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An. bras. dermatol ; 96(3): 346-348, May-June 2021. graf
Article in English | LILACS | ID: biblio-1285064


Abstract Paracoccidioidomycosis is an endemic systemic mycosis caused by Paracoccidioides brasiliensis complex and P. lutzii. It is a rare disease in non-HIV-induced immunosuppressed individuals. In organ transplant recipients, it is more frequently associated with immunosuppression after kidney transplantation. In a liver transplant patient, only one case has been published in the literature to date. The present report comprises the case of a 47-year-old female patient with disseminated skin lesions associated with signs and symptoms of systemic involvement of paracoccidioidomycosis that manifested one year after liver transplantation and under an immunosuppression regimen with tacrolimus and mycophenolate mofetil.

Humans , Female , Paracoccidioides , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/diagnostic imaging , Kidney Transplantation , Liver Transplantation/adverse effects , Transplant Recipients , Middle Aged
Braz. j. infect. dis ; 25(5): 101607, 2021. tab
Article in English | LILACS | ID: biblio-1350318


ABSTRACT Purpose: In-house Paracoccidioides spp. antigens are commonly used in the serological diagnosis of paracoccidioidomycosis (PCM). The sensitivity and specificity of a commercial Paracoccidioides spp. antigen was assessed for PCM serological testing. Method: Counterimmunoelectrophoresis and double immunodiffusion were used to evaluate the Paracoccidioides ID Antigen reagent in sera from PCM cases and patients with other diseases. Results: All active PCM sera (n=24) were reactive using counterimmunoelectrophoresis (sensitivity = 100%), including 11 cases of infection by P. brasiliensis sensu stricto and one by P. americana. Fifteen (88%) out of 17 sera from patients on treatment or cured were reactive, including one case of P. lutzii infection. One to three bands of antigen-antibody precipitate were observed on the agarose gel, with a predominance of two to three bands in the test with untreated PCM sera or at the beginning of antifungal therapy. All sera from patients with histoplasmosis (n=7), aspergillosis (n=5), and other diseases (n=27) tested negative (specificity = 100%). The overall sensitivity and specificity using the commercial antigen and double diffusion test were 75% and 100%, respectively. Conclusion: The commercial antigen performed satisfactorily and may contribute to the dissemination of the use of serological tests for the PCM diagnosis.

Humans , Paracoccidioides , Paracoccidioidomycosis/diagnosis , Counterimmunoelectrophoresis , Immunodiffusion , Antigens, Fungal
Braz. j. infect. dis ; 25(4): 101605, 2021. tab, graf
Article in English | LILACS | ID: biblio-1339437


ABSTRACT Background: Paracoccidioidomycosis is a systemic mycosis considered endemic and limited to Latin America with the majority of registered cases originating from Brazil. The purpose of this paper was to report a case of a female patient with paracoccidioidomycosis mimicking inflammatory bowel disease and to systematically review available cases of the intestinal presentation of this infectious disease. Case report: Female patient, 32-years old, previously asymptomatic, presenting with acute pain in the lower right abdomen, associated with signs of peritoneal irritation and abdominal distension. Urgent surgery was performed, which identified a severe suppurative perforated ileitis. The anatomopathological study revealed fungal structures shaped as a ship's pilot wheel in Grocott-Gomori's staining, suggestive of Paracoccidioides spp. Methods: Studies were retrieved based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), Embase, and Opengray.eu. Languages were restricted to English, Spanish and Portuguese. There was no date of publication restrictions. The reference lists of the studies retrieved were searched manually. Simple descriptive analysis was used to summarize the results. Results: Our search strategy retrieved 581 references. In the final analysis, 34 references were included, with a total of 46 case reports. The most common clinical finding was abdominal pain and weight loss present in 31 (67.3%) patients. Most patients were treated with itraconazole (41.3%) and amphotericin B (36.9%). All-cause mortality was 12.8%. Conclusions: Paracoccidioidomycosis should be suspected in endemics areas, specially as a differential diagnosis for inflammatory bowel disease. Endoscopic tests and biopsy are useful for diagnosis and treatment with antifungal drugs seem to be the first treatment option to achieve a significant success rate.

