Residual Pulmonary Abnormalities in Adult Patients with Chronic Paracoccidioidomycosis: Prolonged Follow-Up after Itraconazole Therapy (original) (raw)
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Pulmonary Paracoccidioidomycosis
Seminars in Respiratory and Critical Care Medicine, 2011
Paracoccidioidomycosis is a subacute or chronic systemic mycosis caused by Paracoccidioides brasiliensis, a soil saprophyte and thermally dimorphic fungus. The disease occurs mainly in rural workers in Latin America and is the most frequent endemic systemic mycosis in many countries of South America, where almost 10 million people are believed to be infected. Paracoccidioidomycosis should be regarded as a disease of travelers outside the endemic area. The primary pulmonary infection is subclinical in most cases, and individuals may remain infected throughout life without ever developing clinical signs. A small proportion of patients present with clinical disease. The lungs are frequently involved, and the pulmonary clinical manifestations must be differentiated from many other infectious and noninfectious conditions. Diagnosis should be based on epidemiological, clinical, and microbiological data. Effective treatment regimens are available to control the fungal infection, but most patients develop fibrotic sequelae that may severely hamper respiratory and adrenal function and the patient's well-being.
The lung in paracoccidioidomycosis: new insights into old problems
Clinics (São Paulo, Brazil), 2013
Chronic paracoccidioidomycosis can diffusely affect the lungs. Even after antifungal therapy, patients may present with residual respiratory abnormalities due to fungus-induced lung fibrosis. A cross-sectional analysis of 50 consecutive inactive, chronic paracoccidioidomycosis patients was performed using high resolution computed tomography, pulmonary function tests, ergospirometry, the six-minute walk test and health-related quality of life questionnaires. Radiological abnormalities were present in 98% of cases, the most frequent of which were architectural distortion (90%), reticulate and septal thickening (88%), centrilobular and paraseptal emphysema (84%) and parenchymal bands (74%). Patients typically presented with a mild obstructive disorder and a mild reduction in diffusion capacity with preserved exercise capacity, including VO2max and six-minute walking distance. Patient evaluation with the Saint-George Respiratory Questionnaire showed low impairment in the health-related ...
Pulmonary Paracoccidioidomycosis: Clinical, Immunological and Histopathological Aspects
Lung Diseases - Selected State of the Art Reviews, 2012
diversity and exclusive morphogenetic characteristics, a different species, designated as P.lutzi, has been proposed (Teixeira et al., 2009). 2.1 General concepts on ecology Geography sets PCM apart from other endemic mycoses of the Americas, such as histoplasmosis and coccidioidomycosis, as it is strictly confined to Latin America from Mexico at 23° North to Argentina at 34° South (Colombo et al., 2011; Nucci et al., 2009; Restrepo et al., 2011). The endemic areas are thus contained within the Tropics of Cancer and Capricorn (Bonifaz, 2010). PCM, however, is much more frequently reported in Souththan in Central-American countries respecting Chile, Surinam, the Guyana, Nicaragua and Belize and with rare exceptions (one case each in Trinidad, Grenada and Guadeloupe), also the Caribbean Islands (Lacaz et al., 2002; Restrepo et al., 2011). Brazil accounts for over 80% of all reported cases with Venezuela, Colombia, Ecuador, Bolivia and Argentina informing lesser proportion of cases (Colombo et al., 2011; Restrepo et al., 2011). Additionally, this mycosis is not distributed homogeneously within a particular endemic territory but is concentrated in tropical and subtropical regions with abundant forests and waterways, high annual rainfall indices (1400-2999 mm), and mild temperatures (17°C-24°C) predominating throughout the year (Borelli, 1972; Calle et al., 2001; Restrepo et al., 2001). Soil texture and moisture availability are also important (Conti-Díaz, 2007; Restrepo et al., 2001), as found in Brazil by spatial and ecologic correlate analyses (Simões et al., 2004). Studies on this aspect discovered a cluster of juvenile patients with the acute or subacute form who were potentially connected to the 1982-83 El Niño Southern Oscillation (ENSO) climatic anomalies (Barrozo et al., 2010). P. brasiliensis's microniche has not been pinpointed precisely because the few isolations from natural sources have been sporadic, with soil being the substrate most frequently mentioned (Franco et al., 2000). Presently, there are indications that the habitat is to be found near waterways or in humid areas also propitious to agricultural crops such as coffee, tobacco and sugar cane (Calle et al., 2001; Restrepo et al., 2001). One hypothesis postulated that fish and aquatic birds would be required around the microniche to allow survival and dispersion of the fungus in nature (Conti-Díaz, 2007). Of ecological importance is the regular isolation of the fungus from armadillos (Dassypus novemcinctus, Cabassous centralis) captured in the endemic areas, some of which revealed internal lesions (Bagaggli et al., 2003). Dogs and other domesticated and feral animals have also been implicated (Ricci et al., 2004; Richini-Pereira et al., 2008). Nonetheless, P. brasiliensis's microniche remains unknown despite many attempts to isolate it from suspected sites such as the permanent areas of residence of patients, in and around armadillos' burrows and their foraging areas (Restrepo et al., 2001). Another circumstance that has hindered tracing the habitat has been the lack of information on outbreaks, which could have facilitated detection of the common source of infection (Lacaz et al., 2002; Restrepo et al., 2001). An increased number of childhood cases in areas where this disorder had previously been considered rare was noted by Coimbra et al. (1994) and Gonçalves et al. (1998), who suggested that colonization, gradual felling of the original native forests or changes in agricultural practices had probably exposed children to aerosolized fungal propagules, leading to increased disease rates. By the same token, in their study of 1,000 patients, Bellissimo-Rodrigues et al. (2011) pinpointed an area with the highest number of juvenile PCM cases, all of whom had resided close to coffee plantations, thereby raising the possibility of aerosol infection through agriculture-related work. None of
