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、帕拉、托坎廷斯及皮奥伊四州共有超过30万名以巴巴苏椰子（babaçu coconut）为收入来源的采集者，该劳作与真菌感染存在关联。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定植情况，同时采集土壤样本与棕榈植株组织。 方法：将采集所得样本接种于含马铃薯葡萄糖琼脂（potato-dextrose-agar）与氯霉素的培养皿中，通过直接真菌镜检与培养生长结果确认病原体。 结果：本研究共走访150户家庭，从80名受试者处采集样本。土壤样本中分离率最高的真菌为黑曲霉（Aspergillus niger），占比53.8%；巴巴苏椰子样本中检出率最高的真菌同样为黑曲霉，占比66.7%。76.3%的女性受试者结膜处存在真菌定植。眼部真菌菌群以丝状真菌为主（80.6%），酵母菌占比19.4%。44%（11/25）的女性被诊断为甲真菌病（onychomycosis）。 结论：在甲真菌病样本中检出新萨托菌属（Neosartorya）、根霉属（Rhizopus）及弯孢霉属（Curvularia），表明可分离得到新发丝状真菌。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.）与塞孢霉属（Scedosporium sp.）。眼结膜样本中分离率最高的真菌为念珠菌属（Candida spp.），仅1名女性受试者检出镰孢霉属（Fusarium sp.）。破椰工近乎持续暴露于外界环境与土壤中，这极可能是其真菌菌群定植与真菌感染发生的原因，且该情况会因个体行为与职业习惯存在差异。