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Abstract
The scarcity of reported cases of paracoccidioidomycosis and AIDS remains unexplained. We review the details of the 27 cases reported in the medical literature. Paracoccidioidomycosis occurs in patients with advanced AIDS who are not receiving prophylaxis for Pneumocystis carinii pneumonia with trimethoprim-sulfamethoxazole, which is also effective against Paracoccidioides brasiliensis. Clinical manifestations include prolonged fever, weight loss, generalized lymphadenopathy, splenomegaly, hepatomegaly, and skin rash. Diagnosis can often be made by direct microscopic examination and culture of the fungus from skin and lymph node specimens and occasionally from sputum, blood, spinal fluid, and bone marrow specimens. Since antibodies to P. brasiliensis are occasionally detected, the diagnosis should not be ruled out for patients whose serology is negative. Despite specific therapy with different regimens, the overall mortality of paracoccidioidomycosis among patients with AIDS is high (30%). The prognosis can be improved by earlier diagnosis and aggressive therapy with amphotericin B, followed by lifelong immunosuppressive therapy with trimethoprim-sulfamethoxazole. Health care providers caring for human immunodeficiency virus-infected patients who live or have resided in areas in which paracoccidioidomycosis is endemic must be aware of the possibility that this systemic mycosis may occur and have potentially severe consequences.
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Review |
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89 |
2
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Benard G, Duarte AJ. Paracoccidioidomycosis: a model for evaluation of the effects of human immunodeficiency virus infection on the natural history of endemic tropical diseases. Clin Infect Dis 2000; 31:1032-9. [PMID: 11049788 DOI: 10.1086/318146] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/1999] [Revised: 03/21/2000] [Indexed: 11/03/2022] Open
Abstract
The interaction of human immunodeficiency virus (HIV) infection with endemic tropical diseases has become a major concern, but its mechanisms are still poorly understood. Paracoccidioidomycosis (PCM), a South America endemic deep mycosis, may provide an interesting model to investigate this interaction, as clinical-epidemiological features of most HIV-PCM-coinfected patients are difficult to classify into the standard acute and chronic forms of PCM. Such patients have presented clinical features indicative of an uncontrolled infection with lymphohematogenous dissemination, similar to the more severe, acute form. However, this infection probably resulted from reactivated latent foci that, in nonimmunocompromised hosts, leads to the less severe chronic form, characterized by mucosal lesions. We propose that a new outcome of the Paracoccidioides brasiliensis-host interaction is induced by concomitant HIV infection. This outcome probably reflects an impaired anti-P. brasiliensis immune response during coinfection that is similar to that seen in the acute form, although the patients have a chronic P. brasiliensis infection.
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Review |
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69 |
3
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Tuder RM, el Ibrahim R, Godoy CE, De Brito T. Pathology of the human pulmonary paracoccidioidomycosis. Mycopathologia 1985; 92:179-88. [PMID: 4088291 DOI: 10.1007/bf00437631] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lungs of twelve patients with chronic paracoccidioidomycosis (Pb) were studied in an attempt to understand the pathogenesis of the pulmonary disease. Ribbons of the lung parenchyma including the hilar region and directed towards apical, basal and lateral regions were subdivided into sections from the hilar, intermediate and peripheral segments. The following histopathological reactions directly or indirectly related to P. brasiliensis were described and analysed in relation to the number of slides studied and the pulmonary region involved: pneumonic reaction; early granulomatous formation; mature and healed granulomata; mixed pattern (early and mature granuloma in the same pulmonary area visualized in the slide); pulmonary fibrosis. It was concluded that chronic pulmonary Pb is a recurrent disease affecting equally both lungs. Fibrosis was connected mainly with the progressive evolution of the granulomata towards cicatrization and to a lesser degree probably to a direct induction by the fungi. Based chiefly on the tendency of the fibrosis to run around bronchi and to make up septa interconnecting bronchi and vessels it was hipothesized that these findings were the result of a previous chronic specific lymphangitis by the fungi. Hilar fibrosis would be the result of this lymphangitis and/or of the progression of the specific granulomatous reaction seen in the hilar lymph nodes. Non specific forms of arteritis and areas of destructive emphysema related to granulomatous inflammation and fibrosis were described. Three cases developed pulmonary hypertension.
