Paracoccidioidomycosis
|
Paracoccidioidomycosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Paracoccidioidomycosis On the Web |
|
American Roentgen Ray Society Images of Paracoccidioidomycosis |
|
Risk calculators and risk factors for Paracoccidioidomycosis |
For patient information click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Paracoccidioidomycosis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | CT | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Case Studies
Related Chapters
Treatment
Sulphonamides are the traditional remedies to paracoccidiodomycosis. They were introduced by Oliveira Ribeiro and used for more than fifty years with good results. The most used sulfa drugs in this infection are sulfadimethoxime, sulfadiazine and co-trimoxazole. This treatment is generally safe but several adverse effects can appear, the most severe of which are the Stevens Johnson Syndrome and agranulocytosis. It must be continued for up to 3 years to obtain cure and relapse and treatment failures aren't unusual.
Antifungal drugs like Amphotericin B or Ketoconazole are also effective in clearing the infection but they are very expensive compared with sulphonamides.
During therapy fibrosis can appear and a surgery be needed to correct this. Other possible complication is Addisonian crisis. The death rate is around ten percent.
Antimicrobial Regimen
- Paracoccidioidomycosis [1]
- Preferred regimen (1):
- Adults: Itraconazole 200 mg/day PO
- Children: Itraconazole (<30/kg and >5 yr) 5-10 mg/kg/day PO
- Note: Treatment duration based on organ involvement:
- Mild involvement: 6-9 months
- Moderate involvement: 12-18 months
- Preferred regimen (2)
- Adults: Trimethoprim/sulfamethoxazole (TMP/SMX) TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV bid
- Children: Trimethoprim/sulfamethoxazole (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, bid
- Note (1): Treatment duration based on organ involvement:
- Minor involvement: 12 months
- Moderate involvement: 18-24 months
- Note (2): Preferred treatment in children due to larger experience.
- Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.
- Preferred regimen (3): Amphotericin B deoxycholate 1 mg/kg/day IV until patient improves and can be treated by the oral route.
- Note: Preferred in severe forms of the disease.
- Alternative regimen (4): Ketoconazole 200-400 mg/day PO for 9-12 months[2]
- Alternative regimen (5): Voriconazole initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months[3]
- Note: Diminish the dose to 50% if weight is <40 kg.
External links
- Template:MerckManual
- Overview at University of Adelaide
Template:Mycoses
it:Paracoccidioidomicosi
- ↑ Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML (2006). "[Guidelines in paracoccidioidomycosis]". Rev Soc Bras Med Trop. 39 (3): 297–310. PMID 16906260.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.