Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients

Abstract

Paracoccidioidomycosis (PCM) is a rare fungal infection in the world, but endemic and acquired exclusively in Latin America, with the highest prevalence in South America and Brazil, particularly. Changes in oral cavity are common and constitute the first clinical manifestation in many patients. The aim of this study was to describe the prevalence of oral PCM and analyse the profile of the disease and patients. Retrospective research, consisting of information present in the medical records in the period 1998-2015, whose histopathological diagnosis was oral PCM. Fifty-five oral PCM cases were confirmed. Of these patients, 90.9% were males and 9.1% were females. The average age was 49.66 years and the most reported occupation was rural workers. The painful symptomatology was present in 61.82% of patients. Erythematous lesions were predominant in 73% of them. In single lesions (22 cases), the most common locations were jugal mucosa and tongue. In multiple involvement (30 cases), the most affected regions were lips, jugal mucosa and alveolar ridge. Epidemiology of PCM, was similar to several other studies, especially in Brazil. This is the most important fungal infection in Latin America and the recognition of oral lesions is extremely important, as is often the first and in many cases the only manifestation of the disease.

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 .…”

“…However, there was no information regarding occupation for almost half the sample investigated. Accordingly, it is important to consider that epidemiological approaches to PCM are challenging, as notification is noncompulsory and the disease is often underestimated (Queiroz‐Telles et al, ; Trindade et al, ).…”

“…Recently, an outbreak of PCM has been reported in a Brazilian region, where deforestation and massive earth removal took place (Valle et al, ). According to the incubation period and the characteristics of the affected individuals, there are two clinical forms of PCM, that is acute/subacute and chronic (López‐Martínez et al, ; Trindade et al, ). The chronic form (adult type) accounts for approximately 80% of PCM cases, mostly among rural male workers.…”

“…The oropharynx may be the first anatomical site of manifestation, and lesions at this site are fairly common (Oliveira, Mariano, Santos Silva, Vargas, & Lopes, ). The classical clinical presentations are granular, erythematous or ulcerated lesions surrounded by jagged edges with a thin haemorrhagic dotted edge (Trindade et al, ). The oral cavity may be affected at one or multiple sites, with the gingiva and palate being the most prevalent sites (Oliveira et al, ; Webber, Martins, Oliveira, Munhoz, & Carrard, ).…”

Diagnosis and treatment of primary paracoccidioidomycosis in oral mucosa

“…1,3,4 Clinically, PCM may be categorized into the following forms: pulmonary, mucocutaneous, lymphatic, and mixed (in which multiple organs are involved).However, typically, the primary site of inoculation is the lungs, and then, the fungus spread via the blood to other organs and to the upper aerodigestive tract, including the oral mucosa, through expiration and sputum. 2,3,5 Due to the severity of this infection and treatment difficulties, health care providers must be aware of the clinical manifestations and management to obtain an early diagnosis. 2,3 The primary inoculation of the fungus in the oral mucosa, as seen in this case, is a rare condition and may cause some confusion because of the lack of further symptoms.…”