Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome

Abstract

SUMMARY From February, 1981 to May, 2001, 63 children under 15 y old (ages 2 -15 y, median = 8 y, mean ± 1 SD = 8 ± 3 y) presenting 70 episodes of Paracoccidioidomycosis were admitted. The main clinical manifestations and laboratory features observed upon admission were: lymph node enlargement (87.1%), fever (75.7%), weakness (48.6%), pallor (41.4%), hepatomegaly (40%), splenomegaly (35.7%), anemia (90%), hypergammaglobulinemia (88.5%), eosinophilia (75.5%) and hypoalbuminemia (72.5%). Moderate to severe malnutrition was detected in 35.7% of the episodes (Gomez's criterion). Radiographic and technetium studies showed bone lesions in 20 of the episodes, most of them being multiple lytic lesions, involving both long (70%) and plain bones (30%). First line treatment consisted of an association of sulfametoxazole-trimethoprin, which was used, exclusively, in 50 episodes. Follow-up of hemoglobin levels, number of eosinophils in the peripheral blood, albumin and gammaglobulin serum levels revealed significant sequential improvement one and six months after hospital admission, being quite useful to evaluate treatment effectiveness. Six patients died (9.3%) and four developed sequelae (6.3%) . In conclusion, the juvenile and disseminated forms can be observed in about 70% of the episodes of PCM occurring in children younger than 15 y old, most of them presenting with a febrile lymphoproliferative syndrome associated to anemia, eosinophilia and hypergammaglobulinemia.

Adrenal function in 23 children with paracoccidioidomycosis

“…These data were not compatible with mineralocorticoid insufficiency, and it can be explained by hypoalbuminemia, which is common in these PCM patients 18 , or different level of dietary sodium 22 , which was not controlled in this study. The relationship between hypoalbuminemia and cases with more severity and/or more time of disease was also not established in these cases.…”

“…These patients are part of a cohort of children with PCM previously described 18 . The study was conducted from January to August 2002.…”

Bilateral paracoccidioidomycotic iliopsoas abscess associated with ileo-colonic lesion

“…Paracoccidioidomycosis can manifest itself in two distinct clinical forms: acute/subacute or chronic. The acute/subacute form represents 3 to 5% of PCM cases, being more common in the first three decades of life, especially in children 3 . It evolves rapidly, with significant general state impairment, fever, hepatosplenomegaly, lymphadenomegaly, together with digestive, osteoarticular, and cutaneous manifestation.…”

Paracoccidioidomicosis juvenil diseminada diagnosticada en una niña en área urbana

“…Se presenta principalmente en adultos de 30 a 60 años de edad y predomina en hombres con una relación de 15 a 1. Los pacientes son, por lo general, personas que trabajan en la agricultura, y las manifestaciones clínicas se presentan meses o inclusive años después de la infección primaria (13).…”

“…Asimismo, se considera criterio de recuperación la desaparición o mejoría notable de las lesiones radiológicas, con estabilización de secuelas cicatriciales y hallazgos de tipo inmunológico como son la negativización de los títulos en la prueba de doble inmunodifusión y la estabilización a niveles bajos de los títulos de anticuerpos medidos por la fijación del complemento o por ELISA (13).…”