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==Overview==
==Overview==
[[Acute (medical)|Acute]] paracoccidioidomycosis affects 5% of the patients, and it has a more rapid and severe evolution. [[Acute (medical)|Acute]] PMC primarily compromises 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 (medical)|chronic]] paracoccidioidomycosis represents 90% of the patients and has a slower evolution. [[Chronic (medical)|Chronic]] PCM 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>
[[Acute (medical)|Acute]] paracoccidioidomycosis affects 5% of the patients, and it has a more rapid and severe evolution. [[Acute (medical)|Acute]] PMC primarily compromises 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 (medical)|chronic]] paracoccidioidomycosis represents 90% of the patients and has a slower evolution. [[Chronic (medical)|Chronic]] PCM 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>


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


===Infection===
===Infection===
*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>
*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 (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>
*[[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 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 find [[Lymphadenopathy|swollen lymph nodes]] in different body regions (cervical, axilar, paravertebral and retroperitoneal ganglia). Digestive, osteoarticular and cutaneous signs and symptoms are found.   
*Patients 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>  
*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 (medical)|Chronic]] paracoccidioidomycosis represents 90% of the disease.
*[[Chronic (medical)|Chronic]] paracoccidioidomycosis represents 90% of the disease.
*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 [[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 ''[[Paracoccidioides brasiliensis|Paracoccidioides 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>


==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;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 (medical)|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>
* [[Acute (medical)|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==

Revision as of 02:30, 23 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

Acute paracoccidioidomycosis affects 5% of the patients, and it has a more rapid and severe evolution. Acute PMC primarily compromises the reticuloendothelial system organs.[1][2] Meanwhile, chronic paracoccidioidomycosis represents 90% of the patients and has a slower evolution. Chronic PCM frequently develops pulmonary symptoms which can leave severe sequela.[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.[4][5][2]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.[6]

Natural History

Infection

  • The infection can be adquired in the first decade of life. PCM infection does not manifest symptoms.[7]

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.[3]
  • 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][7]

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.[2]
  • Deaths can ocurre because of: late diagnosis, dissemination of the disease (multifocal) or sequelae.[6]

References

  1. ↑ 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. ↑ 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. ↑ 3.0 3.1 3.2 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
  4. ↑ 4.0 4.1 4.2 Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249
  5. ↑ 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. ↑ 6.0 6.1 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
  7. ↑ 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.
  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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