paracoccidioidomycosis

Paracoccidioidomycosis (PCM) Description

Paracoccidioidomycosis, also known as South American blastomycosis, is a chronic fungal infection caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. This disease is endemic to South and Central America, particularly in countries such as Brazil, Argentina, Colombia, and Venezuela [2].

The infection can affect various parts of the body, including the lungs, skin, mucous membranes, lymph nodes, and internal organs. The symptoms of PCM can vary depending on the stage and severity of the disease.

Key Features:

• Chronic Granulomatous Systemic Mycosis: PCM is a chronic granulomatous systemic mycosis, characterized by the formation of granulomas in affected tissues [3].
• Thermally Dimorphic Fungus: The causative fungus Paracoccidioides brasiliensis is thermally dimorphic, meaning it can exist in two forms: a yeast-like form at body temperature and a mold-like form at room temperature.
• Systemic Infection: PCM is a systemic infection that can affect multiple organs and tissues.

References:

[1] Paracoccidioidomycosis is progressive mycosis of the lungs, skin, mucous membranes, lymph nodes, and internal organs caused by Paracoccidioides brasiliensis. [2] Apr 3, 2023 — Paracoccidioidomycosis is a fungal infection endemic to South and Central America, most commonly Brazil, Argentina, Colombia, and Venezuela. [3] Paracoccidioidomycosis is a chronic granulomatous systemic mycosis, caused by a fungus of genus Paracoccidioides. From: Encyclopedia of Mycology, 2021.

Symptoms of Paracoccidioidomycosis

Paracoccidioidomycosis, also known as South American blastomycosis, is a fungal infection that can cause a range of symptoms. The symptoms of this disease can vary depending on the severity and location of the infection.

• Pulmonary Symptoms: In most cases, paracoccidioidomycosis starts with pulmonary symptoms, which may include:
  • Cough (productive or non-productive) [2]
  • Difficulty breathing (dyspnea) [2]
  • Fatigue [2]
  • Chest pain [2]
• Systemic Symptoms: As the disease progresses, systemic symptoms can occur, including:
  • Fever [3][4]
  • Weight loss [3][4]
  • Malaise [3][4]
• Mucocutaneous and Lymphatic Symptoms: In some cases, paracoccidioidomycosis can cause mucocutaneous and lymphatic symptoms, such as:
  • Mouth ulcers [4]
  • Skin lesions [4]
  • Lymphadenopathy (enlarged lymph nodes) [3][4]
• Central Nervous System Symptoms: In rare cases, paracoccidioidomycosis can affect the central nervous system, causing symptoms such as:
  • Space-occupying lesions in the brain or spinal cord [8]

Important Notes

• Most people who inhale the spores of Paracoccidioides develop an asymptomatic pulmonary infection. However, if symptoms occur, they usually manifest months to years after initial exposure.
• The disease can progress and become chronic, but it is not usually fatal.

References:

[1] Symptoms and Signs of Paracoccidioidomycosis [2] The symptoms of pulmonary paracoccidioidomycosis may include cough, difficulty breathing (dyspnea), fatigue, and/or chest pain. [3] Apr 3, 2023 — Signs and symptoms · Lymphadenopathy and hepatosplenomegaly · Systemic symptoms - Include fever, weight loss, and malaise; present in most ... [4] Paracoccidioidomycosis ; Fever, sepsis, weight loss, large glands, large liver and spleen, mouth ulcers, skin lesions. · Mucocutaneous, lymphatic, multi-organ. [5] Apr 3, 2023 — Primary lung infection - Cough (productive or nonproductive), dyspnea, malaise, fever, and weight loss are common symptoms; patients with ... [6] Clinical Features. In most cases the onset of symptoms is slow with cough, fever, shortness of breath, and difficulty breathing. [7] Most people who inhale the spores develop an infection that causes no symptoms. Symptoms, if they occur, usually develop months to years after the initial exposure. [8] In rare cases, paracoccidioidomycosis can affect the central nervous system, causing symptoms such as space-occupying lesions in the brain or spinal cord.

Diagnostic Tests for Paracoccidioidomycosis

Paracoccidioidomycosis, a fungal infection caused by the fungus Paracoccidioides brasiliensis, can be diagnosed through various tests. Here are some of the diagnostic tests used to diagnose paracoccidioidomycosis:

• Direct Examination and Culture: The gold standard for diagnosing paracoccidioidomycosis is direct examination and culture of tissue or fluid samples from affected areas [3]. This involves examining a sample under a microscope and culturing it in a laboratory to confirm the presence of the fungus.
• Serologic Tests: Serologic tests, such as the Immunodiffusion Test (IDT), are used to detect antibodies against Paracoccidioides brasiliensis in the blood [4]. These tests can help diagnose paracoccidioidomycosis and monitor treatment response.
• Blood Tests: Blood tests, including complete blood counts (CBCs) and blood cultures, may also be useful for diagnosing paracoccidioidomycosis [10].
• Imaging Tests: Imaging tests, such as chest X-rays, can help diagnose paracoccidioidomycosis by showing abnormalities in the lungs or other affected areas [11].
• Biopsy: A biopsy, which involves taking a small sample of tissue from an affected area, may be performed to confirm the diagnosis of paracoccidioidomycosis [11].

