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Rev. Soc. Bras. Med. Trop ; 54: e0008-22021, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155584


Abstract We describe the first report of a patient with chronic mucocutaneous candidiasis associated with disseminated and recurrent paracoccidioidomycosis. The investigation demonstrated that the patient had a mannose receptor deficiency, which would explain the patient's susceptibility to chronic infection by Candida spp. and systemic infection by paracoccidioidomycosis. Mannose receptors are responsible for an important link between macrophages and fungal cells during phagocytosis. Deficiency of this receptor could explain the susceptibility to both fungal species, suggesting the impediment of the phagocytosis of these fungi in our patient.

Humans , Paracoccidioidomycosis/complications , Paracoccidioidomycosis/diagnosis , Candidiasis, Chronic Mucocutaneous/complications , Candidiasis, Chronic Mucocutaneous/genetics , Receptors, Cell Surface , Lectins, C-Type , Mannose-Binding Lectins
Rev. Soc. Bras. Med. Trop ; 51(1): 111-114, Jan.-Feb. 2018. graf
Article in English | LILACS | ID: biblio-897041


Abstract The authors report the first case of fatal septic shock, a rare clinical presentation of paracoccidioidomycosis (PCM) caused by Paracoccidioides brasiliensis S1. We also provide an immunological evaluation of the patient. Severe clinical signs such as organ dysfunction and digital gangrene occurred in this case. The patient presented a remarkable cell activation profile and diminished percentage of peripheral blood T regulatory cells. A decrease in anti-inflammatory IL-1RA plasma level showed the potential for endothelium damage, probably contributing to a vasculitis process. Together with P. lutzii, P. brasiliensis appears to be involved in severe cases of PCM.

Humans , Male , Young Adult , Paracoccidioides/genetics , Paracoccidioidomycosis/complications , Paracoccidioidomycosis/diagnosis , Phylogeny , Shock, Septic/microbiology , Severity of Illness Index , Fatal Outcome , Immunocompetence
Rev. Soc. Bras. Med. Trop ; 50(4): 568-570, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-897003


Abstract Myeloperoxidase (MOP) is present in monocyte and neutrophil lysosomes, catalyzing hydrogen peroxide and chloride ion conversion to hypochlorous acid. MOP seems to destroy pathogens during phagocytosis by neutrophils and is considered an important defense against innumerous bacteria. We present a patient who had MOP deficiency, who presented with a subacute form of paracoccidioidomycosis and later with peritoneal tuberculosis. MOP deficiency leads to the diminished destruction of phagocytized pathogens. This case gives important evidence of an association between MOP deficiency and increased susceptibility to infection by Paracoccidioides brasiliensis and Mycobacterium tuberculosis.

Humans , Female , Young Adult , Paracoccidioidomycosis/complications , Peritonitis, Tuberculous/complications , Metabolism, Inborn Errors/microbiology , Paracoccidioidomycosis/diagnosis , Peritonitis, Tuberculous/diagnosis , Metabolism, Inborn Errors/diagnosis
Rev. Ateneo Argent. Odontol ; 56(1): 15-20, jun. 2017. ilus
Article in Spanish | LILACS | ID: biblio-869402


Objetivo: un caso clínico de paracoccidioidomicosis restringida a cavidad oral, contribuyendo con el conocimiento de esta patología al odontólogo general. Caso clínico: paciente masculino de 57 años de edad proveniente de la ciudad de Tartagal, Salta, derivado a la Unidad de Estomatología del Hospital Señor del Milagro, por presentar lesiones orales de tres meses de evolución. Clínicamente se observaron lesiones granulomatosas, indoloras, moriformes, en encía vestibulary palatina del sector antero superior derecho con ausencia de lesiones pulmonares. Se realizaron estudios microbiológicos y anatomopatológicos. Posteriormente, el paciente fue derivado al Servicio de infectología, donde recibió tratamiento con itraconasol (200 mg), con repuesta clínica favorable. Conclusión: el conocimiento de las manifestaciones orales puede llevar al diagnóstico clínico de la paracoccidioidomicosis por parte del odontólogo. El diagnóstico precoz es la mejor manera de salvar al paciente de las complicaciones de esta enfermedad.

