Paracoccidioidomycosis: evaluation of treatment and patient profile

Fiol, Fernando Sá Del; Oliveira, Sara de Jesus; Barberato‐Filho, Silvio; Junqueira, Fábio Miranda; Rocha, Maria Carolina Pereira da; Toledo, Maria Inês de

doi:10.1016/j.bjid.2013.07.001

Cited by 6 publications

(7 citation statements)

References 5 publications

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“…However, the adequate therapeutic response rate was higher for patients who received SMX-TMP for > 24 months, with the rate gradually decreasing as the treatment duration decreased. This finding is in agreement with the observations of Cavalcante and others (2014) 17 and Fiol and others (2013), 18 who demonstrated that the average time to the clinical cure of patients with nonsevere chronic PCM treated with SMX-TMP was relatively short, that is, approximately 5 and 15 months, respectively.…”

Section: Discussionsupporting

confidence: 92%

“…Most of the information available about PCM treatment is limited to observational studies or analyses of data obtained from patients' medical records. [16][17][18] This lack of evidence on the efficacy of antimicrobials is most likely due to the incomplete follow-up of patients, which may result for most of them living in rural areas. 5,7 The present study demonstrated a satisfactory rate of adequate treatment response to SMX-TMP among patients with nonsevere chronic PCM.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 However, in contrast, Fiol and others (2013) did not find any statistically significant difference in the efficacy of these treatments or the duration of therapy in the clinical treatment of PCM. 18 Little is known about the several aspects that interfere with the effectiveness of the primary treatments for PCM. Therefore, investigations that aim to identify the factors that may facilitate or impair an adequate therapeutic response in a patient with PCM are required.…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic Response in Adult Patients with Nonsevere Chronic Paracoccidioidomycosis Treated with Sulfamethoxazole–Trimethoprim: A Retrospective Study

Nery

Crepaldi

Rossi

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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According to the Brazilian Consensus on Paracoccidioidomycosis (PCM), itraconazole is the drug of choice for treatment. However, the combination of sulfamethoxazole and trimethoprim (SMX-TMP) is most commonly used in clinical practice because of its higher availability in the public health services. The aims of this study were to evaluate the therapeutic response of patients with nonsevere chronic PCM to SMX-TMP and highlight the factors related to treatment failure. An adequate therapeutic response was defined as completely improved disease signs and symptoms after medication use for a minimum of 6 months, followed by normalized hematological and biochemical changes, radiological improvements, and negative mycological examination findings. Medical records were analyzed for 244 patients with nonsevere chronic PCM who were treated between 1998 and 2014. In total, 41.9% of the patients had PCM for ≥ 8 months. Seven (2.9%) patients were coinfected with human immunodeficiency virus (HIV). The median (25%, 75% percentiles) treatment duration was 21 (10, 25) months. Adequate treatment adherence was reported by 68.3% of patients. In addition, 73.6% of patients exhibited an adequate therapeutic response. The majority (82.6%) of patients who were treated with SMX-TMP for > 24 months displayed an adequate therapeutic response, and the frequency of adequate therapeutic response gradually decreased as the duration of treatment decreased. Treatment nonadherence ( < 0.001) and PCM-HIV coinfection ( = 0.019) were factors associated with therapeutic failure. The study results support the good efficacy of SMX-TMP. Attention should be given to PCM-HIV coinfection, emphasizing the concern of a higher risk of PCM therapeutic failure in these patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Therapeutic Response in Adult Patients with Nonsevere Chronic Paracoccidioidomycosis Treated with Sulfamethoxazole–Trimethoprim: A Retrospective Study

Nery

Crepaldi

Rossi

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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“…Itraconazole, although its low blood-brain penetration, features some good results in cerebral PCM. 26 Amphotericin can also be used with good results. Increased intracranial pressure may also occur in the CNS involvement requiring draining procedures either exterior or in the peritoneum (derivation of external or peritoneal ventricles).…”

Section: Pcm Treatment In the Cnsmentioning

confidence: 99%

“…The duration of treatment depends on the degree of immunosuppression and malnutrition, virulence and inoculum of P. brasiliensis, and antifungal used. 1,2,[21][22][23][24][25][26][27][28][29][30][31][32][33] Clinical cure or apparent cure are more assumed than just cure.…”

Section: Treatment Durationmentioning

confidence: 99%

Paracoccidioidomycosis (Lutz-Splendore-Almeida disease): treatment, duration of treatment, recurrence, paradoxical reaction, prognosis, prophylaxis

Vasconcellos¹,

Ambrósio

Camelo

et al. 2014

Revista Médica De Minas Gerais

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Paracoccidioidomycosis, despite being the most important deep mycosis in Latin America, still has many blindspots in terms of its approach, especially in relation to duration of treatment, cure control and prophylaxis. Depending on severity, the following can be used in the treatment: sulfonamides, azoles (itraconazole and ketoconazole), and amphotericin. The prognosis depends on severity, time between onset and diagnosis, and therapy instituted. In mild forms, prognosis is good; in moderate and severe forms, for which there is risk of developing sequelae and death, it is guarded.

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Objective CT-Based Quantification of Lung Sequelae in Treated Patients With Paracoccidioidomycosis

et al. 2014

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This study presents methodology for objectively quantifying the pulmonary region affected by emphysemic and fibrotic sequelae in treated patients with paracoccidioidomycosis. This methodology may also be applied to any other disease that results in these sequelae in the lungs.Pulmonary high-resolution computed tomography examinations of 30 treated paracoccidioidomycosis patients were used in the study. The distribution of voxel attenuation coefficients was analyzed to determine the percentage of lung volume that consisted of emphysemic, fibrotic, and normal tissue. Algorithm outputs were compared with subjective evaluations by radiologists using a scale that is currently used for clinical diagnosis.Affected regions in the patient images were determined by computational analysis and compared with estimates by radiologists, revealing mean (± standard deviation) differences in the scores for fibrotic and emphysemic regions of 0.1% ± 1.2% and −0.2% ± 1.0%, respectively.The computational results showed a strong correlation with the radiologist estimates, but the computation results were more reproducible, objective, and reliable.

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Paracoccidioidomycosis: evaluation of treatment and patient profile

Cited by 6 publications

References 5 publications

Therapeutic Response in Adult Patients with Nonsevere Chronic Paracoccidioidomycosis Treated with Sulfamethoxazole–Trimethoprim: A Retrospective Study

Therapeutic Response in Adult Patients with Nonsevere Chronic Paracoccidioidomycosis Treated with Sulfamethoxazole–Trimethoprim: A Retrospective Study

Paracoccidioidomycosis (Lutz-Splendore-Almeida disease): treatment, duration of treatment, recurrence, paradoxical reaction, prognosis, prophylaxis

Objective CT-Based Quantification of Lung Sequelae in Treated Patients With Paracoccidioidomycosis

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