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| __NOTOC__ | | __NOTOC__ |
| {{Paracoccidioidomycosis}} | | {{Paracoccidioidomycosis}} |
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| | {{About1|Paracoccidioides brasiliensis}} |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}} {{AE}} {{DL}} |
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| | {{SK}} South American blastomycosis, Brazilian blastomycosis, Paraccocidioidal granuloma, Lutz-Splendore-de-Almeida disease, Almeida disease, PCM |
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| ==[[Paracoccidioidomycosis overview|Overview]]== | | ==[[Paracoccidioidomycosis overview|Overview]]== |
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| ==[[Paracoccidioidomycosis causes|Causes]]== | | ==[[Paracoccidioidomycosis causes|Causes]]== |
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| ==[[Paracoccidioidomycosis differential diagnosis|Differentiating Paracoccidioidomycosis from other Diseases]]== | | ==[[Paracoccidioidomycosis differential diagnosis|Differentiating Paracoccidioidomycosis From Other Diseases]]== |
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| ==[[Paracoccidioidomycosis epidemiology and demographics|Epidemiology and Demographics]]== | | ==[[Paracoccidioidomycosis epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| [[Paracoccidioidomycosis history and symptoms| History and Symptoms]] | [[Paracoccidioidomycosis physical examination | Physical Examination]] | [[Paracoccidioidomycosis laboratory findings|Laboratory Findings]] | [[Paracoccidioidomycosis CT|CT]] | [[Paracoccidioidomycosis other imaging findings|Other Imaging Findings]] | [[Paracoccidioidomycosis other diagnostic studies|Other Diagnostic Studies]] | | [[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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| ==Treatment== | | ==Treatment== |
| [[Paracoccidioidomycosis medical therapy|Medical Therapy]] | [[Paracoccidioidomycosis surgery|Surgery]] | [[Paracoccidioidomycosis primary prevention|Primary Prevention]] | [[Paracoccidioidomycosis secondary prevention|Secondary Prevention]] | [[Paracoccidioidomycosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Paracoccidioidomycosis future or investigational therapies|Future or Investigational Therapies]] | | [[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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| ==Case Studies== | | ==Case Studies== |
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| ==Related Chapters== | | ==Related Chapters== |
| | * [[Paracoccidioides brasiliensis]] |
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| | | [[Category:Fungal diseases]] |
| | | [[Category:Infectious diseases]] |
| == Agent==
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| ''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==
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| 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.
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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]].
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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.
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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.
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| == Treatment==
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| [[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.
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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.
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| ===Antimicrobial Regimen===
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| *'''Paracoccidioidomycosis''' <ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260 }} </ref>
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| :* Preferred regimen (1):
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| ::* Adults: [[Itraconazole]] 200 mg/day PO
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| ::* Children: [[Itraconazole]] (<30/kg and >5 yr) 5-10 mg/kg/day PO
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| ::*Note: Treatment duration based on organ involvement:
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| :::*Mild involvement: 6-9 months
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| :::*Moderate involvement: 12-18 months
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| :* Preferred regimen (2)
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| ::* Adults: [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV bid
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| ::* Children: [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, bid
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| ::* Note (1): 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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| ::*Note (2): Preferred treatment in children due to larger experience.
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| ::*Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.
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| :* Preferred regimen (3): [[Amphotericin B]] deoxycholate 1 mg/kg/day IV until patient improves and can be treated by the oral route.
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| ::*Note: Preferred in severe forms of the disease.
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| :* Alternative regimen (4): [[Ketoconazole]] 200-400 mg/day PO for 9-12 months<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
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| :* Alternative regimen (5): [[Voriconazole]] initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
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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]]
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| [[pt:Paracoccidioidomicose]]
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