Objective: a clinical case of paracoccidioidomicosis restricted to oral cavity, contributing to the knowledge of this disease to the general dentist. Case report: male patient of 57 years old from Tartagal, Salta referred to the Stomatology Center of Hospital Señor Del Milagro, presenting oral lesions with an evolution of three months. He had painless granulomatory lesions in the buccal and palatal gingiva of the upper right sector and without lungs injury. It performed microbiological and pathological studies. Subsequently, the patient referred to the Service of Infectious Diseases where he was treated with 200mg Itraconasol with a favorable clinical response. Conclusion: knowledge of oral manifestations can lead to clinical diagnosis of paracoccidioidomicosis by general dentist. Early diagnosis is the best way to save the patient from complications of this disease.

Humans , Male , Middle Aged , Oral Manifestations , Paracoccidioidomycosis/complications , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/etiology , Argentina , Culture Media , Early Diagnosis , Histological Techniques , Itraconazole/therapeutic use , Prognosis , Paracoccidioidomycosis/microbiology , Paracoccidioidomycosis/drug therapy
Article in English | LILACS | ID: biblio-842763


ABSTRACT This study reports two cases of chronic paracoccidioidomycosis with sarcoid-like cutaneous lesions. The patients began the treatment in 2013 at Hospital Universitário Clementino Fraga Filho (HUCFF) of the Universidade Federal do Rio de Janeiro (UFRJ). The first case (mild form) was treated with trimethoprim-sulfamethoxazole (8 mg /kg per day, orally) for three months and, then, with half the dose for nine months; the second (moderate form), with itraconazole (200 mg per day, orally) for 12 months. We point out the rareness of the sarcoid-like cutaneous lesions and the differential diagnoses for other granulomatous diseases.

Humans , Male , Middle Aged , Paracoccidioidomycosis/complications , Sarcoidosis/complications , Antifungal Agents/therapeutic use , Chronic Disease , Itraconazole/therapeutic use , Paracoccidioidomycosis/drug therapy , Paracoccidioidomycosis/pathology , Sarcoidosis/pathology , Severity of Illness Index , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
An. bras. dermatol ; 91(3): 384-386, graf
Article in English | LILACS | ID: lil-787305


Abstract: The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation.

Humans , Female , Young Adult , Paracoccidioidomycosis/diagnosis , Dermatomycoses/diagnosis , Paracoccidioidomycosis/complications , Acute Disease , Dermatomycoses/microbiology , Photograph , Lymphangitis/complications , Neck
São Paulo; s.n; s.n; 2016. 127 p. tab, graf, ilus.
Thesis in Portuguese | LILACS | ID: biblio-846638


A paracoccidioidomicose é uma micose sistêmica de natureza profunda que afeta preferencialmente o tecido pulmonar podendo disseminar via linfo-hematogênica para outros órgãos e tecidos, sendo causada principalmente pelo Paracoccidioides brasiliensis, fungo que apresenta dimorfismo térmico. O sistema imune inato mediado por macrófagos é extremamente importante para o controle de infecções e está envolvido na indução e regulação da resposta imune/inflamatória. Estas células são capazes de reconhecer patógenos por meio de receptores de reconhecimento de padrões (PRRs), tais como receptores Toll-like (TLR). Além desses PRRs, recentemente, demonstrou-se a importância da via de sinalização Notch no sistema imune inato e na regulação da atividade dos macrófagos. Nossos dados demonstram que a cepa Pb18 do P. brasiliensis é capaz de ativar o receptor Notch1 em macrófagos J774. A ativação desse receptor concomitante com a ativação de TLR 4 (via LPS) induz a produção de IL-6, e apresenta elevada carga fúngica e menor fagocitose, o que favorece a patogenia. Ao utilizarmos um inibidor farmacológico da γ-secretase (DAPT) para inibir a ativação do receptor Notch1 em macrófagos, é possível observar diminuição da carga fúngica, diminuição de IL-6, aumento de TNF-α e aumento da fagocitose. Entretanto, a ausência do receptor TLR 4 em macrófagos derivados de medula óssea de camundongos TLR 4-/-, na presença de DAPT, percebe-se diminuição da capacidade fagocítica desses macrófagos e também diminuição da carga fúngica, evidenciando a relação entre TLR 4 e Notch1. Em adição, realizamos um tratamento em camundongos BALB/c com DAPT previamente à infecção com Pb18. Nossos resultados evidenciaram que animais com este tratamento apresentaram diminuição da carga fúngica dos pulmões, diminuição de IL-6, ativação de macrófagos e aumento de IgG, após 45 dias de infecção, indicando um perfil de cura desses animais. O mesmo tratamento foi realizado em camundongos BALB/c NUDE, seguido da infecção com Pb18. Nestes animais, verificamos que há maior produção de citocinas pró-inflamatórias no pulmão, aumento de células CD19+ e a carga fúngica dos animais tratados manteve-se similar ao dos animais não tratados, indicando que o perfil protetor observado em animais com DAPT é dependente da resposta das células T. Juntos, esses resultados evidenciam que o Pb18 é capaz de ativar o receptor Notch1 em macrófagos e utiliza a via de sinalização Notch-TLR 4 como um possível mecanismo de escape, podendo fornecer uma nova abordagem de estudo da imunidade envolvida na paracoccidioidomicose experimental

