Paracoccidioidomycosis in Brazilian Patients With and Without Human Immunodeficiency Virus Infection

Abstract

Paracoccidioidomycosis (PCM) is endemic to Latin America, where 10 million people may be infected with Paracoccidioides brasiliensis/Paracoccidioides lutzii and 1,600,000 individuals live with human immunodeficiency virus (HIV) infection. An epidemiological overlapping of these infections occurred early in acquired immunodeficiency syndrome era with nearly 180 published cases. This study presents epidemiological, clinical, and outcome profiles for 31 PCM patients with HIV infection diagnosed in a teaching hospital in Brazil, and includes an update of previously reported cases. Medical records were reviewed and data compared with 64 PCM patients without HIV infection. Of the 31 PCM patients with HIV infection, 23 (74.1%) were male, with a median age of 36.7 years, whereas of the 64 PCM, 45 (70.3%) were male, with a median age of 35.1 years. Both groups presented similar proportions for smoking and alcoholism. PCM patients with HIV infection presented more fever, weight loss, and the acute clinical form than the PCM patients who had more mucosal and respiratory involvement characterizing the chronic form. Most PCM patients with HIV infection exhibited overlapping symptoms from both clinical forms with median symptom duration of 4.5 months compared with 8.3 months for the PCM control. Patients received sulfonamides and/or itraconazole for a median of 15.7 and 16.7 months for PCM/HIV-infected and PCM, respectively. Relapses occurred more in PCM (12 [30%]) than PCM/HIV-infected (4 [14.8%]) patients, whose mortality rate was higher (10 [32.8%]) than PCM patients (8 [20%]). The cases of PCM/HIV infection confirm that HIV can interact with some endemic diseases without increasing their frequency, while changing their natural history, clinical presentation, and outcome. The data presented here are in agreement with those observed in other studies.

Brazilian guidelines for the clinical management of paracoccidioidomycosis

“…Opportunistic PCM has been observed in HIV-infected patients, with up to 1.5% of Brazilian AIDS cases reporting simultaneously PCM infection 17,76 . In these co-infected patients, PCM progresses more rapidly and lesions are more widespread, involving lymphadenomegaly, umbilicated cutaneous lesions, hepatosplenomegaly, pulmonary infiltrates, and lesions of the central nervous system and other tissues.…”

Neuroparacoccidioidomycosis: Case Report and Literature Review

“…It is more prevalent in men than women, and more common in rural areas and in rural workers. [1][2][3][4][7][8][9][10][11] Some authors suggest that the gender difference could be explained by an estrogenic inhibitory action on the fungus transformation process. 2…”

“…It is an extra-pulmonary disease with lymphohematogenous dissemination and affects the mononuclear phagocytic system. 1,7,8,11,12 Due to progressive fungal dissemination and reticuloendothelial system organ hypertrophy, the disease is more aggressive and may present high mortality rates. 1,3 The symptoms generally appear in 4 to 12 weeks, and the most common ones are lymphadenopathy, digestive manifestations, hepatosplenomegaly and, mainly, skin and bone lesions.…”

New Insights on Pulmonary Paracoccidioidomycosis

“…In HIV-PCM coinfection, more relapses and higher mortality rates are reported than in nonimmunocompromised hosts. 35,[48][49][50] There are only 11 cases reported in solid organ transplantation, but as organ transplantation becomes more available in endemic areas of PCM, awareness of PCM pre-and posttransplant is important, as is investigation of PCM in cases of chronic granulomatous disease. [51][52][53][54][55][56][57][58] In the same way, the use of immunobiological therapy has been growing, and cases of PCM during its use have been reported.…”