Capítulo 6 - Paracoccidioidomicose

Abstract

Paracoccidioidomycosis is a systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis. The disease is restricted to Latin America. It is the principal systemic mycosis in Brazil, with higher incidences in the southern, southeastern and central regions. The disease is acquired by inhaling fungal propagules. In endemic areas, the primary infection occurs during childhood and involves the immune system. The most common chronic form of paracoccidioidomycosis in adults is the multifocal form, in which there is dissemination to the lungs, lymph nodes, skin and mucosae. This form of the disease has a chronic progression, and the diagnosis is typically delayed. Cough, dyspnea and weight loss due to cutaneous and mucosal lesions are evident and are the principal complaints reported by paracoccidioidomycosis patients. Chest X-rays reveal diffuse reticulonodular infiltrates, which are more evident in the upper lobes. The etiologic diagnosis is based on the identification of P. brasiliensis in clinical specimens, such as lymph node aspirates or BAL fluid, by direct microscopy and culture. Histopathological testing of tissue samples reveals the thick birefringent cell wall of the fungus and the typical pattern of multiple budding around the mother cell. Double agar gel immunodiffusion is useful for the diagnosis when the fungus cannot be detected through mycological tests. Although paracoccidioidomycosis is most often treated with the sulfamethoxazole-trimethoprim combination, itraconazole is preferable. Amphotericin B is used in severe cases.

Serological Diagnosis of Paracoccidioidomycosis through a Western Blot Technique

“…It occurs in individuals during the most productive period of their lives, rendering them unable to work. PCM is a serious public health problem, since it involves high social and economic costs (23). In Brazil, among chronic diseases of infectious and parasitic origin, PCM is the eighth leading cause of death and corresponds to a higher mortality rate among systemic mycoses (5).…”

Cotrimoxazole enhances the in vitro susceptibility of Coccidioides posadasii to antifungals

“…These compounds have a broad antimicrobial spectrum and are active against several aerobic bacteria and some protozoan species and these compounds are frequently used successfully for the treatment and prevention of pneumonia caused by Pneumocystis jiroveci in acquired immune deficiency syndrome patients (Thomas et al 2009). Although these compounds are not common first-line drugs in the management of fungal infections, the combination of SMX/ TMP has shown good results in treating paracoccidioidomycosis (Hahn et al 2003, Wanke & Aidê 2009). Our results show that SMX/TMP was able to enhance the susceptibility of C. posadasii to AMB by reducing the AMB MIC by approximately 5.85 times.…”

Paracoccidioidomicose com Acometimento Ganglionar e Mucoso - Relato de Caso

“…A estrutura fúngica típica, denominada "roda de leme", corresponde a uma levedura arredondada e de membrana espessa, contendo um ou mais brotos com base estreita. 10 O controle da infecção depende da resposta imune celular efetiva, geralmente padrão Th1, com formação de granulomas no local primário de infecção. 1,5 A organização desses granulomas permite o controle da replicação do fungo, mas formas quiescentes podem permanecer em seu interior.…”