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Pedro RDJ, Aoki FH, Boccato RS, Branchiní ML, Gonçales Júnior FL, Papaiordanou PM, Ramos MDC. [Paracoccidioidomycosis and infection by the human immunodeficiency virus]. Rev Inst Med Trop Sao Paulo 1989; 31:119-25. [PMID: 2690307 DOI: 10.1590/s0036-46651989000200010] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We present two cases of paracoccidioidomycosis, one occurring in an AIDS patient and the other in an HIV infected man. This is the first report of such association. The first patient, which was already followed for HIV infection (group IV-A) presented with high fever and hepatosplenomegaly. Plain X-ray, ultrasound and CT-scan of the abdomen showed solid nodules in the spleen, some of them with calcification. Both the direct smear and the culture of a bone marrow aspiration revealed Paracoccidioides brasiliensis. The patient died of acute disseminated Paracoccidioidomycosis. The second patient, a man anti-HIV seropositive presented with a mass on the right lower abdomen and inguinal region. A biopsy of the mass showed the association of Hodgkin's disease of the mixed cellularity type and paracoccidioidomycosis. With the expanding AIDS epidemic we believe this report emphasizes the need to consider Paracoccidioidomycosis in HIV infected persons in countries where this mycosis is endemic. We also suggest the inclusion of Paracoccidioidomycosis as a potential opportunistic infection in these areas.
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Case Reports |
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5
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Verli FD, Marinho SA, Souza SCD, Figueiredo MAZD, Yurgel LS. [Clinical-epidemiologic profile of paracoccidioidomycosis at the Stomatology Department of São Lucas Hospital, Pontificia Universidade Católica of Rio Grande do Sul]. Rev Soc Bras Med Trop 2005; 38:234-7. [PMID: 15895174 DOI: 10.1590/s0037-86822005000300005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of the article was to describe clinical and epidemiological features of 61 oral paracoccidioidomycosis cases from the Stomatology Department of São Lucas Hospital, analyzed from July 1976 to June 2004. The State of Rio Grande do Sul is an endemic region due to ecoepidemiologic conditions, that are favorable for the development of the yeast. Men are the most affected gender, with 58 (95%) affected compared to 3 (5%) women. Ii is most prevalent (70.5%) between 40 and 59 years of age. Agricultural labor was the most common occupation with 27/61 (44.3%) patients. Tobacco smoking was prevalent in 52 (85.3%) of the sample, and alcoholism was a frequent finding. All the patients showed stomatologic manifestations, with ulcers and mulberry-like stomatitis the most prevalent, these oral lesions were also observed in many anatomical sites. Alterations were present in 32 (65.3%) of the pulmonary radiographs.
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Journal Article |
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Goldani LZ, Martinez R, Landell GA, Machado AA, Coutinho V. Paracoccidioidomycosis in a patient with acquired immunodeficiency syndrome. Mycopathologia 1989; 105:71-4. [PMID: 2747786 DOI: 10.1007/bf00444027] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The authors report a case of paracoccidioidomycosis and other opportunistic diseases in a patient with acquired immunodeficiency syndrome.
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Case Reports |
36 |
34 |
7
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Bakos L, Kronfeld M, Hampe S, Castro I, Zampese M. Disseminated paracoccidioidomycosis with skin lesions in a patient with acquired immunodeficiency syndrome. J Am Acad Dermatol 1989; 20:854-5. [PMID: 2715438 DOI: 10.1016/s0190-9622(89)80126-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Case Reports |
36 |
31 |
8
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Paniago AMM, de Freitas ACC, Aguiar ESA, Aguiar JIA, da Cunha RV, Castro ARCM, Wanke B. Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12 cases observed in an endemic region in Brazil. J Infect 2005; 51:248-52. [PMID: 16230222 DOI: 10.1016/j.jinf.2005.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the clinical characteristics of 12 patients with paracoccidioidomycosis (PCM) and human immunodeficiency virus (HIV) infection. METHODS The clinical manifestations, diagnosis, treatment, and outcome of PCM in 12 patients infected with HIV attended at a University Hospital of Mato Grosso do Sul, Brazil, were evaluated. RESULTS All patients were men, mean age 36.1 years old, and 11 had a diagnosis other than PCM as the aids-defining illness. Lymph nodes were the organs most often involved (10 patients, 83.3%), followed by lung involvement, usually with an interstitial pattern (seven patients, 58.3%), papule-nodular skin lesions with central ulceration in six (50%) and ulcerated lesions of oral mucous membrane in five (41.6%) patients. Pleural involvement occurred in one patient who presented large pleural effusion beside a pathologic rib fracture caused by P. brasiliensis. Seven patients showed involvement in more than one extrapulmonary organ. In eight (66.6%) cases the diagnosis was established by direct microscopy of clinical specimens. All patients used trimethoprim-sulfamethoxazole and seven patients were also treated with amphotericin B. Eight patients died with progressive PCM manifestations. CONCLUSION Our review demonstrates that PCM, an endemic systemic mycosis in Brazil, when associated with AIDS, behaves clinically as an opportunistic disease.
