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==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]]. Lutz-Splendore-de Almeida disease is named for the physicians Adolfo Lutz, Alfonso Splendore, and Floriano Paulo de Almeida, who first characterized the disease in Brazil in the early 20th century. <ref> Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016</ref> Paracoccidioidomycosis may be classified according to Franco et al. in 1987 into: paracoccidioidomycosis infection, paracoccidioidomycosis disease, paracoccidioidomycosis associated with inmunosupression and residual form (sequela). Based on the duration of symptoms, paracoccidioidomycosis disease may be classified into: acute, subacute or chronic. The chronic form can be subclassified into: unifocal and multifocal.<ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref><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>Spores of ''Paracoccidioides spp.'' are commonly transmitted via the respiratory route to the human host. Following transmission, ''Paracoccidiodes spp.'' particles invade the terminal bronchioles and alveoli where granulomas are formed, but can be inactive for approximately 40 years. <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> On microscopic histopathological analysis, a pilot's wheel or Mickey mouse ears-like appearance are a characteristic finding of PMC. <ref> Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016</ref> <ref name=?> Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. ''CID''. 1996; 23: 1026-1032 </ref> <ref name=paper>Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>Common risk factors in the development of paracoccidioidomycosis disease are: age, gender, poor hygiene, occupation, malnutrition, tabacco and alcohol consumption. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref> <ref name="pmid25076426">{{cite journal| author=Magalhães EM, Ribeiro Cde F, Dâmaso CS, Coelho LF, Silva RR, Ferreira EB et al.| title=Prevalence of paracoccidioidomycosis infection by intradermal reaction in rural areas in Alfenas, Minas Gerais, Brazil. | journal=Rev Inst Med Trop Sao Paulo | year= 2014 | volume= 56 | issue= 4 | pages= 281-5 | pmid=25076426 | doi= | pmc=PMC4131811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25076426  }} </ref> In paracoccidioidomycosis disease, the majority of infected patients do not develop any 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> The acute form affects 5% of the patients, and it has a more rapid and severe evolution. <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;Vol 6(2):89-117''</ref> Meanwhile, the chronic form which represents 90% of the patients, has a more slow evolution. Chronic PMC most frequently develops pulmonary symptoms which can leave severe sequela. <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>
'''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]]. Lutz-Splendore-de Almeida disease is named for the physicians Adolfo Lutz, Alfonso Splendore, and Floriano Paulo de Almeida, who first characterized the disease in Brazil in the early 20th century. <ref> Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016</ref> Paracoccidioidomycosis may be classified according to Franco et al. in 1987 into: paracoccidioidomycosis infection, paracoccidioidomycosis disease, paracoccidioidomycosis associated with inmunosupression and residual form (sequela). Based on the duration of symptoms, paracoccidioidomycosis disease may be classified into: acute, subacute or chronic. The chronic form can be subclassified into: unifocal and multifocal.<ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref><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>Spores of ''Paracoccidioides spp.'' are commonly transmitted via the respiratory route to the human host. Following transmission, ''Paracoccidiodes spp.'' particles invade the terminal bronchioles and alveoli where granulomas are formed, but can be inactive for approximately 40 years. <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> On microscopic histopathological analysis, a pilot's wheel or Mickey mouse ears-like appearance are a characteristic finding of PMC. <ref> Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016</ref> <ref name=?> Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. ''CID''. 1996; 23: 1026-1032 </ref> <ref name=paper>Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>Common risk factors in the development of paracoccidioidomycosis disease are: age, gender, poor hygiene, occupation, malnutrition, tabacco and alcohol consumption. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref> <ref name="pmid25076426">{{cite journal| author=Magalhães EM, Ribeiro Cde F, Dâmaso CS, Coelho LF, Silva RR, Ferreira EB et al.| title=Prevalence of paracoccidioidomycosis infection by intradermal reaction in rural areas in Alfenas, Minas Gerais, Brazil. | journal=Rev Inst Med Trop Sao Paulo | year= 2014 | volume= 56 | issue= 4 | pages= 281-5 | pmid=25076426 | doi= | pmc=PMC4131811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25076426  }} </ref> In paracoccidioidomycosis disease, the majority of infected patients do not develop any 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> The acute form affects 5% of the patients, and it has a more rapid and severe evolution. <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;Vol 6(2):89-117''</ref> Meanwhile, the chronic form which represents 90% of the patients, has a more slow evolution. Chronic PMC most frequently develops pulmonary symptoms which can leave severe sequela. <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 PMC are: 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. <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> <ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;Vol 6(2):89-117''</ref>
Complications that can develop as a result of PMC 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. <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> <ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;Vol 6(2):89-117''</ref>
The prognosis of paracoccidioidomycosis is good with treatment. Without treatment, PMC will result in death due to disease complications. The presence of late diagnosis and sequelae is associated with a particularly poor prognosis among patients with PMC. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
The prognosis of paracoccidioidomycosis is good with treatment. Without treatment, PMC will result in death due to disease complications. The presence of late diagnosis and sequelae is associated with a particularly poor prognosis among patients with PMC. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac

