Eco-epidemiologic study of emerging fungi related to the work of babaçu coconut breakers in the State of Maranhão, Brazil

Introduction: There are more than 300,000 extractors using the babaçu coconut as a source of income in the States of Maranhão, Pará, Tocantins and Piauí, and this activity is associated with fungal infections. The objective of this study was to examine the occurrence of emergent fungi in the conjunctiva, nails and surface and subcutaneous injuries of female coconut breakers in Esperantinópolis, Maranhão. Additionally, soil samples and palm structures were collected. Methods: The obtained samples were cultured in Petri dishes containing potato-dextrose-agar and chloramphenicol. The etiological agent was confirmed by a direct mycological exam and growth in culture. Results: In total, 150 domiciles were visited, and samples were collected from 80 patients. From the ground, the most frequently isolated fungus was Aspergillus niger (53. 8%). the most frequently detected fungus in babaçu coconut was Aspergillus niger (66.7%). Conjunctival fungal growth occurred in 76.3% of the women. The ocular fungal microbiota consisted of filamentous fungi (80.6%), and yeasts were present in 19.4% of cases. Onychomycosis was diagnosed in 44% (11/25) of the women. Conclusions: The identification of the genera Neosartorya, Rhizopus and Curvularia in onychomycoses shows that emergent filamentous fungi can be isolated. Aspergillus sp., Penicillium sp. and Scedosporium sp. were the predominant genera found in the babaçu coconut. From ocular conjunctiva, Candida spp. were the most prevalent species isolated, and Fusarium sp. was present only in one woman. The nearly permanent exposure of coconut breakers to the external environment and to the soil is most likely the reason for the existence of a mycotic flora and fungal infections, varying according to the individual's practices and occupation.引言：巴西马拉尼昂州、帕拉州、托坎廷斯州与皮奥伊州共有超过30万名以巴巴苏椰子（babaçu coconut）作为收入来源的采集者，该劳作活动与真菌感染存在明确关联。本研究旨在调查马拉尼昂州埃斯佩兰蒂诺波利斯市女性破椰工的结膜、指甲、体表及皮下损伤处的新发真菌检出情况，同时采集了土壤样本与棕榈植株组织样本。 方法：将采集获得的样本接种于添加氯霉素的马铃薯葡萄糖琼脂培养皿中进行分离培养，通过真菌学直接镜检与培养生长结果确认致病病原体。 结果：本次研究共走访150户居所，从80名女性受试者处采集研究样本。土壤样本中分离率最高的真菌为黑曲霉（Aspergillus niger，53.8%）；巴巴苏椰子样本中检出率最高的真菌同样为黑曲霉（66.7%）。76.3%的女性受试者存在结膜真菌定植。眼部真菌菌群以丝状真菌为主（80.6%），酵母菌占比为19.4%。44%（11/25）的女性受试者被确诊为甲真菌病。 结论：在甲真菌病样本中检出新萨托菌属（Neosartorya）、根霉属（Rhizopus）与弯孢霉属（Curvularia），提示可分离得到新发致病性丝状真菌。巴巴苏椰子样本中检出的优势菌属为曲霉属（Aspergillus sp.）、青霉属（Penicillium sp.）及塞孢霉属（Scedosporium sp.）。眼结膜样本中分离率最高的真菌为念珠菌属（Candida spp.），镰孢菌属（Fusarium sp.）仅在1名女性受试者中检出。破椰工几乎长期暴露于外界环境与土壤中，这极有可能是其携带真菌菌群并发生真菌感染的核心原因，且真菌菌群构成与感染类型会因个体劳作习惯及职业暴露情况存在差异。