Humans , Female , Adult , Paracoccidioides , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/drug therapy , Amphotericin B , Itraconazole , Antifungal Agents/therapeutic use
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
An. bras. dermatol ; 95(6): 740-742, Nov.-Dec. 2020. graf
Article in English | LILACS, ColecionaSUS | ID: biblio-1142120


Abstract Paracoccidoiomycosis is a systemic mycosis with a higher incidence in males with history of exposure to the rural environment; its classic clinical manifestation is an oro-pulmonary lesion. The authors report a case of a female, urban, 76-year-old patient with atypical clinical-dermatological presentation and diagnostic conclusion after histopathological examination. The clinical response was quick and complete after treatment with itraconazole 400 mg/day in the first month, decreased to 200 mg/day until the sixth month of treatment.

Humans , Male , Female , Aged , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/drug therapy , Itraconazole/therapeutic use , Lung , Antifungal Agents/therapeutic use
Int. j. odontostomatol. (Print) ; 14(3): 342-347, 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1114904


La Leishmaniasis es un grupo de enfermedades transmitidas por vectores y causada por la Leishmania, un parásito intracelular, que se presenta de preferencia en regiones tropicales y subtropicales. Se manifiesta mediante un amplio rango de formas clínicas como la cutánea, mucocutánea, y visceral, dependiendo de la especie y respuesta inmunológica del paciente. Se presenta el caso de un hombre de 35 años que acudió derivado a Unidad de Estomatología del Hospital Señor del Milagro, Salta, Argentina, presentando en la cavidad oral lesión, granulomatosa, ulcerada, dolorosa a la palpación, única, en paladar blando, de tres meses de evolución. Se realizaron estudios serológicos, parasitológicos y PCR. Los ELISAs lisados, PCRs y cultivos de materiales de lesiones fueron positivos, confirmando diagnóstico de leishmaniasis mucocutánea. El paciente fue derivado al Servicio de Dermatología donde recibió tratamiento con Antimoniato de Meglumina, con repuesta clínica favorable. El conocimiento de las manifestaciones orales puede llevar al diagnóstico clínico de leishmaniasis mucocutánea por parte del odontólogo, pudiendo entregar un tratamiento oportuno y a la vez ayudar al paciente, evitando complicaciones de esta enfermedad.

Leishmaniasis is a group of vector-borne diseases caused by Leishmania, an intracellular parasite, which occurs preferentially in tropical and subtropical regions. It manifests itself through a wide range of clinical forms such as cutaneous, mucocutaneous, and visceral, depending on the species and the patient's immune response. We present a case of a 35-year-old man who was referred to the Stomatology Unit of the Señor del Milagro Hospital, Salta, Argentina, presenting in the oral cavity lesion, granulomatous, ulcerated, painful on palpation, unique, soft palate with three months of evolution. Serological, parasitological and PCR studies were performed. Lysed ELISAs, PCRs and cultures of lesion materials were positive, confirming diagnosis of mucocutaneous leishmaniasis. The patient was referred to the Dermatology Service where he received treatment with Meglumine Antimony, with favorable clinical response. The knowledge of the oral manifestations can lead to the clinical diagnosis of mucocutaneous leishmaniasis by the dentist, being able to provide timely treatment and at the same time help the patient, avoiding complications of this disease.

