ABSTRACT
Neuroparacoccidiodimycosis (NPDM) is an uncommon granulomatous disease, which more frequently affects immunocompromised male patients over 30 years of age in the course of chronic lung disease. Paracoccidioides brasiliensis (PB) is an endemic fungus in Brazil, and grows as thick-walled yeast (with round to oval bodies) measuring 10 µm to 60 µm in diameter. Neuroparacoccidiodimycosi may develop many years after transmission and/or primary lung involvement. The authors describe a case of NPDM affecting a male patient, 52 years of age, farmer, heavy smoker, with clinical complaint of headache, asthenia, seizures, and prostration in the previous nine months. Upon physical examination, the patient presented regular general condition, without other relevant physical alterations. Computed tomography (CT) showed multiple bilateral pulmonary nodules associated to enlargement of the mediastinal lymph node. Magnetic resonance imaging (MRI) and CTscans of the central nervous system showed six heterogeneous nodular lesions compromising the frontal and parietal lobes, the largest one measuring 3.8 3.2 3.2 cm. The hypothesis of a neoplastic process compromising the lung and brain was considered. A biopsy of the mediastinal lymph node showed epithelioid granulomas, which exhibited round, thin-walled fungal structures in Grocott silver stain. The stereotactic biopsy of the frontal lesion was constituted by necrotic tissue admixed with some round to oval, thin-walled fungi measuring 10 µm to 60 µm, compatible with PB (identified on Grocott silver stain/confirmed in culture). The diagnosis of NPDM was then established. The employed therapeutic regimen was intravenous amphotericin B, itraconazole, and sulfamethoxazole-trimetropin. After ninety days of clinical follow-up, no episodes of seizures/neurological deficits were identified, and a marked decrease in the number and size of the lung and brain lesions were found.
Subject(s)
Humans , Male , Middle Aged , Paracoccidioidomycosis/therapy , Immunocompromised Host , Central Nervous System Fungal Infections/surgery , Antifungal Agents/therapeutic use , Paracoccidioides , Paracoccidioidomycosis/diagnostic imaging , Central Nervous System Fungal Infections/diagnostic imagingABSTRACT
Trata-se de apresentação da Análise da Imagem de lesões cutâneas e intracranianas reveladas pelo exame clínico direto e radiológico, em que características clínico-epidemiológicas e de exames complementares permitem a identificação de agente etiológico mais provável, e revela gravidade extrema de nosologia eminentemente brasileira, que requer alerta para seu diagnóstico precoce e tratamento adequado para impedir sequelas e morte precoce. (AU)
This is a presentation of the Image Analysis of cutaneous and intracranial lesions revealed by direct clinical and radiological examination, in which clinical-epidemiological and complementary features allow the identification of the most probable etiological agent, and reveals extreme severity of nosology in Brazil, which requires alertness for its early diagnosis and appropriate treatment to prevent sequelae and early death. (Au)
Subject(s)
Humans , Male , Adult , Paracoccidioidomycosis , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/drug therapy , Cerebrum/injuries , Paracoccidioidomycosis/diagnostic imaging , Basal Ganglia/injuries , Soft Tissue Injuries , Lower Extremity , Lymph Nodes/abnormalitiesABSTRACT
La paracoccidioidomicosis (PCM) es una enfermedad crónica, sistémica, granulomatosa, endémica en nuestro país, producida por un hongo dimorfo denominado Paracoccidioides brasiliensis. Existen numerosas técnicas para realizar el diagnóstico de esta entidad. Nos planteamos la posibilidad de realizar un estudio para determinar la concordancia que pudiese existir entre las diferentes técnicas que se utilizan para el diagnóstico de la PCM. Se realizó un registro de historias clínicas. Se evaluaron 251 historias clínicas de pacientes con diagnóstico de PCM, de la consulta externa de la Sección de Micología Médica Dr. Dante Borelli del IMT-UCV, entre los años 2000 y 2010. Se determinó la concordancia entre los métodos diagnósticos por medio del análisis de concordancia de atributos para datos binarios. Entre el examen directo y el cultivo, no hubo acuerdo. Entre la serología y el examen directo, se encontró que hubo equivalencia, así como entre el cultivo y la serología. No se pudo calcular correlación alguna con la histopatología, ya que no hubo datos negativos, en vista de que todas las muestras procesadas fueron positivas. El diagnóstico de la PCM se basa en la identificación y el aislamiento del hongo. Es obligatoria la realización del examen directo en fresco de toda muestra clínica. Nuestro estudio de muestra que deben realizarse todos los métodos que estén al alcance (examen directo en fresco, cultivo, serología, histopatología) a fin de aumentar la probabilidad de llegar a un diagnóstico certero de esta patología
