Aspectos laboratoriais evolutivos de crianças em tratamento da paracoccidioidomicose

Abstract

RESUMOEstudo de 38 crianças com paracoccidioidomicose, até 14 anos de idade, tratados por 24-30 meses, com um derivado sulfamídico ou cetoconazol, desde o início do tratamento ou em seguida ao uso da anfotericina B. Dados laboratoriais à admissão foram analisados e comparados com exames seqüenciais até 30 meses de acompanhamento. Anemia, eosinofilia e bilirrubinas e aminotransferases elevadas normalizaram-se, na maioria, até os três meses de tratamento e, hipoalbuminemia, até os seis meses, sugerindo que esses achados sejam bons parâmetros para o monitoramento da resposta terapêutica inicial. Leucócitos periféricos, velocidade de hemossedimentação, IgG e títulos sorológicos para o Paracoccidioides brasiliensis estavam elevados e normalizaram-se, freqüentemente, após nove a 12 meses de tratamento, o que sugere utilidade desses exames no monitoramento de todo o tratamento e enfatiza a necessidade de curso terapêutico prolongado da paracoccidioidomicose na infância. Palavras-chaves: Paracoccidioidomicose. Criança. Seguimento de exames laboratoriais. ABSTRACTThe study of 38 children with paracoccidioidomycosis, aged up to 14, treated for 24 to 30 months with either a sulfonamide derivative or ketoconazole either alone or, after the use of amphotericin B. Laboratory data at admission were analyzed and compared with those of sequential tests after up to 30 months follow-up. Anemia, eosinophilia, increased bilirubin and aminotransferases normalized, in most patients, after three months treatment and hypoalbuminemia normalized after six months, suggesting that these laboratory findings are useful for monitoring early therapeutic response. Peripheral leucocytes, erythrocyte sedimentation rate, IgG, and serological titers for Paracoccidioides brasiliensis were increased and frequently normalized after nine to 12 months of treatment. They may be useful for monitoring the entire treatment and emphasize the need for long term treatment of paracoccidioidomycosis in children. Key-words: Paracoccidioidomycosis. Children. Follow-up laboratory.A paracoccidioidomicose (PCM) é uma micose sistêmica que ocorre caracteristicamente em regiões rurais da América Latina, sendo o Brasil o país com o maior número de casos da doença. Afeta pessoas previamente hígidas, tem curso crônico e, muitas vezes, com gravidade. Informações sobre a evolução das alterações laboratoriais de pacientes em tratamento ainda são escassas e resultam, na maioria, de casuísticas pequenas e tempo de acompanhamento inferior ao tempo de tratamento. É conhecido o valor de exames como a sorologia e a velocidade de hemossedimentação no monitoramento terapêutico dos pacientes 1 8 11 27 . Entretanto, apesar dos avançados estudos no campo da imunologia e do

Decreasing Prevalence of the Acute/Subacute Clinical Form of Paracoccidioidomycosis in Mato Grosso Do Sul State, Brazil

“…The acute-subacute form, also called the juvenile form, is less prevalent than the chronic form, or the adult form. However, PCM prevalence was higher in the states of Pará, Maranhão, Minas Gerais, Goiás, São Paulo and Rio de Janeiro 4,7,14,20,23,37,38 , than observed in the state of Rio Grande do Sul and in neighboring countries like Argentina and Paraguay, where the disease occurs almost exclusively in adult men 10,15,18,28 .…”

“…In Brazil, the prevalence of the acute/subacute clinical form varies by state and region as well, being rare in Rio Grande do Sul 10 and more frequent in the states of Maranhão 20,38 , Pará 13 , Minas Gerais 23 , São Paulo 6 , Mato Grosso do Sul 24 , and Rio de Janeiro 37 .…”

Correlation between Histopathological and FT-Raman Spectroscopy Analysis of the Liver of Swiss Mice Infected with Paracoccidioides brasiliensis

“…The liver can also be affected by this disease, and some studies show that liver enzymes are altered [21], [22] indicating that the infection can disrupt the homeostasis of this organ. However, there are no studies of the liver of animals infected with Pb using FT-Raman spectroscopy.…”

The contribution of ultrasonography and computed tomography in the evaluation of abdominal involvement in paracoccidioidomycosis

“…6,77 The disease is usually acquired in the childhood or youth, expressing itself in immunocompetent people as an infection through the inhalation of spores of P. brasiliensis, which reach the pulmonary alveoli forming an inflammatory focus and hence reaching the peribronchial lymph nodes and establishing the primary pulmonary complex. 2,5,8,9 The primary complex does not calcify or is rare in people from endemic zones infected with P. brasiliensis, however, without PCM. 10,11 The initial infection may be followed by a hematogenous spread of the fungus to other organs.…”

“…2,3 The confirmed diagnosis is determined by the detection of the fungus in the collected material, in general from punctures or aspirations of affected tissues, and presumptive when based on serological evidence. 8,9,[18][19][20][21] Imaging methods help to define alterations in organs and systems, however, there are no typical patterns of PCM.…”