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Severo LC, Geyer GR, Londero AT, Porto NS, Rizzon CF. The primary pulmonary lymph node complex in paracoccidioidomycosis. Mycopathologia 1979; 67:115-8. [PMID: 481558 DOI: 10.1007/bf00440683] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Case Reports |
46 |
31 |
10
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Silva-Vergara ML, Teixeira AC, Curi VGM, Costa Júnior JC, Vanunce R, Carmo WM, Silva MR. Paracoccidioidomycosis associated with human immunodeficiency virus infection. Report of 10 cases. Med Mycol 2003; 41:259-63. [PMID: 12964719 DOI: 10.1080/369378031000137215] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We describe here the epidemiological and clinical characteristics of 10 HIV-infected patients with paracoccidioidomycosis. All patients were adult males from small towns in Brazil and had a previous history of work or residence in a rural area. The two infections were diagnosed concomitantly in six of the ten patients, and for six of the patients, the mycosis was the first clinical manifestation of HIV infection. Risk factors for HIV infection were injection drug use in some patients and multiple sexual partners in others. Six patients died and autopsy revealed severe disseminated paracoccidioidomycosis in three. Exuberant and severe clinical pictures suggest an alteration in the natural history of this mycosis as a result of HIV immunosuppression. The frequency of paracoccidioidomycosis in the HIV-infected population is not known to differ from that reported for this mycosis in non-HIV patients.
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Case Reports |
22 |
29 |
11
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Abstract
Among the Cayabi Indians in Central Brazil, we found a high and unexpected prevalence of lobomycosis, which represents 21% of all the cases reported in the world medical literature until now. Most of the Cayabi patients have been observed for many years, and recently two developed cauliflower-like tumours in old lobomycosis scar lesions. The diagnosis of squamous cell carcinoma was confirmed histologically. In both cases, the tumor was surgically removed, but several months later tumors recurred in both patients. The appearance of squamous cell carcinoma in chronic scar lesions and ulcers of various etiologies has been reported by many authors, and should include lobomycosis.
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Case Reports |
36 |
28 |
12
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Abstract
The relationship between alcoholism and paracoccidioidomycosis was evaluated by the case-control method. The alcohol consumption of 4 groups of patients was compared: 50 patients with chronic paracoccidioidomycosis, 20 patients with the acute or subacute form of this mycosis and their respective control groups of hospitalized patients, each case matched by sex and age. Between September 1986 and July 1988 the cases and their controls were interviewed by one and the same investigator using a questionnaire on drinking habits: quantity and type of beverage consumed, time of onset and frequency of use and whether they had manifested symptoms of inebriation or of alcohol dependence previously. As compared with control patients, the mean daily ingestion of alcohol in excess of 60 ml was more frequent in the chronic paracoccidioidomycosis group (50.0% x 30.0%). These patients also preferred to drink sugar cane brandy more frequently (89.4% x 68.3%). When the average daily consumption of ethyl alcohol exceeded 100 ml, most patients presented a recurrence of infection during or after antifungal therapy. In the acute-subacute paracoccidioidomycosis group, 64.3% of the patients reported inebriation on one or more occasions, versus 17.6% in the respective control group. The results suggest that alcoholism can be a predisposing factor to paracoccidioidomycosis and, probably, accounts for a worse prognosis for this infection.
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Comparative Study |
33 |
25 |
13
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Horré R, Schumacher G, Alpers K, Seitz HM, Adler S, Lemmer K, De Hoog GS, Schaal KP, Tintelno K. A case of imported paracoccidioidomycosis in a German legionnaire. Med Mycol 2002; 40:213-6. [PMID: 12058735 DOI: 10.1080/mmy.40.2.213.216] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We report on a case of the chronic form of paracoccidioidomycosis with swelling and ulcerations of the mouth in a German legionnaire who also suffered from a chronic bronchitis. The patient had worked for many years in Brazil, an area endemic for the disease. Infection due to Paracoccidioides brasiliensis was diagnosed in Germany, more than 10 years after the patient's return. Diagnosis was established by the presence of yeast cells with multipolar budding in the tissue of the oral lesion. Furthermore, the fungus was grown in a liquid Leishmania culture medium. Identification of the fungus was based on morphology and genetic sequencing. Furthermore, IgG antibodies against a 43-kDa antigen of P. brasiliensis were detected in a western blot. After itraconazole therapy (400 mg day(-1)) for 4 weeks, the lesions had disappeared almost completely, but the therapy was continued for further 5 months to avoid relapse of the infection.