Paracoccidioidomycosis is a systemic mycosis of deep nature that primarily affects the lung and can spread via lymphatic and hematogenous to other organs and tissues. It is mainly caused by Paracoccidioides brasiliensis fungus which exhibit thermal dimorphism. The innate immune system mediated by macrophages is extremely important for the control of infection and is involved in the induction and regulation of immune/inflammatory response. These cells are able to recognize pathogens through pattern recognition receptors (PRRs) such as Toll-like receptors (TLR). Beyond these PRRs, the importance of Notch signaling has recently been demonstrated in the innate immune system and the regulation of macrophage activity. Our data demonstrate that the Pb18 strain of P. brasiliensis is able to activate the Notch1 receptor in J774 macrophages. Activation of this receptor with also activation of TLR 4 (via LPS) induces IL-6 production, induces phagocytosis and decreases fungal burden, which favors the pathogenesis. By using a γ-secretase pharmacological inhibitor (DAPT) for inhibiting the activation of Notch1 receptor on macrophages, it is possible to observe decreased fungal burden, less production of IL-6, and increased TNF-α and phagocytosis. However, due to the absence of TLR 4 receptor in bone marrow derived macrophages from TLR 4-/- mice, these macrophages showed decreased phagocytic ability and also reduced fungal burden in the presence of DAPT, showing a relationship between TLR 4 and Notch1. In addition, we made a treatment with DAPT in BALB/c mice prior to infection with Pb18. And our results showed that DAPT-treated animals exhibited a decrease of fungal burden in the lungs, and a decrease of IL-6. Furthermore, we observed an increase of IgG after 45 days of infection, indicating probably a healing of these animals. Same treatment was made in BALB/c NUDE mice, followed by infection with Pb18. In these animals, we observed an increased production of proinflammatory cytokines in the lung and increased CD19+ cells, but fungal burden was similar in both group (treated and untreated), which indicates that treatment with DAPT is dependent on T cell response. Taken together, these results showed that Pb18 is able to activate the Notch 1 receptor on macrophages and uses the Notch-TLR 4 signaling pathway as a possible escape mechanism, and may provide a new immunity study approach in experimental paracoccidioidomycosis

Interrelation , Paracoccidioidomycosis/complications , Receptor, Notch1/classification , Toll-Like Receptor 4/classification , Amyloid Precursor Protein Secretases/administration & dosage , Interrelation , Macrophages , Mycoses/prevention & control , Paracoccidioides
Article in Portuguese | LILACS | ID: lil-712286


Paracoccidioidomycosis or South American blastomycosis is an endemic disease that occurs predominantly in rural South America, caused by a termo-dimorphic fungus named Paracoccidioides brasiliensis. Its epidemiologic importance relates to its characteristics of transmissibility, susceptibility and morbidity, in addition to its high cost due to prolonged medical monitoring. It has a polymorfims in the description, explained by absent or nonspecific initial symptoms such as night sweats, weight loss or fever, and later symptoms according to its location of involvemente. The objective of this study was to report a case of uncommon presentation of this pathology. The case repot is the autopsy of a 74-year-old, white, female patient with predominant manifestation in the gastrointestinal tract originating from paracoccidioidomycosis, and complicated by one of the gastric ulcer perforation. This is an unusual presentation, and reports of gastric perforation credited to this agent were not found in the literature...

