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==Overview== | ==Overview== | ||
Among all infected patients 5% are acute with a more rapid and severe progression compared to the chronic subtype. Acute PMC primarily affects the reticuloendothelial system organs.<ref name="pmid22236894">{{cite journal| author=Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL et al.| title=Thoracic paracoccidioidomycosis: radiographic and CT findings. | journal=Radiographics | year= 2012 | volume= 32 | issue= 1 | pages= 71-84 | pmid=22236894 | doi=10.1148/rg.321115052 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22236894 }} </ref><ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;6(2):89-117''</ref> Meanwhile, chronic paracoccidioidomycosis represents 90% of infected patients and has a slower progression. Patients with chronic PCM frequently develops pulmonary symptoms.<ref name="a">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref><ref name="b">Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. ''J. bras. pneumol.'' 2009; 35(12):1245-1249 </ref> Complications that can develop as a result of PCM are [[chronic obstructive pulmonary disease]] (COPD), [[pulmonary fibrosis]], bullae, [[pulmonary hypertension]], [[dyspnea]], [[Addison's disease|adrenal gland insufficiency]], [[dysphonia]], laryngeal lesions (such as glottis estenosis), [[microstomia]], [[seizures]], and motor deficiency.<ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;6(2):89-117''</ref><ref name="b">Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. ''J. bras. pneumol.'' 2009; 35(12):1245-1249 </ref><ref name="c">Francesconi F, da Silva MT, Costa RL, et al. Long-term outcome of neuroparacoccidioidomycosis treatment. ''Rev Soc Bras Med Trop.'' 2011;44(1):22-25</ref> The prognosis of paracoccidioidomycosis is good with adequate treatment. Without treatment, death is due to PCM related complications.<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> | |||
==Natural History== | ==Natural History== | ||
===Infection=== | ===Latent Paracoccidioides Infection=== | ||
* | *Latent paracoccidioides infection can be adquired in the first decade of life. | ||
*Patienes with latent PCM infection do not manifest symptoms.<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref> | |||
===Acute/Subacute/Juvenile=== | ===Acute/Subacute/Juvenile=== | ||
* | *Acute PCM occurs in children and young adults. It constitutes only 3-5% of PCM disease.<ref name="pmid22236894">{{cite journal| author=Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL et al.| title=Thoracic paracoccidioidomycosis: radiographic and CT findings. | journal=Radiographics | year= 2012 | volume= 32 | issue= 1 | pages= 71-84 | pmid=22236894 | doi=10.1148/rg.321115052 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22236894 }} </ref> | ||
*Symptoms take place weeks or months after the | *Symptoms take place weeks or months after the transmission.<ref name="pmid22236894">{{cite journal| author=Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL et al.| title=Thoracic paracoccidioidomycosis: radiographic and CT findings. | journal=Radiographics | year= 2012 | volume= 32 | issue= 1 | pages= 71-84 | pmid=22236894 | doi=10.1148/rg.321115052 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22236894 }} </ref> | ||
*The [[reticuloendothelial system]] organs and | *The [[reticuloendothelial system]] organs and gastrointestinal tract are usually involved at this stage of the disease.<ref name="pmid22236894">{{cite journal| author=Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL et al.| title=Thoracic paracoccidioidomycosis: radiographic and CT findings. | journal=Radiographics | year= 2012 | volume= 32 | issue= 1 | pages= 71-84 | pmid=22236894 | doi=10.1148/rg.321115052 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22236894 }} </ref> | ||
*Acute PCM starts with nonspecific symptoms such as [[fever]], [[weight loss]], [[weakness]], [[anorexia]], [[pallor]], etc. | *Acute PCM starts with nonspecific symptoms such as [[fever]], [[weight loss]], [[weakness]], [[anorexia]], [[pallor]], etc. | ||
*Patients | *Patients may also report [[Lymphadenopathy|swollen lymph nodes]] in different body regions (cervical, axilar, paravertebral and retroperitoneal ganglia). Digestive, osteoarticular and cutaneous signs and symptoms may also be present. | ||
*Pulmonary manifestations are rare. <ref name="a">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | *Pulmonary manifestations in the acute for are rare.<ref name="a">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | ||
===Chronic/Adult=== | ===Chronic/Adult=== | ||
