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;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>
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, motor deficiency. <nowiki><ref name=b> Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. </nowiki>''J. bras. pneumol.'' 2009; 35(12):1245-1249 <nowiki></ref></nowiki> <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. 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. 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==
Line 17: Line 17:
*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 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>  


===Chronic/Adult===
===Chronic/Adult===
*Chronic paracoccidioidomycosis represents 90% of the disease.
*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 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 paracoccidioidomycosis typically develop 20-30 years after exposure to ''Paracoccioides spp.''
*The symptoms of paracoccidioidomycosis typically develop 20-30 years after exposure to ''Paracoccioides 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>


==Complications==
==Complications==
Line 38: Line 38:
*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;Vol 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;Vol 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;Vol 6(2):89-117</ref>
* 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;Vol 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==

Revision as of 15:31, 19 January 2016

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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 PMC most frequently develops pulmonary symptoms which can leave severe sequela. [4] [5] 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> [6] [3] The prognosis of paracoccidioidomycosis is good with treatment. Without treatment, PMC will result in death. The presence of late diagnosis and sequelae is associated with a particularly poor prognosis among patients with PMC. [7]

Natural History

Infection

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

Acute/Subacute/Juvenile

  • Acute PMC occurs in children and young adults. It constitutes only 3-5% of PMC 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 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. [4]

Chronic/Adult

  • 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. [4]
  • The symptoms of paracoccidioidomycosis typically develop 20-30 years after exposure to Paracoccioides 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 PMC is most a critical condition as it has a rapid evolution. Juvenile PMC has higher mortality rates than adult PMC. [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;Vol 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 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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