Paracoccidioidomycosis natural history, complications and prognosis
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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
- Acute PCM occurs in children and young adults. It constitutes only 3-5% of PCM disease.[1]
- Symptoms take place weeks or months after the infection.[1]
- The reticuloendothelial system organs and gastrointestinal tract are involved at this stage of the disease.[1]
- Acute PCM starts with nonspecific symptoms such as fever, weight loss, weakness, anorexia, pallor, etc.
- Patients 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 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:
- 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[4][5][2]
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
- ↑ 1.0 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.
- ↑ 2.0 2.1 2.2 2.3 Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev.1993;6(2):89-117
- ↑ 3.0 3.1 3.2 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
- ↑ 4.0 4.1 4.2 Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249
- ↑ 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
- ↑ 6.0 6.1 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
- ↑ 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.
- ↑ 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