Paracoccidioidomycosis natural history, complications and prognosis
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Overview
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. [3]
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. [3]
- 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%). [4] [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] [7]
Prognosis
- Acute PMC is most a critical condition as it has a rapid evolution. Juvenile PMC has higher mortality rates than adult PMC. [7]
- Deaths can ocurre because of: late diagnosis, dissemination of the disease (multifocal) or sequelae. [8]
References
- ↑ 1.0 1.1 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 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 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
- ↑ 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
- ↑ Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249
- ↑ 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 Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev.1993;Vol 6(2):89-117
- ↑ Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20