Humans , Male , Adult , Leishmaniasis, Mucocutaneous/diagnosis , Leishmaniasis, Mucocutaneous/parasitology , Mouth Diseases/diagnosis , Mouth Diseases/parasitology , Paracoccidioidomycosis/diagnosis , Enzyme-Linked Immunosorbent Assay , Polymerase Chain Reaction , Diagnosis, Differential , Histoplasmosis/diagnosis , Leishmania/isolation & purification , Mouth Mucosa/parasitology
Prensa méd. argent ; 105(10): 661-665, oct 2019. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1025853


La paracoccidioidomicosis es una micosis sistemática, endémica de amplias regiones de América Latina, causada por un hongo termodimorfo, Paracoccidioides brasiliensis. Afecta de manera predominante a individuos de mediana edad y sexo masculino, en particular aquellos que cumplen tareas rurales. la infección se adquiere por vía inhalatoria, y puede diseminarse por vía hemática a diversos órganos y tejidos. La enfermedad puede evolucionar en forma aguda, subaguda o crónica. El diagnóstico presuntivo de la paracoccidioidomicosis se sustenta en los antecedentes epidemiológicos del paciente y en las manifestaciones clínicas. El diagnóstico etiológico clásico consiste en la visualización, el aislamiento y la identificación del agente causal, o bien el empleo de pruebas serológicas para determinar la presencia de anticuerpos específicos en sangre. Se presentan tres casos de paracoccidioidomicosis en pacientes varones, dos con formas agudas de la enfermedad y el restante con una forma crónica. En todos los casos, el diagnóstico se efectuó por los hallazgos de la microscopia, los cultivos y las pruebas serológicas

Paracoccidioidomycosis is a systemic mycosis, endemic to large regions of Latin America, caused by a thermodimorphic fungus, Paracoccidioides brasiliensis. It predominantly affects middle-aged and male individuals, particularly those who perform rural tasks. The infection is acquired by inhalation, and it can spread by blod to various organs and tissues. The disease can evolve in acute, subacute or chronic form. The presumptive diagnosis of paracoccidiodomycosis is based on the patient's epidemiological history and clinical manifestations. The classic etiological diagnosis consists of visualization, isolation and identification of the causative agent, or the use of serological tests to determine the presence of specific antibodies in the blood. There are threee cases of paracoccidioidomycosis in male patients, two with acute forms of the disease and the remaining with a chronic form. In all cases, the diagnosis was made by the findings of microscopy, cultures and serological tests

Humans , Male , Adult , Middle Aged , Aged , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/transmission , Paracoccidioidomycosis/epidemiology , Skin Manifestations , Rural Workers , Serologic Tests , Microscopy
An. bras. dermatol ; 94(4): 470-472, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1038288


Abstract: Paracoccidioidomycosis is a fungal infection that occurs in immunocompetent patients and are classified into two forms: the acute-subacute form, predominantly in young patients, and the chronic adult form that may present classic ulcerated lesions to rare sarcoid ones. We present the case of a boy whose infection began with sarcoid lesions but, after being mistakenly diagnosed with cutaneous sarcoidosis and treated (for three years) with prednisone, developed painful ulcerations throughout the body. After the correct diagnosis, with evidence of the fungus in histopathological and mycological examinations, the patient was properly treated with itraconazole for eight months and evolved with total remission of the disease.

Humans , Male , Adolescent , Paracoccidioidomycosis/etiology , Paracoccidioidomycosis/pathology , Glucocorticoids/adverse effects , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/drug therapy , Sarcoidosis/diagnosis , Sarcoidosis/pathology , Prednisone/adverse effects , Treatment Outcome , Itraconazole/therapeutic use , Antifungal Agents/therapeutic use
Rev. argent. microbiol ; 51(2): 144-147, jun. 2019. map, tab
Article in Spanish | LILACS | ID: biblio-1013364