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Case Reports |
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14
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Marques SA, Conterno LO, Sgarbi LP, Villagra AM, Sabongi VP, Bagatin E, Gonçalves VL. Paracoccidioidomycosis associated with acquired immunodeficiency syndrome. Report of seven cases. Rev Inst Med Trop Sao Paulo 1995; 37:261-5. [PMID: 8525274 DOI: 10.1590/s0036-46651995000300014] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We report the clinical findings and evolution of seven patients (five men and two women), the majority of them intravenous drug users, with paracoccidioidomycosis associated to acquired immunodeficiency syndrome (AIDS). In four of the patients the paracoccidioidomycosis was restricted to the lung and in the three others was generalized with cutaneous involvement. Only two of them had lived recently in rural area, an indication of the possible reactivation of latent focal infection in the other five patients. The recognition of the role of cell-mediated immunity in host defense against Paracoccidioides brasiliensis leds to the prediction of a growing occurrence of the paracoccidioidomycosis-AIDS association in areas that are endemic for these diseases.
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Case Reports |
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21 |
15
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Silva CO, Almeida ADS, Pereira AAC, Sallum AW, Hanemann JAC, Tatakis DN. Gingival Involvement in Oral Paracoccidioidomycosis. J Periodontol 2007; 78:1229-34. [PMID: 17608577 DOI: 10.1902/jop.2007.060490] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Paracoccidioidomycosis, a deep mycosis endemic in parts of Latin America, often presents with oral lesions involving the gingiva. Nevertheless, the periodontal literature is devoid of references to oral paracoccidioidomycosis. The purpose of this study was to characterize the gingival involvement in oral paracoccidioidomycosis and to contrast clinical and histopathologic diagnosis of the disease. Differential diagnosis and management of oral paracoccidioidomycosis were reviewed. METHODS From January 1995 to October 2006, the files of the Oral Pathology Laboratory, School of Dentistry, Alfenas Federal University, were reviewed to identify cases referred because of a clinical diagnosis of oral paracoccidioidomycosis. Data collected included patient demographics (age, gender, race, and occupation), clinical information (oral lesion location), and histopathologic diagnosis. RESULTS Forty-six cases were identified, and 34 were histopathologically confirmed as paracoccidioidomycosis. Of the remaining 12 cases, one-half were diagnosed as either carcinoma or dysplastic leukoplakia. Of the 34 confirmed paracoccidioidomycosis cases, 45% presented with multiple site involvement, whereas the gingiva/alveolar process was the most prevalent site overall (52%). The gingiva/alveolar process was the most prevalent site in both multiple and single site cases. The majority of patients were men (88%), white (75%), and in their fourth decade of life (47%). Statistical analysis revealed that patients with gingival/alveolar process involvement were demographically indistinguishable from those without. CONCLUSIONS Oral paracoccidioidomycosis has a strong predilection for the gingiva, whereas patients with gingival lesions do not differ from patients lacking such involvement. Early diagnosis of gingival/oral lesions may prevent life-threatening complications of this mycosis.
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Goldani LZ, Coelho IC, Machado AA, Martinez R. Paracoccidioidomycosis and AIDS. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1991; 23:393. [PMID: 1882205 DOI: 10.3109/00365549109024331] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Case Reports |
34 |
19 |
17
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Colombo AL, Faiçal S, Kater CE. Systematic evaluation of the adrenocortical function in patients with paracoccidioidomycosis. Mycopathologia 1994; 127:89-93. [PMID: 7984218 DOI: 10.1007/bf01103064] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Limited cortisol response to ACTH stimulation has been documented in 22 to 48% of patients with paracoccidioidomycosis (PM). Different approaches to interpret the test and inadequate selection of patients preclude an accurate appraisal of the actual incidence of adrenal insufficiency in PM. Rapid cosyntropin (ACTH) stimulation tests were performed in 38 consecutive patients (9 with the localized and 29 with the disseminated form of PM) and 40 normal controls. Subnormal cortisol responses to ACTH (60 minutes post-ACTH values below 455 nmol/l, 95% confidence limits) were found in only 4 patients (14%) with disseminated PM. If a retrospective sample of 6 patients studied previously (in whom tests were indicated due to clinical suspicion of Addison's disease) were included, or if the absolute cortisol increment above baseline was used for interpretation, we would find figures closer to those previously reported (23 and 24%, respectively). These data reflect that non-systematic evaluation or selection of a substandard criterion to interpret the test overestimates the frequency of adrenocortical insufficiency in PM.
