Paracoccidioides brasiliensis (Lutz, 1908) isolado por meio de hemocultura em um paciente portadora de símdrome de imunodeficiência adquirida (SIDA)

Abstract

Relata-se o primeiro caso de isolamento de Paracoccidioides brasiliensis (P. brasiliensis) em sangue de paciente HIV positivo, 28 anos, sexo masculino, natural de Nova Londrina que, ao exame físico e ultrassonográfico, apresentava esplenomegalia febril a esclarecer. Para estabelecer o diagnóstico etiológico, hemoculturas em triplicata foram realizadas para pesquisa de bactérias aeróbias, micobactérias e fungos. As hemoculturas para bactérias aeróbias e micobactérias foram negativas e P. brasiliensis foi isolado de duas hemoculturas, na fase leveduriforme em ágar BHI, 20 dias após a semeadura, a partir do meio de Negroni. O paciente classificado, segundo o "Centers for Disease Control (CDC)", no grupo IV devido a uma pneumocistose pulmonar, interrompeu o tratamento por problemas particulares na segunda dose de anfotericina B, sendo tratado alternativamente com 800 mg/dia de cetoconazol. O óbito ocorreu um ano após o isolamento do P.brasiliensis em hemocultura.

Paracoccidioidomycosis: A Model for Evaluation of the Effects of Human Immunodeficiency Virus Infection on the Natural History of Endemic Tropical Diseases

“…We also cannot rule out the possibility that the use of prophylaxis was in some degree underreported. The only 7 patients receiving "prophylaxis" when PCM was diagnosed were taking co-trimoxazole for ∼1 month for cryptosporidiosis (1 patient [45]) or pneumocystosis (1 patient [16]); ketoconazole for moniliasis (2 patients [42]); itraconazole for maintenance treatment of histoplasmosis (1 patient [25]); or co-trimoxazole prophylactically for pneumocystosis (2 patients [28,47]). …”

Paracoccidioidomycosis in an HIV‐positive patient: a case report with gingival aspects

“…Oral itraconazole can also produce a clinical cure in most patients (Scully et al, 1997). The use of azoles has ensured better tolerated treatments and it seems particularly useful for fungal diseases that need lengthy therapeutical courses (Goldani, 1991;Haddad et al, 1992;Goldani and Sugar, 1995;Marques et al, 1995;Lortholary et al, 1999). Our patient was treated with sulphadiazine associated with anti-retroviral therapy, and satisfactory results were obtained after a 4-month therapy (Figure 1c, d).…”

Fatal septic shock caused by Paracoccidioides brasiliensis phylogenetic species S1 in a young immunocompetent patient: a case report

“…is a typical event in PCM pathogenesis, isolation of the fungus from blood samples is unusual, being mostly reported in cases of immunosuppression 7,8 . The direct observation of Paracoccidioides structures in blood smears is even more rare because it indicates a high fungal burden.…”