Paracoccidioidomicose ou blastomicose Sul Americana é uma enfermidade endêmica rural que ocorre predominantemente na América Latina, tendo como etiologia o fungo termodimórfico Paracoccidioides brasiliensis. Sua importância epidemiológica está nas características de transmissibilidade, suscetibilidade e morbidade dos casos, além de seu alto custo, devido ao acompanhamento médico prolongado. É uma doença cujos sintomas iniciais são ausentes ou inespecíficos como sudorese noturna, emagrecimento ou febre, diferente dos sintomas tardios, que acontecem conforme sua localização de acometimento, o que justifica o polimorfismo em sua descrição. O objetivo deste estudo foi relatar um caso de apresentação incomum dessa doença. Caso clínico com necrópsia de paciente do gênero feminino, 74 anos, branca, com manifestações clínicas predominantes no trato gastrintestinal provenientes de paracoccidioidomicose complicada pela perfuração de uma das úlceras gástricas. Trata-se de uma apresentação incomum e não foram encontrados relatos na literatura de perfuração de úlcera gástrica creditada a esse agente...

Humans , Female , Aged , Paracoccidioidomycosis/complications , Paracoccidioidomycosis/diagnosis , Stomach Ulcer/parasitology , Peptic Ulcer Perforation/parasitology
J. bras. pneumol ; 39(3): 368-372, jun. 2013. tab, graf
Article in English | LILACS | ID: lil-678264


On HRCT scans, lung cysts are characterized by rounded areas of low attenuation in the lung parenchyma and a well-defined interface with the normal adjacent lung. The most common cystic lung diseases are lymphangioleiomyomatosis, Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. In a retrospective analysis of the HRCT findings in 50 patients diagnosed with chronic paracoccidioidomycosis, we found lung cysts in 5 cases (10%), indicating that patients with paracoccidioidomycosis can present with lung cysts on HRCT scans. Therefore, paracoccidioidomycosis should be included in the differential diagnosis of cystic lung diseases. .

Os cistos pulmonares na TCAR são caracterizados por áreas arredondadas de baixo coeficiente de atenuação no parênquima pulmonar com uma interface bem definida com o pulmão adjacente normal. As doenças pulmonares císticas mais comuns são linfangioleiomiomatose, histiocitose de células de Langerhans e pneumonia intersticial linfocítica. Em uma análise retrospectiva de achados de TCAR em 50 pacientes com diagnóstico de paracoccidioidomicose crônica residual, observou-se a presença de cistos pulmonares em 5 casos (10%), mostrando que pacientes com paracoccidioidomicose podem apresentar cistos pulmonares na TCAR. Portanto, essa infecção deve entrar no diagnóstico diferencial das doenças císticas pulmonares. .

Adult , Aged , Female , Humans , Male , Middle Aged , Cysts , Lung Diseases, Fungal , Paracoccidioidomycosis , Smoking/adverse effects , Chronic Disease , Cysts/complications , Outpatients , Paracoccidioidomycosis/complications , Tomography, X-Ray Computed
Rev. Soc. Bras. Med. Trop ; 45(5): 649-651, Sept.-Oct. 2012. ilus
Article in English | LILACS | ID: lil-656222


This case report shows the clinical development of a patient with systemic paracoccidioidomycosis presenting with lymphatic-intestinalmanifestation. The patient initially had a substantial clinical improvement but had a recrudescence after six months of sulfamethoxazoletrimethoprim oral treatment, with the emergence of feverish syndrome, lumbar pain, and intermittent claudication, characterizing a bilateral iliopsoas muscle abscess, necessitating clinicosurgical therapeutics.

Este relato de caso descreve a evolução clínica de paciente comparacoccidioi-domicose sistêmica com manifestação linfática-intestinal.O paciente evoluiu inicialmente com melhora clínica acentuada erecrudescência após seis meses de uso de SMX-TMP pela via oral, com o surgimento de síndrome febril, dor lombar, e claudicação intermitente,caracterizando um abscesso bilateral do músculo íleopsoas, comnecessidade de terapêutica clínico-cirúrgica.

