Paracoccidioidomycosis: a series of 66 patients with oral lesions from an endemic area

Abstract

Paracoccidioidomycosis (PCM) is the most important systemic mycosis in Latin America. It has been regarded as a multifocal disease, with oral lesions as the prominent feature. To provide useful information concerning the diagnosis and management of the disease, this study describes demographic and clinical data from the medical records of a consecutive series of 66 Brazilian patients from an endemic area, evaluated in a referral centre for oral diagnosis. In this sample of patients, there was a predominance of middle-aged male patients, who were primarily rural workers. Chronic multifocal disease was prevalent, with lesions also detected in the lungs, lymph nodes, skin or adrenal glands. Most of the cases presented with lesions at the gingival mucosa followed by the palate and lips; these conditions occurring in the oral cavity were frequently associated with pain. Importantly, most of the patients sought professional care for oral lesions. The diagnosis was obtained through exfoliative cytology and/or biopsy of the oral lesions. Medical treatment was effective, and there were no mortalities in the sample. The present findings not only confirm the importance of oral lesions in the diagnosis and management of PCM but also illustrate that questions still remain unclear, such as the possibility of direct inoculation of the fungus onto oral tissues.

Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients

“…Multiple injuries affected predominantly the lips, oral mucosa and alveolar ridge, while the only injuries were more present in the oral mucosa, tongue and alveolar ridge. As in the present work, Brazão‐Silva et al . and Verli et al .…”

“…The age of patients with oral manifestations ranged 06‐81 years and the average age was 49.66 years. Some similar studies have found similar results with average age that also fall into the fourth decade of life, which can be explained by greater exposure to the fungus by adults in their work activities. Furthermore, it is believed that the great majority of the cases belongs to study chronic form of the disease which is seen in 90% of patients, it affects adults and often show secondary mucosal lesions …”

“…All the cases in question were diagnosed by histopathological examination of biopsied specimens of oral lesions. The incisional biopsy was the most used technique (85.45% of cases) for diagnosis, and shown to be effective in the diagnosis of oral lesions as demonstrated in other studies . Some differential diagnosis should be included to such injuries, especially squamous cell carcinoma, tuberculosis, sarcoidosis and Wegener's granulomatosis …”

“…The acute form, responsible for 10% of patients, is characterised by an abrupt and severe progression of infection that affects children and young people of both sexes. The chronic form, which is seen in 90% of cases, affects adults, mostly male and presents with primary pulmonary impairment and, secondary, mucosal lesions, skin, lymph nodes and adrenal glands …”

Expanding the Clinical and Genetic Spectrum of Human CD40L Deficiency: The Occurrence of Paracoccidioidomycosis and Other Unusual Infections in Brazilian Patients

“…The disease progresses slowly with symptoms of cough, expectoration, weight loss, and fever. A characteristic of the chronic form is pulmonary manifestation; however, it can also occur as a multifocal form with fungal spread to more than one organ or tissue such as the oral mucosa, skin, lymph nodes [35][36][37], central nervous system, and gastrointestinal and ocular manifestations [38][39][40].…”