhibited a constant temporal occurrence, whereas the NEA showed episodic occurrence/outbreaks potentially triggered by anthropogenic and climatic changes. Severe nutritional impairment and generalized lymphadenopathy were common clinical signs in both regions. Hepatosplenic enlargement and abdominal compromise with gastrointestinal manifestations dominated in the NWA (53.1%), while a higher prevalence of cutaneous/mucocutaneous (76.9%), pulmonary (38.4%) and osteoarticular (38.4%) manifestations characterized the clinical profiles in the NEA. These findings support the existence of distinct regional epidemiological and clinical phenotypes of pediatric PCM in Argentina. Recognizing these disparities is essential to improve clinical suspicion, diagnostic strategies, and the implementation of effective public health strategies for this severe pediatric disease.