Paracoccidioidomycosis natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
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;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>
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 (medical)|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;6(2):89-117''</ref> Meanwhile, the [[Chronic (medical)|chronic]] form which represents 90% of the patients, has a more slow evolution. [[Chronic (medical)|Chronic]] PCM 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 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="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;6(2):89-117''</ref>The prognosis of paracoccidioidomycosis is good with treatment. Without treatment, PCM 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 PCM. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</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;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>


==Natural History==
==Natural History==


===Infection===
===Infection===
*The infection can be adquired in the first decade of life. PMC infection does 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>
*The infection can be adquired in the first decade of life. PCM infection does 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 PMC occurs in children and young adults. It constitutes only 3-5% of PMC 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 (medical)|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 infection. <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 infection. <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 gastrointestinal tract are 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>
*The [[reticuloendothelial system]] organs and [[gastrointestinal tract]] are 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 PMC starts with nonspecific symptoms such as fever, weight loss, weakness, anorexia, pallor, etc. Patients also find swollen lymph nodes in different body regions (cervical, axilar, paravertebral and retroperitoneal ganglia). Digestive, osteoarticular and cutaneous signs and symptoms are found. Pulmonary manifestations are rare. <ref name="a">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>  
*Acute PCM starts with nonspecific symptoms such as [[fever]], [[weight loss]], [[weakness]], [[anorexia]], [[pallor]], etc. Patients also find [[Lymphadenopathy|swollen lymph nodes]] in different body regions (cervical, axilar, paravertebral and retroperitoneal ganglia). Digestive, osteoarticular and cutaneous signs and symptoms are found. Pulmonary manifestations 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.
*[[Chronic (medical)|Chronic]] paracoccidioidomycosis represents 90% of the disease.
*The symptoms of chronic PMC usually start to develop in the third decade of life, even though the infection 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 [[Chronic (medical)|chronic]] PCM usually start to develop in the third decade of life, even though the infection 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 ''Paracoccioides spp.''
*The symptoms of paracoccidioidomycosis typically develop 20-30 years after exposure to ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]''
*Symptoms develop slowly through the years.  
*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="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>
*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="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>
Line 28: Line 26:
==Complications==
==Complications==
Paracoccidioidomycosis develops sequelae frequently:
Paracoccidioidomycosis develops sequelae frequently:
*Chronic obstructive pulmonary disease (COPD)
*[[Chronic obstructive pulmonary disease]] (COPD)
*Pulmonary fibrosis
*[[Pulmonary fibrosis]]
*Bullae  
*Bullae  
*Pulmonary hypertension
*[[Pulmonary hypertension]]
*Dyspnea
*[[Dyspnea]]
*Adrenal gland insufficiency
*[[Addison's Disease|Adrenal gland insufficiency]]
*Dysphonia  
*[[Dysphonia]]
*Laryngeal lesions (such as glottis estenosis)
*Laryngeal lesions (such as glottis estenosis)
*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</ref> <ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;6(2):89-117''</ref>
*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;6(2):89-117''</ref>


==Prognosis==
==Prognosis==
* Acute PMC is most a critical condition as it has a rapid evolution. Juvenile PMC has higher mortality rates than adult PMC. <ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;6(2):89-117''</ref>
* Acute PCM is most a critical condition as it has a rapid evolution. Juvenile PCM has higher [[Mortality rate|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 ocurre because of: late diagnosis, dissemination of the disease (multifocal) or sequelae. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
*Deaths can ocurre because of: late diagnosis, dissemination of the disease (multifocal) or [[sequelae]]. <ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
   
   
==References==
==References==

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Overview

In paracoccidioidomycosis disease, the majority of infected patients do not develop any symptoms.[1] The acute form affects 5% of the patients, and it has a more rapid and severe evolution. [2][3] Meanwhile, the chronic form which represents 90% of the patients, has a more slow evolution. Chronic PCM most frequently develops pulmonary symptoms which can leave severe sequela. [4] [5]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. [5] [6] [3]The prognosis of paracoccidioidomycosis is good with treatment. Without treatment, PCM 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 PCM. [7]

Natural History

Infection

  • The infection can be adquired in the first decade of life. PCM infection does not manifest symptoms. [1]

Acute/Subacute/Juvenile

Chronic/Adult

  • Chronic paracoccidioidomycosis represents 90% of the disease.
  • The symptoms of chronic PCM usually start to develop in the third decade of life, even though the infection can be acquired in the first decade of life. [4]
  • The symptoms of paracoccidioidomycosis typically develop 20-30 years after exposure to Paracoccidioides spp.
  • 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%). [8] [1]

Complications

Paracoccidioidomycosis develops sequelae frequently:

Prognosis

  • Acute PCM is most a critical condition as it has a rapid evolution. Juvenile PCM has higher mortality rates than adult PCM. [3]
  • Deaths can ocurre because of: late diagnosis, dissemination of the disease (multifocal) or sequelae. [7]

References

  1. ↑ 1.0 1.1 1.2 Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA (2011). "Immunology of paracoccidioidomycosis". An Bras Dermatol. 86 (3): 516–24. PMID 21738969.
  2. ↑ 2.0 2.1 2.2 2.3 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.
  3. ↑ 3.0 3.1 3.2 3.3 Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev.1993;6(2):89-117
  4. ↑ 4.0 4.1 4.2 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
  5. ↑ 5.0 5.1 5.2 Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249
  6. ↑ 6.0 6.1 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
  7. ↑ 7.0 7.1 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
  8. ↑ 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
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