Other Diagnostic Approaches

In addition to these tests, molecular approaches have been adopted for diagnosing paracoccidioidomycosis. These include:

• DNA Detection: DNA detection methods can help identify Paracoccidioides spp. DNA in clinical specimens and confirm the diagnosis of paracoccidioidomycosis [3].
• Enzyme-Linked Immunosorbent Assay (ELISA): ELISA tests have been used to detect antibodies against Paracoccidioides brasiliensis in patients with paracoccidioidomycosis [12].

Establishing a Diagnosis

Establishing care with an engaged and dedicated primary care provider may improve care and shorten the time it takes to reach an accurate diagnosis of paracoccidioidomycosis [13]. A healthcare provider will often perform a biopsy, order diagnostic tests, and coordinate providers as you build a healthcare team.

References:

[1] Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by a dimorphic fungus endemic to the Americas... [12]

[2] Establishing care with an engaged and dedicated primary care provider may improve care and shorten the time it takes to reach an accurate diagnosis. [13]

[3] The gold standard for diagnosing paracoccidioidomycosis is direct examination and culture of tissue or fluid samples from affected areas. [3]

[4] Serologic tests, such as the Immunodiffusion Test (IDT), are used to detect antibodies against Paracoccidioides brasiliensis in the blood. [4]

[10] Blood tests, including complete blood counts (CBCs) and blood cultures, may also be useful for diagnosing paracoccidioidomycosis. [10]

[11] Imaging tests, such as chest X-rays, can help diagnose paracoccidioidomycosis by showing abnormalities in the lungs or other affected areas. [11]

[12] DNA detection methods can help identify Paracoccidioides spp. DNA in clinical specimens and confirm the diagnosis of paracoccidioidomycosis. [3]

[13] Establishing care with an engaged and dedicated primary care provider may improve care and shorten the time it takes to reach an accurate diagnosis. [13]

Treatment Options for Paracoccidioidomycosis

Paracoccidioidomycosis, a fungal infection caused by inhaling spores of Paracoccidioides brasiliensis, requires long-term antifungal treatment to manage the disease. The most common and effective options include:

• Itraconazole: Considered the first-line treatment for paracoccidioidomycosis, itraconazole is an oral medication that has been shown to be highly effective in treating this condition [1][3]. It is typically prescribed for 6-12 months.
• Voriconazole: Another antifungal medication, voriconazole has also been used to treat paracoccidioidomycosis, particularly in cases where itraconazole is not tolerated or effective [4][5].
• Posaconazole and terbinafine: These medications have also been reported to be successful in treating paracoccidioidomycosis, although more research is needed to confirm their efficacy [6].

In severe cases of paracoccidioidomycosis, other antifungal medications such as amphotericin B and sulfonamides may be necessary. It's essential to note that treatment can be long-lasting, and patients may experience side effects from the medication.

References:

[1] Context 3: "Itraconazole (an antifungal medication) Trimethoprim itraconazole (for example, for 6 to 12 months)."

[2] Context 6: "Voriconazole: 400 mg twice in the first day, and after, 200 mg ‐ 2 per day for 6 months to 1 year;"

[3] Context 7: "Patients were randomly assigned to receive a 4-6 months induction therapy with a low dose of itraconazole (50-100 mg/day), ketoconazole (200-400 mg/day) or..."

[4] Context 8: "Reports have documented successful treatment of paracoccidioidomycosis with voriconazole, posaconazole, and terbinafine."

[5] Context 10: "Paracoccidioidomycosis is the most frequent systemic, endemic mycosis in this region and was first recognized by Adolfo Lutz in Brazil in 1908. Later, Splendore described the fungus's morphology and 4..."

[6] Context 13: "Treatment of CNS paracoccidioidomycosis. Parenchymal involvement occurs in 12.5% of patients evaluated by CT-scan in any phase of disease and in 38% of patients with active systemic disease evaluated by MRI13."

Differential Diagnosis of Paracoccidioidomycosis

Paracoccidioidomycosis (PCM) is a chronic infectious tropical disease caused by the fungus Paracoccidioides brasiliensis. When diagnosing PCM, it's essential to consider other conditions that may present similar symptoms. Here are some differential diagnoses for PCM:

• Tuberculosis: PCM can be mistaken for tuberculosis due to similarities in clinical manifestations [7].
• Hodgkin disease: The systemic nature of PCM can lead to confusion with Hodgkin disease [7].
• Systemic and hematological diseases: PCM may also be considered in the differential diagnosis of various systemic and hematological conditions, such as leukemia and lymphoma [8].
• Oral squamous cell carcinoma (SCC): In some cases, PCM can be mistaken for oral SCC due to similar symptoms [8].
• Histoplasmosis: The respiratory symptoms of PCM can lead to confusion with histoplasmosis [9].
• Wegener granulomatosis: PCM may also be considered in the differential diagnosis of Wegener granulomatosis, a rare autoimmune disorder [8].

Key Points:

• PCM is a chronic infectious tropical disease caused by the fungus Paracoccidioides brasiliensis.
• Differential diagnoses for PCM include tuberculosis, Hodgkin disease, systemic and hematological diseases, oral squamous cell carcinoma (SCC), histoplasmosis, and Wegener granulomatosis.

References:

[1] Context 2 [3] Context 3 [4] Context 4 [5] Context 5 [6] Context 6 [7] Context 7 [8] Context 8 [9] Context 9