Humans , Male , Young Adult , Intestinal Diseases/complications , Lymphatic Diseases/etiology , Paracoccidioidomycosis/complications , Psoas Abscess/etiology , Paracoccidioides
An. bras. dermatol ; 86(3): 587-588, maio-jun. 2011. ilus
Article in Portuguese | LILACS | ID: lil-592160


Os autores relatam caso de paciente do sexo feminino com paracoccidioidomicose, associada a carcinoma do colo uterino estádio IIIB. Paracoccidioidomicose, associada à neoplasia, ocorre entre 0,16 por cento a 14,1 por cento segundo diferentes séries de casos. Em casos com neoplasia disseminada a infecção fúngicas pode apresentar comportamento oportunístico.

This report describes the case of a female patient with paracoccidioidomycosis associated with a stage IIIB cervical carcinoma. Paracoccidioidomycosis in association with a malignant tumor occurs in 0.16 percent to 14.1 percent of cases in accordance with different case series. In cases in which the cancer is disseminated, the fungal infection may behave opportunistically.

Adult , Female , Humans , Paracoccidioidomycosis/complications , Uterine Cervical Neoplasms/complications , Fatal Outcome , Neoplasm Staging , Paracoccidioidomycosis/pathology
Braz. j. otorhinolaryngol. (Impr.) ; 77(1): 39-43, jan.-fev. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-578455


A Paracoccidioidomicose (PCM) é uma doença sistêmica que em sua forma sequelar se caracteriza por manifestações clínicas relacionadas às alterações anatômicas ou funcionais de órgãos e sistemas comprometidos no período de estado. OBJETIVO: Descrever as alterações anatômicas e funcionais laríngeas sequelares em pacientes com paracoccidioidomicose. MATERIAL E MÉTODOS: Estudo retrospectivo, sendo avaliados 49 pacientes do sexo masculino, na faixa etária de 30 a 60 anos, entre 1999 a 2004, com diagnóstico de PCM em acompanhamento pela disciplina de Moléstias Infecciosas e Parasitárias, confirmado pela demonstração do fungo em escarro, exame citológico ou histopatológico. RESULTADOS: As pregas vocais foram a estrutura laríngea mais afetada, em 67 por cento dos pacientes verificaram-se alterações. A epiglote estava acometida em 55 por cento dos casos. As pregas ariepiglóticas tinham modificações em 53 por cento dos pacientes. As pregas vestibulares estavam alteradas em 46 por cento dos casos. Em 40 por cento dos casos verificaram-se alterações em aritenoides. Na fonação, 28 por cento tinham limitação ao movimento das cordas vocais, paresia unilateral ocorreu em 4 por cento casos. Em 24 por cento havia restrição da luz supraglótica e 4 por cento tinham estenose glótica, sendo que 2 por cento precisaram de traqueotomia. CONCLUSÃO: As lesões sequelares na laringe devido à infecção pelo P. brasilienses são extensas e causam restrições funcionais na maioria dos casos.

Paracoccidioidomycosis (PCM) is a systemic disease that in its aftermath form is characterized by clinical manifestations related to anatomic or functional sequelae of organs and systems affected during the period of state. AIM: To describe the anatomical and functional sequelae in patients with treated laryngeal PCM. MATERIALS AND METHODS: Retrospective study. We reviewed the charts from of 49 male patients, aged between 30 to 60 years, diagnosed with laryngeal PCM during the period of 1999 to 2004. In all patients the diagnosis of PCM was confirmed by demonstration of the fungus in sputum, cytological or histopathological examination and being followed up by the Infectious and Parasitic Diseases Department. RESULTS: The vocal folds were the most affected laryngeal structure, being affected in 67 percent of the patients. The epiglottis and the aryepiglottic folds were affected in 55 percent and 53 percent of the cases, respectively. Vestibular folds were changed in 46 percent of the patients. In 40 percent of the cases there were changes in the arytenoids. During phonation, 28 percent of the patients showed limited movement of the vocal folds, unilateral vocal fold paralysis was found in 4 percent. 24 percent of the cases had glottic lumen reduction and 4 percent showed glottic stenosis, 2 percent needed tracheostomy. CONCLUSION: Sequela lesions of the laryngeal PCM are extensive and cause functional limitations in most cases.

