A retrospective study of oral manifestations in patients with paracoccidioidomycosis

Abstract

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.

Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients

“…All the cases in question were diagnosed by histopathological examination of biopsied specimens of oral lesions. The incisional biopsy was the most used technique (85.45% of cases) for diagnosis, and shown to be effective in the diagnosis of oral lesions as demonstrated in other studies . Some differential diagnosis should be included to such injuries, especially squamous cell carcinoma, tuberculosis, sarcoidosis and Wegener's granulomatosis …”

A multicentre study of oral paracoccidioidomycosis: Analysis of 320 cases and literature review

“…Paracoccidioidomycosis, also known as Lutz disease or Lutz–Splendore–de Almeida mycosis, was first described by Dr. Adolpho Lutz approximately 110 years ago as a deep systemic condition (Colombo et al, ; Filho, ; Life International Fungal Education (LIFE), ). It is recognized as one of the main endemic mycoses in Latin America (Colombo et al, ; Life International Fungal Education (LIFE), ) and it is prevalent in Brazil, Venezuela, Colombia, Ecuador, Argentina and Mexico (Azenha et al, ; Bicalho et al, ; Colombo et al, ; Godoy & Reichart, ; López‐Martínez et al, ; Sposto et al, ; Trindade et al, ). However, sporadic cases have been reported in other continents among individuals who visited endemic areas, as shown in Figure .…”

“…The diagnosis of PCM is based on the detection of fungal elements of P. brasiliensis by histopathological examination of specimens stained with haematoxylin–eosin (H&E; López‐Martínez et al, ). Periodic acid–schiff (PAS) and Grocott–Gomori staining are also helpful staining techniques (Azenha, Caliento, Brentegani, & Lacerda, ; Girardi & Scrofernecker, ). The oropharynx may be the first anatomical site of manifestation, and lesions at this site are fairly common (Oliveira, Mariano, Santos Silva, Vargas, & Lopes, ).…”

Oral Manifestations Associated to Paracoccidioidomicosis and Histoplasmosis

“…Chronic ulcers are usually painful and do not heal spontaneously; these ulcers characteristically have a red granulomatous or berry-like surface. In our cohort, 13.79% patients had macrochelia, which some authors report as a frequently observed manifestation in adult chronic multifocal PCM [5,6,[24][25][26][27].…”