Paracoccidioidomycosis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Revision as of 22:07, 21 January 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac
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
- Acute PCM occurs in children and young adults. It constitutes only 3-5% of PCM disease. [2]
- Symptoms take place weeks or months after the infection. [2]
- The reticuloendothelial system organs and gastrointestinal tract are involved at this stage of the disease. [2]
- Acute PCM 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. [4]
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:
- 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 [5] [6] [3]
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
- ↑ 1.0 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.
- ↑ 2.0 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.
- ↑ 3.0 3.1 3.2 3.3 Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev.1993;6(2):89-117
- ↑ 4.0 4.1 4.2 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
- ↑ 5.0 5.1 5.2 Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249
- ↑ 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
- ↑ 7.0 7.1 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
- ↑ 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