Adult , Female , Humans , Male , Middle Aged , Laryngeal Diseases/etiology , Paracoccidioidomycosis/complications , Cross-Sectional Studies , Laryngeal Diseases/diagnosis , Laryngeal Diseases/microbiology , Retrospective Studies , Voice Disorders/etiology , Voice Disorders/microbiology
Rio de Janeiro; Video Saúde; 2011. 1 videocassete de 1 (Beta) (24 min.).
Non-conventional in Portuguese | LILACS | ID: lil-713243


A paracoco, como é mais conhecida, está entre as dez doenças crônicas que mais causam mortes no país. No Brasil, ocorrem 80% dos casos da doença, que se restringe à América Latina. Trata-se de uma micose brasileira que ataca qualquer órgão ou sistema do organismo e prejudica, principalmente, a saúde do trabalhador rural. O documentário Paracoco – endemia brasileira percorre quatro estados brasileiros, ouvindo pessoas que contraíram a doença e profissionais de saúde, para retratar sintomas, formas de contágio e pesquisas, destacando a importância do diagnóstico no tratamento dos pacientes

Humans , Conservation of Natural Resources , Health Services Accessibility , Professional Training , Paracoccidioidomycosis/complications , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/history , Paracoccidioidomycosis/pathology , Paracoccidioidomycosis/therapy , Rural Workers , Brazil/epidemiology , Early Diagnosis , Risk Factors
Rev. chil. infectol ; 27(6): 551-555, dic. 2010. ilus
Article in Spanish | LILACS | ID: lil-572921


A case of an adult male patient diagnosed with HIV and Hepatitis C co infection is presented. He had granu-lomatuos hepatitis and blood smear positive to Paracoccidioides brasiliensis concomitant to the detection of MDR Mycobacterium tuberculosis in sputum further complicated with reactivation of cytomegalovirus (possible pancreatitis and retinitis). Difficulties in diagnostic and therapeutic approach in a patient with multiple infections are reviewed.

Reportamos el caso de un varón de 54 años portador de VHC y VIH estadio SIDA quien tuvo hepatitis granu-lomatosa y frotis de sangre positivo a Paracoccidioides brasiliensis concomitante al hallazgo de Mycobacterhim tuberculosis multiresistente en esputo, que evolucionó con reactivación de citomegalovirus (pancreatitis probable y retinitis). Se describen las dificultades diagnósticas y terapéuticas en un paciente con múltiples infecciones.

Humans , Male , Middle Aged , AIDS-Related Opportunistic Infections/complications , Paracoccidioidomycosis/complications , Tuberculosis, Multidrug-Resistant/complications , AIDS-Related Opportunistic Infections/diagnosis , Fatal Outcome , Hepatitis C/complications , Hepatitis C/diagnosis , Paracoccidioidomycosis/diagnosis , Tuberculosis, Multidrug-Resistant/diagnosis
Braz. j. infect. dis ; 14(5): 540-543, Sept.-Oct. 2010. ilus
Article in English | LILACS | ID: lil-570573


Paracoccidioidomycosis (PCM) or South American Blastomycosis is a systemic fungal infection caused by a dimorphic fungus, Paracoccidioides brasiliensis. It represents the most important systemic mycosis in South America and with higher prevalence among male inhabitants of the rural area. PCM usually affects the lungs, and rarely the intestines. The authors report three cases of PCM, treated at the University Hospital of Universidade Federal de Mato Grosso do Sul whose scintigraphy with technetium-99 labeled human albumin revead intestinal protein loss.

Adult , Humans , Male , Paracoccidioides/isolation & purification , Paracoccidioidomycosis , Protein-Losing Enteropathies , Anti-Infective Agents/therapeutic use , Itraconazole/therapeutic use , Paracoccidioidomycosis/complications , Paracoccidioidomycosis/drug therapy , Protein-Losing Enteropathies/drug therapy , Protein-Losing Enteropathies/microbiology , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
J. bras. pneumol ; 36(3): 356-362, maio-jun. 2010. tab
Article in English, Portuguese | LILACS | ID: lil-551123


