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de Almeida JN, Peçanha-Pietrobom PM, Colombo AL. Paracoccidioidomycosis in Immunocompromised Patients: A Literature Review. J Fungi (Basel) 2018; 5:E2. [PMID: 30587784 PMCID: PMC6463037 DOI: 10.3390/jof5010002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/09/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is an endemic mycosis found in Latin America that causes systemic disease mostly in immunocompetent hosts. A small percentage of PCM occurs in immunocompromised patients where low clinical suspicion of the infection, late diagnosis, and uncertainties about its management are factors that negatively impact their outcomes. We conducted a literature review searching reports on PCM associated to HIV, cancer, maligned hemopathies, solid organ transplantation, and immunotherapies, in order to check for peculiarities in terms of natural history and challenges in the clinical management of PCM in this population. HIV patients with PCM usually had low T CD4⁺ cell counts, pulmonary and lymph nodes involvement, and a poorer prognosis (≈50% mortality). Most of the patients with PCM and cancer had carcinoma of the respiratory tract. Among maligned hemopathies, PCM was more often related to lymphoma. In general, PCM prognosis in patients with malignant diseases was related to the cancer stage. PCM in transplant recipients was mostly associated with the late phase of kidney transplantation, with a high mortality rate (44%). Despite being uncommon, reactivation of latent PCM may take place in the setting of immunocompromised patients exhibiting clinical particularities and it carries higher mortality rates than normal hosts.
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Affiliation(s)
- João N de Almeida
- Central Laboratory Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, CEP 05403-000 São Paulo, Brazil.
| | - Paula M Peçanha-Pietrobom
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, CEP 04039-032 São Paulo, Brazil.
| | - Arnaldo L Colombo
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, CEP 04039-032 São Paulo, Brazil.
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Unusual Intestinal Involvement by Paracoccidioidomycosis Diagnosed After Oral Manifestation. Mycopathologia 2018; 183:987-993. [DOI: 10.1007/s11046-018-0250-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/08/2018] [Indexed: 01/02/2023]
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Almeida FAD, Neves FF, Mora DJ, Reis TAD, Sotini DM, Ribeiro BDM, Andrade-Silva LE, Nascentes GN, Ferreira-Paim K, Silva-Vergara ML. Paracoccidioidomycosis in Brazilian Patients With and Without Human Immunodeficiency Virus Infection. Am J Trop Med Hyg 2016; 96:368-372. [PMID: 27895278 DOI: 10.4269/ajtmh.16-0254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is endemic to Latin America, where 10 million people may be infected with Paracoccidioides brasiliensis/Paracoccidioides lutzii and 1,600,000 individuals live with human immunodeficiency virus (HIV) infection. An epidemiological overlapping of these infections occurred early in acquired immunodeficiency syndrome era with nearly 180 published cases. This study presents epidemiological, clinical, and outcome profiles for 31 PCM patients with HIV infection diagnosed in a teaching hospital in Brazil, and includes an update of previously reported cases. Medical records were reviewed and data compared with 64 PCM patients without HIV infection. Of the 31 PCM patients with HIV infection, 23 (74.1%) were male, with a median age of 36.7 years, whereas of the 64 PCM, 45 (70.3%) were male, with a median age of 35.1 years. Both groups presented similar proportions for smoking and alcoholism. PCM patients with HIV infection presented more fever, weight loss, and the acute clinical form than the PCM patients who had more mucosal and respiratory involvement characterizing the chronic form. Most PCM patients with HIV infection exhibited overlapping symptoms from both clinical forms with median symptom duration of 4.5 months compared with 8.3 months for the PCM control. Patients received sulfonamides and/or itraconazole for a median of 15.7 and 16.7 months for PCM/HIV-infected and PCM, respectively. Relapses occurred more in PCM (12 [30%]) than PCM/HIV-infected (4 [14.8%]) patients, whose mortality rate was higher (10 [32.8%]) than PCM patients (8 [20%]). The cases of PCM/HIV infection confirm that HIV can interact with some endemic diseases without increasing their frequency, while changing their natural history, clinical presentation, and outcome. The data presented here are in agreement with those observed in other studies.
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Affiliation(s)
- Fabrício Arantes de Almeida
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Fernando Freitas Neves
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Delio Jose Mora
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Tarcisio Albertin Dos Reis
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Diego Moelas Sotini
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Barbara De Melo Ribeiro
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | | | | | - Kennio Ferreira-Paim
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil
| | - Mario León Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Uberaba, Brazil.
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Synchronous oral paracoccidioidomycosis and pulmonary tuberculosis in an immunocompetent patient. Mycopathologia 2015; 179:459-64. [PMID: 25652419 DOI: 10.1007/s11046-015-9868-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 01/27/2015] [Indexed: 12/30/2022]
Abstract
Paracoccidioidomycosis (PCM) and tuberculosis (TB) are chronic granulomatous infectious diseases, in which the main form of contraction is through inhalation of the microorganism-Paracoccidioides brasiliensis and Mycobacterium tuberculosis. Oral involvement of PCM is observed in up to 70 % of the cases and usually presents clinically as ulcerations with granular surface showing tiny hemorrhagic areas. Oral presentation of TB is rare with prevalence smaller than 0.5 % of all cases. Clinical presentation of oral TB mainly consists of single ulcers with irregular limits and necrotic base. A 70-year-old immunocompetent man presented simultaneously oral PCM and pulmonary TB. Medical history revealed a previous diagnosis of pulmonary TB; however, even under treatment for TB, the patient remained with oral lesions and intense pulmonary fibrosis. The physician requested P. brasiliensis serological analysis, which resulted positive. Although the combination of PCM and TB has been reported in the literature, it is still considered an uncommon condition and their diagnosis may represent a challenge to healthcare professionals because of the similarity between their clinical and radiological presentations.
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