* | *Chronic paracoccidioidomycosis represents 90% of the disease. | ||
*The symptoms of | *The symptoms of chronic PCM usually start to progress in the third decade of life, even though the organism can be acquired in the first decade of life.<ref name="a">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref> | ||
*The symptoms of paracoccidioidomycosis typically develop 20-30 years after exposure to ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' | *The symptoms of paracoccidioidomycosis typically develop 20-30 years after exposure to ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' | ||
* | *PCM symptoms develop slowly through the years. | ||
*Patients develop pulmonary symptoms (90%), with or without nonespecific symptoms. Nevertheless, other symptoms can occur such as cutaneous or mucosal lesions (51-82%). <ref name="?">Morón C, Ivanov M, Verea M, Pecotche D. Paracoccidioidomicosis, presentación de la casuística de diez años y revisión de la literatura. ''Arch. Argent. Dermatol''. 2012; 62: 92-97</ref> <ref name=" | *Patients develop pulmonary symptoms (90%), with or without nonespecific symptoms. Nevertheless, other symptoms can occur such as cutaneous or mucosal lesions (51-82%).<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref><ref name="?">Morón C, Ivanov M, Verea M, Pecotche D. Paracoccidioidomicosis, presentación de la casuística de diez años y revisión de la literatura. ''Arch. Argent. Dermatol''. 2012; 62: 92-97</ref> | ||
*[[Paracoccidioides brasiliensis|''Paracoccidioides'']] can enter the bloodstream and disseminate to CNS and cause neuroparacoccidioidomycosis.<ref name="pmid1234146">{{cite journal| author=Passl R, Staudacher M, Szalay S, Kobienia G, Martinek H| title=[Problems and surgical therapy in the neglected Paget-Schroetter syndrome]. | journal=Hefte Unfallheilkd | year= 1975 | volume= | issue= 126 | pages= 170-1 | pmid=1234146 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1234146 }} </ref> | |||
==Complications== | ==Complications== | ||
=== Acute paracoccidioidomycosis complications include === | |||
*Bone marrow failure | |||
=== Chronic paracoccidioidomycosis complications include === | |||
*[[Chronic obstructive pulmonary disease]] (COPD) | *[[Chronic obstructive pulmonary disease]] (COPD) | ||
*[[Pulmonary fibrosis]] | *[[Pulmonary fibrosis]] | ||
| Line 38: | Line 44: | ||
*[[Microstomia]] | *[[Microstomia]] | ||
*[[Seizures]] | *[[Seizures]] | ||
*Motor deficiency <ref name="b">Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. ''J. bras. pneumol.'' 2009; 35(12):1245-1249 </ref> <ref name="c">Francesconi F, da Silva MT, Costa RL, et al. Long-term outcome of neuroparacoccidioidomycosis treatment. ''Rev Soc Bras Med Trop.'' 2011;44(1):22-25 | *Motor deficiency<ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;6(2):89-117''</ref><ref name="b">Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. ''J. bras. pneumol.'' 2009; 35(12):1245-1249 </ref><ref name="c">Francesconi F, da Silva MT, Costa RL, et al. Long-term outcome of neuroparacoccidioidomycosis treatment. ''Rev Soc Bras Med Trop.'' 2011;44(1):22-25</ref> | ||
==Prognosis== | ==Prognosis== | ||
* | * The prognosis varies with the type of infection; chronic PCM have the most favorable prognosis with adequate treatment. | ||
*Deaths can | * Juvenile PCM has higher mortality rates than adult PCM.<ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;6(2):89-117''</ref> | ||
*Deaths can occur because of late diagnosis, dissemination of the disease (multifocal) or development of complications.<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> | |||
==References== | ==References== | ||
Latest revision as of 21:08, 12 February 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac
Overview
Among all infected patients 5% are acute with a more rapid and severe progression compared to the chronic subtype. Acute PMC primarily affects the reticuloendothelial system organs.[1][2] Meanwhile, chronic paracoccidioidomycosis represents 90% of infected patients and has a slower progression. Patients with chronic PCM frequently develops pulmonary symptoms.[3][4] Complications that can develop as a result of PCM are chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, bullae, pulmonary hypertension, dyspnea, adrenal gland insufficiency, dysphonia, laryngeal lesions (such as glottis estenosis), microstomia, seizures, and motor deficiency.[2][4][5] The prognosis of paracoccidioidomycosis is good with adequate treatment. Without treatment, death is due to PCM related complications.[6]
Natural History
Latent Paracoccidioides Infection
- Latent paracoccidioides infection can be adquired in the first decade of life.