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. Lutz-Splendore-de Almeida disease is named for the physicians Adolfo Lutz, Alfonso Splendore, and Floriano Paulo de Almeida, who first characterized the disease in Brazil in the early 20th century. [1] Paracoccidioidomycosis may be classified according to Franco et al. in 1987 into: paracoccidioidomycosis infection, paracoccidioidomycosis disease, paracoccidioidomycosis associated with inmunosupression and residual form (sequela). Based on the duration of symptoms, paracoccidioidomycosis disease may be classified into: acute, subacute or chronic. The chronic form can be subclassified into: unifocal and multifocal.[2][3]Spores of Paracoccidioides spp. are commonly transmitted via the respiratory route to the human host. Following transmission, Paracoccidiodes spp. particles invade the terminal bronchioles and alveoli where granulomas are formed, but can be inactive for approximately 40 years. [3] On microscopic histopathological analysis, a pilot's wheel or Mickey mouse ears-like appearance are a characteristic finding of PMC. [4] [5] [6]Common risk factors in the development of paracoccidioidomycosis disease are: age, gender, poor hygiene, occupation, malnutrition, tabacco and alcohol consumption. [2] [7] In paracoccidioidomycosis disease, the majority of infected patients do not develop any symptoms.[3] The acute form affects 5% of the patients, and it has a more rapid and severe evolution. [8][9] Meanwhile, the chronic form which represents 90% of the patients, has a more slow evolution. Chronic PMC most frequently develops pulmonary symptoms which can leave severe sequela. [10] [11] Complications that can develop as a result of PMC 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. [11] [12] [9] The prognosis of paracoccidioidomycosis is good with treatment. Without treatment, PMC will result in death due to disease complications. The presence of late diagnosis and sequelae is associated with a particularly poor prognosis among patients with PMC. [13]

Historical Perspective

Lutz-Splendore-de Almeida disease is named for the physicians Adolfo Lutz, Alfonso Splendore, and Floriano Paulo de Almeida, who first characterized the disease in Brazil in the early 20th century. [14]

Classification

Paracoccidioidomycosis may be classified according to Franco et al. in 1987 into: paracoccidioidomycosis infection, paracoccidioidomycosis disease, paracoccidioidomycosis associated with inmunosupression and residual form (sequela). Based on the duration of symptoms, paracoccidioidomycosis disease may be classified into: acute, subacute or chronic. The chronic form can be subclassified into: unifocal and multifocal.[2][3]Paracoccidioidomycosis tends to affect agriculture workers from southern Mexico to northern Argentina. Paracoccidioidomycosis is prevalent in Brazil, Colombia, Venezuela, and Argentina, and is classically associated with individuals from rural areas. The typical patient is a man aged 30 to 50 years. [15] PMC disease affects men, more commonly than women. However, PMC infection can affect anyone. [3]

Pathophysiology

Spores of Paracoccidioides spp. are commonly transmitted via the respiratory route to the human host. Following transmission, Paracoccidiodes spp. particles invade the terminal bronchioles and alveoli where granulomas are formed, but can be inactive for approximately 40 years. [3] On microscopic histopathological analysis, a pilot's wheel or Mickey mouse ears-like appearance are a characteristic finding of PMC. [16] [5] [6]

Causes

Paracoccidioidomycosis may be caused by either Paracoccidioides brasiliensis or Paracoccidioides lutzii.

Differential Diagnosis

Paracoccidioidomycosis must be differentiated from tuberculosis, histoplasmosis and metastasis. [17]

Epidemiology and Demographics

Paracoccidioidomycosis has been reported as an autochthonous disease, that tends to affect agriculture workers from southern Mexico to northern Argentina. Paracoccidioidomycosis is prevalent in Brazil, Colombia, Venezuela, and Argentina, and is classically associated with individuals from rural areas. The typical patient is a man aged 30 to 50 years. [18] PMC disease affects men, more commonly than women. However, PMC infection can affect anyone. [3]

Risk Factors

Common risk factors in the development of paracoccidioidomycosis disease are: age, gender, poor hygiene, occupation, malnutrition, tabacco and alcohol consumption. [2] [7]

Natural History, Complications and Prognosis

In paracoccidioidomycosis disease, the majority of infected patients do not develop any symptoms.[3] The acute form affects 5% of the patients, and it has a more rapid and severe evolution. [8][9] Meanwhile, the chronic form which represents 90% of the patients, has a more slow evolution. Chronic PMC most frequently develops pulmonary symptoms which can leave severe sequela. [10] [11] Complications that can develop as a result of PMC are: 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. [11] [12] [9] The prognosis of paracoccidioidomycosis is good with treatment. Without treatment, PMC will result in death due to disease complications. The presence of late diagnosis and sequelae is associated with a particularly poor prognosis among patients with PMC. [13]

References

  1. ↑ Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016
  2. ↑ 2.0 2.1 2.2 2.3 de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F; et al. (2015). "Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis". Front Microbiol. 6: 1319. doi:10.3389/fmicb.2015.01319. PMC 4658449. PMID 26635779.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA (2011). "Immunology of paracoccidioidomycosis". An Bras Dermatol. 86 (3): 516–24. PMID 21738969.
  4. ↑ Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016
  5. ↑ 5.0 5.1 Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. CID. 1996; 23: 1026-1032
  6. ↑ 6.0 6.1 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
  7. ↑ 7.0 7.1 Magalhães EM, Ribeiro Cde F, Dâmaso CS, Coelho LF, Silva RR, Ferreira EB; et al. (2014). "Prevalence of paracoccidioidomycosis infection by intradermal reaction in rural areas in Alfenas, Minas Gerais, Brazil". Rev Inst Med Trop Sao Paulo. 56 (4): 281–5. PMC 4131811. PMID 25076426.
  8. ↑ 8.0 8.1 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.
  9. ↑ 9.0 9.1 9.2 9.3 Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev.1993;Vol 6(2):89-117
  10. ↑ 10.0 10.1 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
  11. ↑ 11.0 11.1 11.2 11.3 Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249
  12. ↑ 12.0 12.1 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
  13. ↑ 13.0 13.1 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
  14. ↑ Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016
  15. ↑ Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016
  16. ↑ Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016
  17. ↑ Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. CID. 1996; 23:1026-1032
  18. ↑ Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016
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