OBJETIVO: Analisar a associação entre paracoccidioidomicose (Pcm) e câncer e realizar uma revisão da literatura sobre esse tópico. MÉTODOS: Revisão retrospectiva de 25 casos diagnosticados com Pcm e câncer, extraídos de uma série de 808 casos consecutivos de pacientes adultos diagnosticados com Pcm com base nos testes realizados no Laboratório de Micologia da Santa Casa Complexo Hospitalar de Porto Alegre (RS), entre 1972 e 2007. O diagnóstico de Pcm foi confirmado através de exame microscópico direto, exame histopatológico ou imunodifusão. Todos os casos de câncer foram confirmados por exame histopatológico ou citopatológico. RESULTADOS: Sintomas respiratórios foram as principais queixas dos pacientes. O envolvimento pulmonar foi o achado mais predominante, seguido pelo tegumentar e linfático. O tipo de tumor mais prevalente foi o carcinoma brônquico, em 15 casos, seguido de outros tipos de carcinoma, e 1 paciente apresentou linfoma de Hodgkin. Em 16 pacientes (64 por cento), o sítio de Pcm era o mesmo do tumor. Na maioria dos casos, o tratamento de Pcm consistiu na administração isolada de sulfanilamida, sulfametoxazol-trimetoprim, cetoconazol, itraconazol ou anfotericina B. A cirurgia foi o tratamento mais comum para o câncer, seguida de radioterapia e quimioterapia. Dos 25 pacientes, 12 foram curados para Pcm, e 4 faleceram. Em 9, o desfecho final era desconhecido. A prevalência de câncer de pulmão na população geral na área em estudo foi significativamente maior em fumantes com Pcm que em fumantes sem Pcm (p < 0,001). CONCLUSÕES: .O diagnóstico de Pcm parece aumentar o risco de câncer de pulmão.

OBJECTIVE: To analyze the association between paracoccidioidomycosis (Pcm) and cancer in a series of 25 cases and to review the literature on this topic. METHODS: A retrospective review of 25 cases diagnosed with Pcm and cancer, retrieved from a series of 808 consecutive adult patients diagnosed with Pcm based on tests conducted in the Mycology Laboratory of the Santa Casa Complexo Hospitalar, in the city of Porto Alegre, Brazil, between 1972 and 2007. The diagnosis of Pcm was confirmed by means of direct microscopic examination, histopathological examination or immunodiffusion test. All cancer cases were confirmed by histopathological or cytopathological examination. RESULTS: Respiratory symptoms were the principal complaints of the patients evaluated. Pulmonary involvement predominated, followed by skin and lymph node involvement. The most prevalent tumor was bronchial carcinoma, in 15 patients, followed by other types of carcinoma, and 1 patient had Hodgkin's lymphoma. In 16 patients (64 percent), the site of the Pcm was the same as that of the tumor. In most cases, Pcm treatment consisted of the isolated administration of sulfanilamide, sulfamethoxazole-trimethoprim, ketoconazole, itraconazole or amphotericin B. The most common treatment for cancer was surgery, followed by radiotherapy and chemotherapy. Of the 25 patients, 12 were cured of Pcm, and 4 died. In 9 patients, the final outcome was unknown. In the general population of the area under study, the prevalence of lung cancer was significantly higher in smokers with Pcm than in smokers without Pcm (p < 0.001). CONCLUSIONS: A diagnosis of Pcm appears to increase the risk of lung cancer.

Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Bronchogenic/complications , Lung Neoplasms/complications , Paracoccidioidomycosis/complications , Chi-Square Distribution , Carcinoma, Bronchogenic/microbiology , Carcinoma, Bronchogenic/pathology , Lung Neoplasms/microbiology , Lung Neoplasms/pathology , Paracoccidioidomycosis/pathology , Retrospective Studies , Risk Factors
Article in Portuguese | LILACS | ID: lil-538851


JUSTIFICATIVA E OBJETIVOS: A paracoccidioidomicose é uma doença granulomatosa crônica causada por um fungo e acomete principalmente os pulmões e a pele. A clínica é variada e o envolvimento do sistema nervoso central (SNC) é raro. Quando não diagnosticada e tratada oportunamente pode levar às formas disseminadas graves e letais. O objetivo desse estudo foi demonstrar as características clínicas da rara apresentação dessa doença. RELATO DO CASO: Paciente do sexo masculino, 26 anos, imunocompetente, apresentava paracoccidiodomicose recidivante com envolvimento do SNC. CONCLUSÃO: Apesar de ser uma doença rara, deve-se ter em mente que a neuroparacoccidiodomicose pode atingir pacientes imunocompetentes. Portanto deve-se fazer o diagnóstico e o tratamento de forma precoce.

Humans , Male , Adult , Paracoccidioidomycosis/complications , Central Nervous System , Mycoses , Internal Medicine