Overview
Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidioides brasiliensis, typically acquired through inhalation of conidia that transform into yeast forms in the lungs, leading to granulomatous disease with potential dissemination to multiple organs 12.Diagnosis
Clinical Presentation: Often manifests as chronic pulmonary or mucocutaneous disease; acute/subacute forms can involve reticuloendothelial system 1.
Imaging: Chest X-rays may show pulmonary involvement, though often mild; other imaging modalities may reveal extrapulmonary lesions 1.
Microbiology: Culture of clinical specimens (e.g., sputum, tissue biopsies) on specialized media is definitive 23.
Serology: Detection of gp43 antigen via immunodiffusion, immunoelectrophoresis, and immunoblotting can aid in diagnosis 23.
Histopathology: Demonstrates yeast forms and granulomatous inflammation in tissue samples 23.Management
First-Line Treatment: Amphotericin B (initial induction therapy) followed by trimethoprim-sulfamethoxazole (TMP-SMX) for maintenance therapy 6 (Evidence: Moderate).
Adjunctive Therapy: Ketoconazole can be used as an alternative or adjunct to TMP-SMX 6 (Evidence: Moderate).
Monitoring: Regular follow-up with clinical evaluation, imaging, and serological monitoring to assess response and prevent relapse 4 (Evidence: Expert opinion).Special Populations
Pediatrics: Acute/subacute forms can occur, often involving reticuloendothelial system; lungs may be spared or mildly affected 1 (Evidence: Moderate).
Comorbidities: Patients with disseminated disease may develop severe complications like ARDS; early diagnosis and treatment are crucial 1 (Evidence: Weak).Key Recommendations
Early Diagnosis and Treatment: Essential for preventing dissemination and severe complications, especially in endemic areas 4 (Evidence: Moderate).
Use of TMP-SMX for Maintenance Therapy: After initial induction with Amphotericin B, TMP-SMX is effective for long-term management 6 (Evidence: Moderate).
Consider Serological Testing: Utilize gp43 antigen detection methods to support diagnosis, particularly in endemic regions 23 (Evidence: Moderate).References
1 Benard G, Costa AN, Ravanini J, Goulart S, Nicodemo EL, Barbas CS et al.. Fatal acute respiratory distress syndrome in a patient with paracoccidioidomycosis: first case report. Medical mycology 2010. link
2 Lacaz Cda S, Vidal MS, Heins-Vaccari EM, de Melo NT, Del Negro GM, Arriagada GL et al.. Paracoccidioides brasiliensis. A mycologic and immunochemical study of two strains. Revista do Instituto de Medicina Tropical de Sao Paulo 1999. link
3 Vidal MS, de Melo NT, Garcia NM, Del Negro GM, de Assis CM, Heins-Vaccari EM et al.. Paracoccidioides brasiliensis. A mycologic and immunochemical study of a sample isolated from an armadillo (Dasipus novencinctus). Revista do Instituto de Medicina Tropical de Sao Paulo 1995. link
4 Castañeda OJ, Alarcón GS, García MT, Lumbreras H. Paracoccidioides brasiliensis arthritis. Report of a case and review of the literature. The Journal of rheumatology 1985. link
5 Severo LC, Porto NS, Camargo JJ, Geyer GR. Multiple paracoccidioidomas simulating Wegener's granulomatosis. Mycopathologia 1985. link
6 Benoldi D, Alinovi A, Pezzarossa E, Bassissi P, Polonelli L. Paracoccidioidomycosis (South American blastomycosis): a report of an imported case previously diagnosed as tuberculosis. European journal of epidemiology 1985. link
7 Carbonell LM. Intrayeast hyphae in Paracoccidioides brasiliensis. Journal of bacteriology 1969. link