Paracoccidioidomycosis

Pulmonary Paracoccidioidomycosis: Clinical, Immunological and Histopathological Aspects

“…(Bellissimo- Rodrigues et al, 2011;Paniago et al, 2003;Shankar et al, 2011). Clinically manifested PCM occurs, consequently, more often (>80%) in adult patients 30-60 years old with the fourth decade of life presenting the largest number of cases (Colombo et al, 2011;Nucci et al, 2009;Paniago et al, 2003). The predominance of adult patients is reflected in higher mortality rates for those within this age group (Bittencourt et al, 2005;Coutinho et al, 2002;Prado et al, 2009;Santo, 2008).…”

“…Approximately 60% of the patients with active PCM work or have worked in agriculturerelated jobs, notably in tobacco, coffee and sugarcane fields (Calle et al, 2001;Colombo et al, 2011;Nucci et al, 2009;Paniago et al, 2003). Other occupations mentioned in large series are masonry, bricklaying and mining, as well as lumberjacking in indigenous forests.…”

“…Even though residence in rural areas is a common trait among PCM patients, migration to urban settlements would be accompanied by a change in jobs so that when the diagnosis is established in these secondary localities, the medical history may record a different, non-PCM-related occupation. Additionally, recent land exploitation methods rely on insecticide application and soil burning, as done in sugarcane plantations, which should kill the fungus if present in the soil (Nucci et al, 2009;Restrepo et al, 2011). As a consequence, human exposure would no longer be as common; however, further observations are required to fully understand this point.…”

“…The microscopic visualization in representative clinical samples (including respiratory specimens or biopsies) of multiple budding yeast cells with a pilot's wheel-like appearance by direct KOH preparations or special stains, establishes the diagnosis (Lacaz et al, 2002;Nucci et al, 2009;Restrepo et al, 2009Restrepo et al, , 2011. Isolation of the fungus in culture is considered the gold standard and is successful in 60-85% of the cases.…”

“…Another important blocking factor in the search for the fungus's habitat is its capacity to enter prolonged quiescent stages, which has been demonstrated by the approximately 90 imported cases reported from nonendemic countries, as exemplified by the patients recently diagnosed in Europe (Buitrago et al, 2011;Mayayo et al, 2007;Poisson et al, 2007). All patients corresponded to emigrants living in Japan, the USA, Canada or several of the European countries where they had lived for a mean of 14 years after abandoning their native PCM-endemic homelands (Lacaz et al, 2002;Nucci et al, 2009;Shankar et al, 2011). These data clearly reveal P. brasiliensis's ability to enter prolonged latency, to revive without notice and cause clinically manifested disease.…”