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Comparative Study |
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18
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da Silva CE, Cordeiro AF, Gollner AM, Cupolilo SM, Quesado-Filgueiras M, Curzio MF. [Paracoccidioidomycosis of the central nervous system: case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 2000; 58:741-7. [PMID: 10973120 DOI: 10.1590/s0004-282x2000000400024] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The involvement of the central nervous system in paracoccidioidomycosis is more frequent than previously thought. The first reference to the possibility that Paracoccidioides brasiliensis could affect the central nervous system was by Pereira & Jacobs in 1919. Since then, a great number of other studies has showed this form of clinical behavior and, in some of them, the frequency has ranged 27.27%. We report a clinical case of a 34-year-old white Brazilian woman admitted because of bacterial pneumonia. In the sixth day of admission, the patient developed cerebellar symptomatology with nausea, vomiting, dysmetria and gait disturbance. Central nervous system computer tomographic scanning disclosed a hypodense lesion in the right cerebellar hemisphere. The patient was submitted to surgery with total excision of the lesion. Histopathological examination confirmed the diagnosis of neuroparacoccidioidomycosis. Coadjuvant treatment with sulfamethoxazole-trimetoprim was introduced. The patient had a good outcome and was discharge 30 days after surgery.
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Case Reports |
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19
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Do Valle AC, Guimaraes MR, Cuba J, Wanke B, Tendrich M. Recovery of adrenal function after treatment of paracoccidioidomycosis. Am J Trop Med Hyg 1993; 48:626-9. [PMID: 8390794 DOI: 10.4269/ajtmh.1993.48.626] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In endemic areas, the systemic mycosis paracoccidioidomycosis (PCM) is the most frequent etiology of Addison's disease. Paracoccidioides brasiliensis, the causative agent of PCM, exhibits a high tropism for the adrenal glands, which results in a low hormone reserve and in more severe cases, in symptoms of primary adrenal insufficiency. In these cases, the hormone deficit is usually treated with replacement corticoid therapy for the rest of the patient's life. Recently, we identified three patients with disseminated PCM who had adrenal insufficiency; one of them had Addison's disease. All showed complete recovery of adrenal function after a 1-2-year period of specific therapy with ketoconazole or sulfonamides. Plasma cortisol levels were determined by radioimmunoassay of baseline blood samples, as well as those taken after the rapid stimulation test with synthetic adrenocorticotrophic hormone, and before and after the antifungal therapy.
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de Arruda JAA, Schuch LF, Abreu LG, Silva LVDO, Mosconi C, Monteiro JLGC, Batista AC, Hildebrand LDC, Martins MD, Sobral APV, Rivero ERC, Gomes APN, Silva TA, Vasconcelos ACU, Mesquita RA. A multicentre study of oral paracoccidioidomycosis: Analysis of 320 cases and literature review. Oral Dis 2018; 24:1492-1502. [PMID: 29949225 DOI: 10.1111/odi.12925] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/29/2018] [Accepted: 06/20/2018] [Indexed: 04/24/2025]
Abstract
OBJECTIVES To investigate the frequency of oral paracoccidioidomycosis from representative geographical regions of Brazil and to compare the data with a literature review. MATERIALS AND METHODS A retrospective study was conducted on 108,304 biopsies obtained from 1953 to 2016 at six Brazilian oral and maxillofacial pathology services. Demographic data and clinical and histopathological diagnosis of oral paracoccidioidomycosis were evaluated. A literature review of oral paracoccidioidomycosis studies published in three electronic databases was carried out. Data were analysed descriptively. RESULTS A total of 320 cases of oral paracoccidioidomycosis were surveyed (0.3% of the oral lesions at the centres studied). The lesions were more frequent among male patients. The gingiva/alveolar ridge was the most affected site. Mean age of affected individuals was 51.3 years (±11.7). The literature review showed a higher incidence of oral paracoccidioidomycosis in the south-east and south regions of Brazil. Male individuals and individuals between 50 and 59 years were most affected. CONCLUSIONS Oral paracoccidioidomycosis is an uncommon lesion observed in oral biopsy samples. The differences in the relative frequency of oral paracoccidioidomycosis are related to geographical variations. Men between 50 and 59 years are more affected. This study provides helpful information for clinicians in the diagnosis of oral paracoccidioidomycosis.
