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| {{Infobox_Disease |
| | __NOTOC__ |
| Name = {{PAGENAME}} |
| | {{Paracoccidioidomycosis}} |
| Image = Paracoccidioides brasiliensis 01.jpg |
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| Caption = [[Paracoccidioides brasiliensis]] |
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| DiseasesDB = 29815 |
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| ICD10 = {{ICD10|B|41||b|35}} |
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| ICD9 = {{ICD9|116.1}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = med |
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| eMedicineTopic = 1731 |
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| MeshID = D010229 |
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| }} | |
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| {{CMG}} | | {{About1|Paracoccidioides brasiliensis}} |
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| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| | {{CMG}} {{AE}} {{DL}} |
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| {{SI}} | | {{SK}} South American blastomycosis, Brazilian blastomycosis, Paraccocidioidal granuloma, Lutz-Splendore-de-Almeida disease, Almeida disease, PCM |
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| ==Overview== | | ==[[Paracoccidioidomycosis overview|Overview]]== |
| '''Paracoccidioidomycosis''' (also known as '''Lutz-Splendore-Almeida disease''' or '''Brazilian blastomycosis''') is a [[mycosis]] caused by the [[fungus]] ''[[Paracoccidioides brasiliensis]]''. Sometimes called ''South American blastomycosis'', paracoccidioidomycosis is caused by a different fungus than that which causes [[blastomycosis]].
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| == Agent== | | ==[[Paracoccidioidomycosis historical perspective|Historical Perspective]]== |
| ''P. brasiliensis'' is a thermally-dimorphic fungus distributed in Brazil and South America. The habitat of the infectious agent is not known but appears to be aquatic. In [[biopsies]] the fungus appears as a polygemulating<!-- not a real word? --> yeast with a pilot's wheel-like appearance.
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| == Disease== | | ==[[Paracoccidioidomycosis classification|Classification]]== |
| Paracoccidioidomycosis is a [[systemic mycosis]] caused by the dimorphic fungus Paracoccidioides. It frequently involves [[mucous membrane]]s, [[lymph node]]s, bone and lungs and requires some degree of host [[immunosuppression]].
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| Primary infection is thought to be autolimited and almost asymptomatic as [[histoplasmosis]] or Valley Fever. In young people, there is a progressive form of the disease (akin of tuberculous [[septicemia]] in tuberculous priminfection) with high prostrating fever, generalized [[lymphadenopathy]] and pulmonary involvement with milliary lesions. This juvenile form has a more severe prognosis even with treatment. The most common form is the so called adult form of paracoccidioidomycosis that is almost certainly a reactivation of the disease.
| | ==[[Paracoccidioidomycosis pathophysiology|Pathophysiology]]== |
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| Painful lesions with a violaceous hue in lips and oral mucosa are common as is cervical lymphadenitis teeming with polygemulating yeasts in the biopsy. In this form, differential diagnosis must be made with mucocutaneous [[leishmaniasis]], [[yaws]] and [[Tuberculosis|TB]].
| | ==[[Paracoccidioidomycosis causes|Causes]]== |
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| [[Pulmonary]] involvement is also common, it starts as [[lobar pneumonia]] or [[pleurisy]] but without remission at ninth day; the patient remains [[febrile]], [[cough]]s, [[loses weight]] and the [[X rays]] reveal milliary shadows throughout lung fields. Other organs can be involved, like bones, [[meninges]], arteries and [[spleen]] but this is very rare. | | ==[[Paracoccidioidomycosis differential diagnosis|Differentiating Paracoccidioidomycosis From Other Diseases]]== |
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| Diagnosis is made with a biopsy of affected tissue, this shows the characteristic helm-shaped yeasts and culture shows the agent. Serology is also used in endemic areas.
| | ==[[Paracoccidioidomycosis epidemiology and demographics|Epidemiology and Demographics]]== |
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| == Treatment== | | ==[[Paracoccidioidomycosis risk factors|Risk Factors]]== |
| [[Sulphonamide]]s are the traditional remedies to paracoccidiodomycosis. They were introduced by Oliveira Ribeiro and used for more than fifty years with good results. The most used [[sulfa drugs]] in this infection are sulfadimethoxime, [[sulfadiazine]] and [[co-trimoxazole]]. This treatment is generally safe but several adverse effects can appear, the most severe of which are the [[Stevens Johnson Syndrome]] and [[agranulocytosis]]. It must be continued for up to 3 years to obtain cure and relapse and treatment failures aren't unusual. | |
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| Antifungal drugs like [[Amphotericin B]] or [[Ketoconazole]] are also effective in clearing the infection but they are very expensive compared with sulphonamides.
| | ==[[Paracoccidioidomycosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| During therapy [[fibrosis]] can appear and a surgery be needed to correct this. Other possible complication is Addisonian crisis. The death rate is around ten percent.
| | ==Diagnosis== |
| | [[Paracoccidioidomycosis diagnostic criteria| Diagnostic Criteria]] | [[Paracoccidioidomycosis history and symptoms| History and Symptoms]] | [[Paracoccidioidomycosis physical examination | Physical Examination]] | [[Paracoccidioidomycosis laboratory findings|Laboratory Findings]] | [[Paracoccidioidomycosis imaging findings|Imaging Findings]] |
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| ===Antimicrobial Regimen=== | | ==Treatment== |
| *Paracoccidioidomycosis
| | [[Paracoccidioidomycosis medical therapy|Medical Therapy]] | [[Paracoccidioidomycosis surgery|Surgery]] | [[Paracoccidioidomycosis primary prevention|Primary Prevention]] | [[Paracoccidioidomycosis secondary prevention|Secondary Prevention]] | [[Paracoccidioidomycosis future or investigational therapies|Future or Investigational Therapies]] |
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| :*Preferred regimen(1):
| | ==Case Studies== |
| ::* Adults [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV divided into two doses per day
| | [[Paracoccidioidomycosis case study one|Case#1]] |
| ::* Children [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, divided into two doses per day
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| ::* Note: Treatment duration based on organ involvement:
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| :::*Minor involvement: 12 months
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| :::*Moderate involvement: 18-24 months
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| :*Preferred regimen(2): [[Ketoconazole]] 200-400 mg/day PO for 9-12 months
| | ==Related Chapters== |
| | * [[Paracoccidioides brasiliensis]] |
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| :*Preferred regimen(3):
| | [[Category:Fungal diseases]] |
| ::*Adults: [[Itraconazole]] 600 mg/day PO for 3 days; continue 200 mg/day PO for 6-9 months
| | [[Category:Infectious diseases]] |
| ::*Children: [[Itraconazole]] (<30/kg and >5 yr) 5-10 mg/kg/day PO for 6-9 months
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| :*Preferred regimen(4): [[Voriconazole]] initial dose 400 mg PO/IV each 12 hr for one day, then 200 mg each 12 hr for 6 months
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| ::*Note: Diminish the dose to 50% if weight is <40 kg
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| ==External links==
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| * {{MerckManual|13|158|e}}
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| * [http://www.mycology.adelaide.edu.au/Mycoses/Dimorphic_systemic/Paracoccidioidomycosis/ Overview] at University of Adelaide
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| {{Mycoses}}
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| [[es:Paracoccidioidomicosis]]
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| [[it:Paracoccidioidomicosi]] | |
| [[pt:Paracoccidioidomicose]] | |
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