Paracoccidioidomycosis (PCM) is a chronic, granulomatous disease, endemic in our country, produced by a dimorphic fungus, Paracoccidioides brasiliensis. Several techniques are used for the diagnosis. A study was performed to determine the agreement that could exist between the different techniques, used for the diagnosis of PCM. Clinical records of patients with diagnosis of PCM was made. 251 clinical records were reviewed, from the Sección de Micología Médica Dr. Dante Borelli, IMT- UCV, between 2000 and 2010. The agreement between the methods was determined by means of the analysis of agreement of attributes for binary data. Between direct examination and culture, there was no agreement. Between serology and direct examination, there was equivalence, as well as between culture and serology. Correlation could not be calculated with histopathology, since there were no negative data, due to the fact that all the processed samples were positive. The diagnosis of the PCM is based on the identification and isolation of the fungus. Direct examination is mandatory in all clinical samples. Our study demonstrates that all the methods must be performed (direct examination, culture, serology, histopathology) in order to increase the probability of reaching an accurate diagnosis
Subject(s)
Humans , Diagnostic Techniques and Procedures , Medical Examination/methods , Mycology/methods , Paracoccidioidomycosis/diagnosis , Serology/methods , Infectious Disease MedicineABSTRACT
Se presenta el caso de un paciente alcoholista con una ulceración perianal y manifestaciones cutáneas de enfermedad de Hansen. La biopsia de la lesión perianal y otros estudios arribaron al diagnóstico de una forma diseminada de paracoccidioidomicosis, así como también las biopsias cutáneas y los estudios baciloscópicos fueron diagnósticos de lepra lepromatosa. La respuesta a la terapéutica fue satisfactoria con desaparición de las lesiones cutáneas. La disminución de la respuesta inmunológica celular genera un terreno propicio para la infección de estos gérmenes y al compartir área endémica la asociación entre ambas patologías puede ocurrir.
Lepra and Paracoccidioidomycosis are endemic diseases in Argentina. We report a case of a patient with an unusual perianal ulceration and cutaneous manifestations of Hansen's disease. The biopsy of perianal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, as well as skin biopsy and baciloscopic finding diagnostic of Lepromatous Leprosy. The main portal of entry of paracoccidioides is the lung. Hematogenous dissemination of the fungus may occur at this time, with the establishment of metastatic foci in any organ. Anal and perianal lesions are present only in 1.3 to 2.4% of the patients. The pathogenesis of anal lesions remains unclear, it may be secondary from a systemic or a local disease. The patient response to the therapeutic was notable, with disappearance of lesions up to the third month of started itraconazole orally 400 mg/day leading just atrophy scars in perianal areas. The treatment of Hansen's disease was made according to OMS guidelines for multibacillary disease.
Subject(s)
Humans , Male , Middle Aged , Leprosy, Lepromatous/diagnosis , Paracoccidioidomycosis/diagnosis , Endemic Diseases , Leprosy, Lepromatous/drug therapy , Leprosy, Lepromatous/pathology , Paracoccidioidomycosis/drug therapy , Paracoccidioidomycosis/pathologyABSTRACT
A paracoccidioidomicose é a micose sistêmica mais prevalente na América Latina, principalmente no Brasil. Apesar de existirem vários estudos sobre o diagnóstico e patologia dessa micose, pouco se conhece sobre a ecologia do agente etiológico Paracoccidioides brasiliensis. Seu habitat ainda não foi determinado, mas provavelmente o fungo vive saprofiticamente no solo. Há também pouca informação quanto a participação de outras espécies de animais na eco-epidemiologia do fungo e os isolamentos obtidos de animais como morcego e pingüim não foram reprodutíveis. Até o presente, o fungo tem sido isolado com maior freqüência do tatu, Dasypus novencinctus. Estudos soroepidemiológicos demonstraram que a infecção é freqüente em cães, principalmente da área rural e recentemente foi relatado o primeiro caso de paracoccidiodomicose natural em cão. O papel de outras espécies de animais na eco-epidemiologia do fungo ainda não está esclarecido.