Paracoccidioidomycosis Treatment

Abstract

SUMMARYConsidered to be an emerging endemic mycosis in Latin America, paracoccidioidomycosis is characterized by a chronic course and involvement of multiple organs in immunocompromised hosts. Infection sequelae are mainly related to pulmonary and adrenal insufficiency. The host-parasite interaction results in different expressions of the immune response depending on parasite pathogenicity, fungal load and genetic characteristics of the host. A few controlled and case series reports have shown that azoles and fast-acting sulfa derivatives are useful treatment alternatives in milder forms of the disease. For moderate/severe cases, more prolonged treatments or even parenteral routes are required especially when there is involvement of the digestive tract mucosa, resulting in poor drug absorption. Although comparative studies have reported that shorter treatment regimens with itraconazole are able to induce cure in chronically-infected patients, there are still treatment challenges such as the need for more controlled studies involving acute cases, the search for new drugs and combinations, and the search for compounds capable of modulating the immune response in severe cases as well as the paradoxical reactions.

Antifungal and antioxidant activity of fatty acid methyl esters from vegetable oils

“…Moreover, FAMEs (soybean, corn and sunflower) showed better activity than SMX-THT (P = 0.0001) against the isolates of P. brasiliensis Pb-18, Pb-608, Pb-1017, Pb-9673 and P. lutzii 01. SMX-THT is used in the treatment of PCM, mainly in endemic regions where other therapy (such as itraconazole) is not easily available; consequently, therapy consisting of SMX-THT is a useful option (de Oliveira et al 2015, Shikanai-Yasuda 2015. The difference in antifungal activity between different FAMEs, against 11 isolates of Paracoccidioides spp., is not statistically significant (P < 0.05).…”

Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients

“…The treatment comprises addition of antifungal agents and the use of measures to improve the general condition of the patient. Some controlled studies and case series have shown that azoles fast action and sulfa derivatives are useful therapeutic options for milder forms of the disease while in moderate/severe cases, longer treatments or parenterally are needed, especially when there is mucosal involvement …”

“…Some controlled studies and case series have shown that azoles fast action and sulfa derivatives are useful therapeutic options for milder forms of the disease while in moderate/severe cases, longer treatments or parenterally are needed, especially when there is mucosal involvement. 9 The epidemiological approach to PCM is difficult, since its notification is not compulsory. The prevalence calculations, incidence and morbidity are based on reports of epidemiological studies and case series.…”

Immunotherapy against Systemic Fungal Infections Based on Monoclonal Antibodies

“…Thermodimorphic fungi of the Paracoccidioides genus cause paracoccidioidomycosis (PCM), an endemic granulomatous mycosis of the sub-tropical regions of Latin America, widespread from south of Mexico to north of Argentina, with a high prevalence in South America [120][121][122][123]. PCM generally affects male workers in close contact with the soil in rural areas.…”