Con el objetivo de describir las características clínico-epidemiológicas de la paracoccidioidomicosis, se realizó un estudio descriptivo de los casos diagnosticados por el Servicio de Microbiología Clínica del hospital de adultos Dr. Julio C. Perrando, de la ciudad de Resistencia (Chaco, Argentina). Entre 2011 y 2014 se detectaron 46 casos. En 2013 y 2014 se constató un incremento de la tasa de incidencia de alrededor de 4 veces con respecto a los anos anteriores. La forma crónica fue la predominante, con una media de edad de los pacientes de 53 anos. Del total de ellos, a 39 se les realizaron pruebas serológicas. En 15 de 39 casos, las pruebas serológicas fueron la única herramienta diagnóstica, mientras que en 4 de estos casos con diagnóstico microbiológico, la prueba resultó no reactiva. La inclusión de la paracoccidioidomicosis en el diagnóstico diferencial de pacientes de áreas endémicas que presentan un síndrome infeccioso inespecífico y la aplicación de las herramientas diagnósticas disponibles contribuyen al diagnóstico oportuno, así como a disminuir las secuelas de esta afección y su impacto socioeconómico.

In order to describe the clinical and epidemiological characteristics of paracoccidioidomycosis, a descriptive study of all the cases diagnosed by the Clinical Microbiology Service at Dr. Julio C. Perrando hospital in the city of Resistencia (Chaco Province, Argentina) was conducted. Between 2011 and 2014, 46 cases were detected. In the period 2013-2014, an almost 4-fold increase in the incidence rate was detected. The chronic form of the disease was predominant with an average age of 53 years. Serological tests in 39 out of 46 patients were performed. In 15 of 39 patients, serological tests were the only diagnostic tool while in 4 patients with a microbiological diagnosis serological tests were non-reactive. In patients from endemic areas with non-specific infectious syndrome it is important to include paracoccidioidomycosis in the differential diagnosis and to apply all available diagnostic tools to reach a timely diagnosis and to reduce the long-term sequelae and their socio-economic impact.

Paracoccidioidomycosis/epidemiology , Serologic Tests/methods , Paracoccidioidomycosis/diagnosis , Incidence , Endemic Diseases/statistics & numerical data
Actual. SIDA. infectol ; 27(99): 20-26, 20190000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1354231


La paracoccidioidomicosis (PCM) es una micosis endémica de zonas tropicales y subtropicales, con mayor prevalencia en América Latina, producida por especies del género Para-coccidioides. Es una micosis profunda sistémica que en su forma crónica afecta principalmente a varones adultos. La afectación del sistema nervioso central (SNC) está descrita en un 10-27%. Nosotros presentamos dos casos con mani-festación neurológica al ingreso

Paracoccidioidomycosis (PCM) is an endemic mycosis, from tropical and subtropical zones, with a higher prevalence in Latin America, produced by species of the genus Paracoccidioides. It is a deep chronic systemic my-cosis, which mainly affects adult males. The involvement of the central nervous system (CNS) is described in 10-27%. We present two cases with neurological manifestation upon admission.

Male , Adult , Middle Aged , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/etiology , Paracoccidioidomycosis/prevention & control , Paracoccidioidomycosis/therapy , Serologic Tests , Epidemiologic Factors , Central Nervous System , Rural Areas , Amphotericin B/therapeutic use , Endemic Diseases , Central Nervous System Fungal Infections , Diagnosis, Differential , Blood Culture
An. bras. dermatol ; 93(6): 902-904, Nov.-Dec. 2018. graf
Article in English | LILACS | ID: biblio-1038284


Abstract: Molecular studies have shown more than one species of the genus Paracoccidioides to be the causal agent of paracoccidioidomycosis. Efforts have been made to correlate the identified species with epidemiological and clinical data of patients, aiming to determine the real meaning and impact of new species. Bearing this objective in mind, the authors report a clinical case of paracoccidioidomycosis, from São Paulo state, Brazil, that manifested as uncommon sarcoid-like cutaneous lesions and was caused by Paracoccidioides brasiliensis sensu stricto (S1a). The patient was treated with itraconazole 200mg/day for 12 months, with complete clinical remission.