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Multicenter Study |
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de Freitas MR, Nascimento OJ, Chimelli L. Tapia's syndrome caused by Paracoccidioidis brasiliensis. J Neurol Sci 1991; 103:179-81. [PMID: 1880535 DOI: 10.1016/0022-510x(91)90161-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Tapia's syndrome is due to extracranial involvement of the XIIth nerve and the recurrent laryngeal branch of the Xth nerve. There is ipsilateral paralysis of vocal cords, soft palate and tongue. The main causes are parotid and other tumors or injuries to the high neck. We describe here a Brazilian female patient who presented with a lesion in the nasal mucosa, and soon after had dysphagia and dysphonia. Examination revealed paralysis of the soft palate, vocal cords and tongue ipsilaterally. Microscopic examination of the lesion in the nasal mucosa revealed the presence of the fungus. The patient was treated with sulfonamide and ketoconasol.
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Case Reports |
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22
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de Moura LP, Raffin CN, del Negro GM, Ferreira MS. [Paracoccidioidomycosis evidencing spinal cord involvement treated with success by fluconazole]. ARQUIVOS DE NEURO-PSIQUIATRIA 1994; 52:82-6. [PMID: 8002815 DOI: 10.1590/s0004-282x1994000100015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The involvement of central nervous system in paracoccidiodomycosis has rarely been described, with an incidence rate varying from 9.99% to 27.27%. There are two basic forms of clinical presentation: meningeal and tumor-like (abscesses, granulomas, nodules, and cysts). The Paracoccidioides brasiliensis is preferentially described in cerebral hemispheres, cerebellum, medulla oblonga and meninges, and exceptionally in the spinal cord. The authors present a case of paracoccidioidomycosis which diagnosis was achieved by microscopic examination of material from oral lesions and specific serology. The patient presented clinical signs of spinal cord involvement confirmed by lesions found in magnetic resonance imaging. They emphasize the inedit therapeutic response to a new antifungal agent (fluconazole) used for the first time in this kind of clinical manifestation, and the excellent prognosis when diagnosis is promptly made.
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Case Reports |
31 |
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23
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Paniago AMM, de Oliveira PA, Aguiar ESA, Aguiar JIA, da Cunha RV, Leme LM, Salgado PR, Domingos JA, Ferraz RL, Chang MR, Bóia MN, Wanke B. Neuroparacoccidioidomycosis: analysis of 13 cases observed in an endemic area in Brazil. Trans R Soc Trop Med Hyg 2007; 101:414-20. [PMID: 17011605 DOI: 10.1016/j.trstmh.2006.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2006] [Revised: 07/29/2006] [Accepted: 07/31/2006] [Indexed: 10/24/2022] Open
Abstract
The epidemiological, clinical and laboratory features of 13 cases of neuroparacoccidioidomycosis (NPCM) were analysed. All patients were men, with a mean age of 41.6 years. The lungs were involved in 11 cases (84.6%) and only two cases had mycosis limited to the central nervous system. Co-morbidity was observed in four patients (malignant neoplasm in three and diabetes mellitus in one). The most frequent neurological manifestations were paresis (eight cases), headache (five cases) and gait disturbance (four cases). Neuroimaging diagnosis showed a predominance of multiple round lesions with ring enhancement following contrast medium injection. Lesions were seen in the brain hemispheres (nine cases), thalamus (nine cases), cerebellum (four cases), brainstem (four cases) and spinal cord (four cases). Most cases responded well to therapy. Lesions with enhancement following contrast medium injection persisted in four patients for a period of 6 months to 8 years. These findings emphasize the importance of considering NPCM in the differential diagnosis of brain and spinal cord lesions in endemic areas of paracoccidioidomycosis.
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Abstract
A patient with South American blastomycosis (paracoccidioidomycosis) was studied using computed tomography (CT), which showed six granulomas in the brain. The patient was treated with amphotericin B and observed by repeated CT scans. Two of the lesions disappeared completely after the first cycle of treatment, and residual images, probably representing granulomas in the cicatricial stage, remained after completion of the treatment.
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Rocha N, Suguiama EH, Maia D, Costa H, Coelho KI, Franco M. Intestinal malakoplakia associated with paracoccidiodomycosis: a new association. Histopathology 1997; 30:79-83. [PMID: 9023562 DOI: 10.1046/j.1365-2559.1997.d01-564.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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