Severe acute paracoccidioidomycosis in children

Benard, Gil; Orii, Noemia Mie; Marques, Heloisa; Mendonça, Mitzi G.; Aquino, Maria Zilda de; Campeas, Alexandre Ely; Negro, G. Del; Durandy, Anne; Duarte, Adriana Pereira

doi:10.1097/00006454-199406000-00009

Cited by 37 publications

(21 citation statements)

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“…Duration of symptoms before the diagnosis and the clinical manifestations of PCM were similar to other studies [2][3]6,9,11,[15][16][17] . Most of the clinical manifestations were related to the reticuloendothelial system, especially lymph node enlargement, hepatomegaly and splenomegaly.…”

Section: Discussionsupporting

confidence: 88%

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

Pereira

Bucaretchi

Barison

et al. 2004

Rev. Inst. Med. trop. S. Paulo

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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.

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Section: Discussionsupporting

confidence: 88%

“…The lack of published reports about this disease in children [2][3]6,9,11,[15][16][17]22 prompted us to report our experience with 63 children less than 15 y old who presented 70 episodes of PCM, admitted to the University Hospital of the State University of Campinas (UNICAMP), São Paulo, Brazil.…”

Section: Introductionmentioning

confidence: 99%

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

Pereira

Bucaretchi

Barison

et al. 2004

Rev. Inst. Med. trop. S. Paulo

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“…In addition, patients with acute paracoccidioidomycosis have reduced cell-mediated immunity, including a low CD4 : CD8 ratio, a reduced absolute number of T lymphocytes, and decreased lymphocyte responsiveness to P. brasiliensis cell wall antigen. [12][13][14][15] Patients with acute paracoccidioidomycosis also demonstrate an impaired Th1 lymphocyte response, the major mechanism of host defense against P. brasiliensis. 16 A gradual correction of these abnormalities usually accompanies treatment, but may require months.…”

Section: Resultsmentioning

confidence: 99%

“…16 A gradual correction of these abnormalities usually accompanies treatment, but may require months. 12,13 Thus, impaired host immunity may have contributed to the observed failure of amphotericin B colloidal dispersion. It is also possible that amphotericin B in the deoxycholate preparation has more interaction with these immune cells than when it is encased in a lipid preparation.…”

Section: Resultsmentioning

confidence: 99%

Failure of amphotericin B colloidal dispersion in the treatment of paracoccidioidomycosis.

Dietze

Fowler²,

Steiner³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. Although amphotericin B desoxycholate is considered the most effective treatment for disseminated Paracoccidioides brasiliensis infections, little is known about the efficacy of lipid-based formulations of amphotericin B in this infection. In this study, we treated four adults with the juvenile form of paracoccidioidomycosis with 3 mg/ kg/day of amphotericin B colloidal dispersion for at least 28 days. Although all of the patients initially responded by clinical observation, all four patients relapsed within six months. The use of amphotericin B colloidal dispersion for the initial induction of paracoccidioidomycosis failed to cure this infection. Possible reasons for failure include dose, duration, or reduced efficacy of this lipid preparation. For many fungal infections, lipid-based preparations have been shown to have a therapeutic-toxic advantage, but our experience with Paracoccidioides infections suggests that more careful studies will need to be performed before they can be recommended for use in this mycosis.

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“…The juvenile form is characterized by predominant involvement of the reticuloendothelial system. The mean duration of symptoms at consultation is 60 days and the most frequently involved organs are lymph nodes, skin, liver and spleen; less frequently bone marrow, stomach, small bowel, bones and joints are also invaded (Benard et al, 1994;Londero et al, 1996;Mendes, 1994;Morejon et al, 2009;Pereira et al, 2004). …”

Section: Acute/subacute or Juvenile-type Diseasementioning

confidence: 99%

Lung Diseases - Selected State of the Art Reviews

Irusen¹

2012

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Severe acute paracoccidioidomycosis in children

Cited by 37 publications

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

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

Failure of amphotericin B colloidal dispersion in the treatment of paracoccidioidomycosis.

Lung Diseases - Selected State of the Art Reviews

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