Humans , Male , Middle Aged , Paracoccidioides/classification , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/microbiology , Sarcoidosis/diagnosis , Paracoccidioides/isolation & purification , Paracoccidioidomycosis/drug therapy , Itraconazole/therapeutic use , Diagnosis, Differential , Antifungal Agents/therapeutic use
Prensa méd. argent ; 104(6): 277-280, Ago2018. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1051226


Paracoccidioides brasiliensis is the predominant dimorphic fungal disease in Latin America. Males between 29 to 40 years of age are most often affected. Inhalation of the infecting particle produces a localized alveolitis. The organisms then may disseminate to the skin, mucous membranes, lymph nodes, adrenal glands, liver, spleen, bones, central nervous system and digestive tract, giving a multisystemic affectation, mainly in immunocompromised hosts. A male 34 years old with a history of immunocompromised VIH +, was studied. The characteristics in authopsy are described, with previous diagnosis of diseminated. Paracoccidioides brasiliensis, with intraalveolar hemorrhage, pleuritis and pericarditis. Deep systemic micosis and opportunistic are pathologies that present with increased frequency in recent years, mainly by the rise of the VIH+ infected population. Despite this circumstance, the coexistence of Paracoccidioide infection and VIH+ is scarce in the literature, and for that reason, we present this case of autopsy.

Humans , Male , Adult , Paracoccidioidomycosis/diagnosis , Pericarditis/diagnosis , Pleurisy/diagnosis , Autopsy , HIV/immunology , Immunocompromised Host , Hemorrhage
Medicina (B.Aires) ; 78(3): 199-202, jun. 2018. ilus
Article in Spanish | LILACS | ID: biblio-954978


La paracoccidioidomicosis es endémica en bosques húmedos subtropicales de América Latina. En sus formas agudas/subagudas se disemina agresivamente por el sistema linfoganglionar, pero en sus formas crónicas (más frecuentes) se presenta como diagnóstico diferencial de otras enfermedades que comprometen pulmón, orofaringe, piel y eventualmente cerebro. Presentamos el caso de un hombre con diagnóstico presuntivo de cáncer de pulmón con metástasis cerebrales. El hallazgo de levaduras multibrotadas y el posterior desarrollo de un hongo dimorfo identificado como Paracoccidioides sp. a partir de la biopsia de cerebro resultó en un cambio cardinal en el pronóstico y la terapéutica. Este caso resalta la importancia de considerar las micosis sistémicas en el diagnóstico diferencial de cuadros clínicos compatibles en personas que hayan habitado o transitado áreas endémicas.

Paracoccidioidomycosis is endemic in subtropical rainforests of Latin America. Acute/subacute presentations involve an aggressive dissemination throughout the lymphatic system, while chronic forms (more frequent) arise as differential diagnosis for other conditions involving lung, oropharynx, skin, and eventually the brain. We present the case of a man referred for evaluation and treatment of a possible lung tumor with brain metastasis. The finding of multibudded yeasts and the microbiological isolation of a dimorphic fungus identified as Paracoccidioides sp. from a brain biopsy prompted a cardinal change in prognosis and treatment. This case alerts on the importance of considering systemic fungal diseases as differential diagnosis of compatible clinical presentations in patients who had lived in, or visited, endemic areas.

Humans , Male , Middle Aged , Paracoccidioidomycosis/diagnosis , Brain Neoplasms/diagnosis , Lung Neoplasms/diagnosis , Biopsy , Tomography, X-Ray Computed , Diagnosis, Differential , Immunocompetence
Medicina (B.Aires) ; 78(3): 180-184, jun. 2018. ilus
Article in Spanish | LILACS | ID: biblio-954974