Paracoccidioidomicose: perfil clínico e epidemiológico de pacientes internados em Passo Fundo - RS
Revista de Medicina, 2022
Paracoccidioidomycosis (PCM) is not a notifiable disease despite its relevance in Latin America, and therefore estimates of the prevalence, incidence, and associated morbidity of this mycosis are based on reports of epidemiological surveys, case series, hospitalization records, and mortality data. The objective of this study was to describe aspects related to the patient, disease evolution, diagnostic confirmation, and treatment of confirmed cases of PCM treated at a teaching hospital in southern Brazil. Information was collected from the medical records of 27 patients diagnosed with PCM, confirmed in the period from 2010 to 2019. The prevalent profile was a male patient, with a mean age of 53 years, who was involved in various work activities, of urban origin, immunocompetent and without comorbidities, and a smoker, but not an alcoholic. For most cases, the initial involvement was pulmonary, with significant involvement of the lymphatic system during the course of the disease. Microscopic observation of pathognomonic fungal structures in biopsy samples, lymph node aspirates, and sputum was the most common method to confirm the clinical suspicion. Itraconazole was the first treatment option, followed by amphotericin B.
The American journal of tropical medicine and hygiene, 2008
In paracoccidioidomycosis (PCM), the primary lung infection remains silent. In this study, attempts were done to define the primary target organ by correlating lung radiographic abnormalities with the time course of mucosal/skin lesions concurrently exhibited at diagnosis by 63 patients in whom microscopy and/or isolation of Paracoccidioides brasiliensis from respiratory secretions had been positive. Mucosal and skin lesions were found in 65.1% and 12.7% of the patients, respectively. Odynophagia and dysphagia were present in 38.1% each. All patients had lung interstitial infiltrates, and 31.7% had also alveolar lesions; fibrosis was recorded in 46% of them. An inverse correlation was shown for fibrosis and presence of either odynophagia or dysphagia. Cluster analyzes strongly supported two sets of patients: those with mucosal damage, odynophagia/dysphagia, and alveolo-interstitial infiltrates and those with dermal lesions, dyspnea, and lung fibrosis. These groups may represent nove...
Pulmonary paracoccidoidomycosis: radiology and clinical-epidemiological evaluation
Revista da Sociedade …, 2010
Introduction: The purpose of this study was to compare respiratory signs and symptoms between patients with and without chest X-ray abnormalities in order to establish the meaning of radiographic findings in pulmonary PCM diagnosis. Methods: The epidemiological, clinical and radiological lung findings of 44 patients with paracoccidiodomycosis (PCM) were evaluated. Patients were divided into two groups of 23 and 21 individuals according to the presence (group 1) or absence (group 2) of chest X-ray abnormalities, respectively, and their clinical data was analyzed with the aid of statistical tools. Results: As a general rule, patients were rural workers, young adult males and smokers-group 1 and 2, respectively: males (91.3% and 66.7%); mean age (44.4 and 27.9 year-old); smoking (34.7% and 71.4 %); acute/subacute presentation (38.1% and 21.7%); chronic presentation (61.9% and 78.3%). The most frequent respiratory manifestations were-group 1 and 2, respectively: cough (25% and 11.4%) and dyspnea (22.7% and 6.8%). No statistical difference was observed in pulmonary signs and symptoms between patients with or without radiographic abnormalities. The most frequent radiological finding was nodular (23.8%) or nodular-fibrous (19%), bilateral (90.5%) and diffuse infiltrates (85.7%). Conclusions: Absence of statistical difference in pulmonary signs and symptoms between these two groups of patients with PCM indicates clinical-radiological dissociation. A simplified classification of radiological lung PCM findings is suggested, based on correlation of these data and current literature review.
Inapparent lung involvement in patients with the subacute juvenile type of paracoccidioidomycosis
Revista do Instituto de Medicina Tropical de São Paulo, 1989
Three patients with the diagnosis of subacute juvenile paracoccidioidomycosis who, at the time of their first visit, had no signs or symptoms of lung involvement, were studied. Initially the diagnosis was confirmed by the observation of P. brasiliensis in biopsy material obtained from clinically involved lymphadenopathies. The lung X-rays done in all patients, did not reveal pathologic changes, although it was possible to observe and isolate the fungus from sputum samples obtained from the three patients. This fact reinforces the pulmonary genesis of the mycosis and proofs the existence of a pulmonary primary infection, even in patients with the juvenile manifestations, in whom the lung component is obscured by the predominant lymph node involvement.