- Patienes with latent PCM infection do not manifest symptoms.[7]
Acute/Subacute/Juvenile
- Acute PCM occurs in children and young adults. It constitutes only 3-5% of PCM disease.[1]
- Symptoms take place weeks or months after the transmission.[1]
- The reticuloendothelial system organs and gastrointestinal tract are usually involved at this stage of the disease.[1]
- Acute PCM starts with nonspecific symptoms such as fever, weight loss, weakness, anorexia, pallor, etc.
- Patients may also report swollen lymph nodes in different body regions (cervical, axilar, paravertebral and retroperitoneal ganglia). Digestive, osteoarticular and cutaneous signs and symptoms may also be present.
- Pulmonary manifestations in the acute for are rare.[3]
Chronic/Adult
- Chronic paracoccidioidomycosis represents 90% of the disease.
- The symptoms of chronic PCM usually start to progress in the third decade of life, even though the organism can be acquired in the first decade of life.[3]
- The symptoms of paracoccidioidomycosis typically develop 20-30 years after exposure to Paracoccidioides spp.
- PCM symptoms develop slowly through the years.
- Patients develop pulmonary symptoms (90%), with or without nonespecific symptoms. Nevertheless, other symptoms can occur such as cutaneous or mucosal lesions (51-82%).[7][8]
- Paracoccidioides can enter the bloodstream and disseminate to CNS and cause neuroparacoccidioidomycosis.[9]
Complications
Acute paracoccidioidomycosis complications include
- Bone marrow failure
Chronic paracoccidioidomycosis complications include
- Chronic obstructive pulmonary disease (COPD)
- Pulmonary fibrosis
- Bullae
- Pulmonary hypertension
- Dyspnea
- Adrenal gland insufficiency
- Dysphonia
- Laryngeal lesions (such as glottis estenosis)
- Microstomia
- Seizures
- Motor deficiency[2][4][5]
Prognosis
- The prognosis varies with the type of infection; chronic PCM have the most favorable prognosis with adequate treatment.
- Juvenile PCM has higher mortality rates than adult PCM.[2]
- Deaths can occur because of late diagnosis, dissemination of the disease (multifocal) or development of complications.[6]
References
- ↑ 1.0 1.1 1.2 1.3 Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL; et al. (2012). "Thoracic paracoccidioidomycosis: radiographic and CT findings". Radiographics. 32 (1): 71–84. doi:10.1148/rg.321115052. PMID 22236894.
- ↑ 2.0 2.1 2.2 2.3 Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev.1993;6(2):89-117
- ↑ 3.0 3.1 3.2 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
- ↑ 4.0 4.1 4.2 Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249
- ↑ 5.0 5.1 Francesconi F, da Silva MT, Costa RL, et al. Long-term outcome of neuroparacoccidioidomycosis treatment. Rev Soc Bras Med Trop. 2011;44(1):22-25
- ↑ 6.0 6.1 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
- ↑ 7.0 7.1 Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA (2011). "Immunology of paracoccidioidomycosis". An Bras Dermatol. 86 (3): 516–24. PMID 21738969.
- ↑ Morón C, Ivanov M, Verea M, Pecotche D. Paracoccidioidomicosis, presentación de la casuística de diez años y revisión de la literatura. Arch. Argent. Dermatol. 2012; 62: 92-97
- ↑ Passl R, Staudacher M, Szalay S, Kobienia G, Martinek H (1975). "[Problems and surgical therapy in the neglected Paget-Schroetter syndrome]". Hefte Unfallheilkd (126): 170–1. PMID 1234146.