Dissociação clínico-radiológica nas manifestações pulmonares da paracoccidioidomicose

Abstract

A paracoccidioidomicose é uma micose sistêmica de natureza granulomatosa causada pelo fungo dimórfico Paracoccidioides brasiliensis 6 16 .A via inalatória é considerada a principal porta de entrada do agente e as alterações observadas nos vários sítios anatômicos ocorrem como conseqüência da disseminação do fungo. Uma vez inalados, os propágulos ambientais dão origem a sua forma parasitária encontrada nos tecidos do hospedeiro 18 . ABSTRACTLungs are among the main sites affected by paracoccidioidomycosis. However, the alterations are not always easy to differentiate from other respiratory disorders. The objectives of the present study were to investigate the frequency of lung impairment in paracoccidioidomycosis cases and to investigate whether any clinical-radiological association exists. A retrospective study was carried out from March 1996 to November 2006, among patients with paracoccidioidomycosis at the Regional University Hospital of Maringá, Paraná, brazil. Over this period, 45 cases were confirmed, of which 79.5% presented radiological abnormalities on chest X-rays, and four of them also presented pulmonary tuberculosis. Out of the total of 40 patients with paracoccidioidomycosis alone, 57.5% presented respiratory clinical manifestations, whereas 77.5% presented radiological abnormalities, thus demonstrating clinical-radiological dissociation. On the other hand, 80.6% of the patients who presented radiological abnormalities said that they smoked. We concluded that although morphological abnormalities in the lungs are frequent, they do not always correspond to respiratory signs and symptoms and cannot easily be attributed exclusively to paracoccidioidomycosis. Key-words:Paracoccidioidomycosis. Lung impairment. Radiological appearance. Smoking.A paracoccidioidomicose apresenta extensa gama de sinais e sintomas, que são agrupados em dois padrões principais: a forma aguda tipo juvenil, que ocorre em indivíduos com idade inferior a 30 anos, é de curso rápido e grave, comprometendo preferencialmente o sistema monocítico fagocitário e manifestandose clinicamente de forma disseminada. A outra forma é a crônica ou tipo adulto, mais freqüente que a aguda, se manifesta entre a terceira e quinta década de vida, com uma evolução lenta e

Disseminated paracoccidioidomycosis diagnosis based on oral lesions

“…[5] Among infectious diseases, PCM and tuberculosis are those that usually present lung and oral manifestations concurrently. [67] The most common oral manifestations of these diseases are ulcerative lesions, especially in the palate and gums. [3] Another possibility is that the patient had a lung disease unrelated to these mucocutaneous lesions, such as recurrent pneumonia.…”

“…[3] Another possibility is that the patient had a lung disease unrelated to these mucocutaneous lesions, such as recurrent pneumonia. [6]…”

“…However, it is well-known that the radiological changes observed in PCM are diverse and unspecific. [68] Other diagnostic aids such as computed tomography and pulmonary scintilography could contribute in diagnosis. Regardless, it should be emphasized that multidisciplinary efforts become evident, in order to achieve the definitive diagnosis.…”

Pulmonary paracoccidoidomycosis: radiology and clinical-epidemiological evaluation

“…Although pulmonary PCM has been exhaustively studied in other Brazilian regions, very little is known about the correlation between respiratory symptoms and radiographic abnormalities in patients with this disease. Gomes et al reports clinical radiological dissociation in a study with 40 patients, although the data presented suggests a trend towards an association with respiratory symptoms and more severe radiologic abnormalities in the chest X-ray 31 . However, as in our study, the limited number of patients, as well as other intervening factors such as smoking, limits more definitive conclusions.…”

Paracoccidioidomicose e tuberculose: diagnóstico diferencial

“…Imagens radiológicas alteradas em tórax são frequentes no exame de rotina de pacientes com doenças pulmonares. Porém, as imagens encontradas podem ser semelhantes em vários tipos de agressão inflamatória imposta ao parênquima pulmonar (8) .…”