La paracoccidioidomicosis (PCM) es una de las micosis sistémicas que son endémicas exclusivamente en América Latina. Está causada por hongos termodimorfos del género Paracoccidoides: P. brasiliensis (S1), P. americana (PS2), P. restrepiensis (PS3), P. venezuelensis (PS4) y P. lutzii. Paracoccidioides habita y produce conidios infecciosos en suelos de zonas subtropicales húmedas. En Argentina está presente al norte del paralelo 34.5° S. Poco se sabe sobre su nicho ecológico específico, lo que dificulta el diseño de medidas de control de la PCM. La infección ocurre en hospederos susceptibles cuando inhalan conidios aerosolizados. Los trabajadores rurales varones son el grupo más expuesto a contraer PCM. La primoinfección puede ser asintomática o causar un cuadro respiratorio leve; este, a su vez, puede autolimitarse o progresar a enfermedad, ya sea pulmonar o diseminada. Existen dos formas de presentación: (i) aguda/subaguda, en niños, adolescentes y personas con sistemas inmunes comprometidos; y (ii) crónica progresiva, en adultos. La cicatrización de las lesiones resulta en secuelas fibróticas que pueden causar disfagia, disfonía, insuficiencia suprarrenal y obstrucción intestinal. Aunque existen herramientas para su diagnóstico, la PCM es rara vez sospechada precozmente porque sus manifestaciones clínicas iniciales son inespecíficas. Sumados, el diagnóstico tardío y la baja adherencia a los efectivos pero largos tratamientos antimicóticos permiten el avance de la enfermedad y el desarrollo de fibrosis tisular extensa, lo que compromete gravemente la función respiratoria y suprarrenal, altera permanentemente la calidad de vida del paciente y puede causar su muerte.

Paracoccidioidomycosis (PCM) is among the systemic mycoses which are endemic only in Latin America. In Argentina, the vast majority of the cases are reported at north of latitude 34.5° S. The disease is produced by thermodimorphic fungi of the genus Paracoccidoides: P. brasiliensis (S1), P. americana (PS2), P. restrepiensis (PS3), P. venezuelensis (PS4) y P. lutzii. The natural habitat of members of this genus is the soil, where they produce infectious conidia. Little is known, however, about their specific ecologic niche(s), and this knowledge gap hampers the design of measures to control the infection. Rural male workers are the group most at risk of developing PCM. Infection occurs by inhalation of aerosolized conidia and may either be asymptomatic or cause mild respiratory symptoms. In turn, this primary infection may be self-limited or progress to severe pulmonary or disseminated disease. The disease has two clinical presentations: (i) acute or subacute (juvenile), frequent in children, adolescents and people with immunodeficiencies; and (ii) chronic progressive, in adults. Active lesions often resolve into fibrotic scars which can cause dysphagia, dysphonia, adrenal insufficiency, and intestinal obstruction. Although efficient tools are available for diagnosis and treatment, the nonspecific nature of PCM clinical manifestations frequently delay the diagnosis. In addition, the poor adherence to long antifungal treatments allows the advance of the disease and the development of extensive fibrosis compromising severely and permanently respiratory and adrenal functions, thus altering the patient´s quality of life and even causing his/her death.

Humans , Paracoccidioides/classification , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/parasitology , Paracoccidioidomycosis/therapy , Neglected Diseases
Rev. Soc. Bras. Med. Trop ; 51(2): 249-252, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-897059


Abstract Paracoccidioidomycosis is an endemic disease in Latin America that is rarely associated with immunosuppression and biological therapy. Herein, we report for the first time a case of pulmonary paracoccidioidomycosis reactivation after infliximab treatment. A 47-year-old man from Brazil received infliximab to treat psoriatic spondyloarthropathy and presented with cough, dyspnea, weight loss, and fever. Chest computed tomography revealed a pulmonary nodule and biopsy confirmed paracoccidioidomycosis. Treatment with sulfamethoxazole and trimethoprim was initiated for fungal infection and infliximab was reintroduced two months later. Considering his clinical improvement and favorable radiologic evolution, antifungal therapy was discontinued after 29 months.

Humans , Male , Paracoccidioidomycosis/immunology , Antirheumatic Agents/adverse effects , Infliximab/adverse effects , Lung Diseases, Fungal/immunology , Paracoccidioidomycosis/diagnosis , Antirheumatic Agents/therapeutic use , Spondylarthritis/drug therapy , Infliximab/therapeutic use , Lung Diseases, Fungal/diagnosis , Middle Aged
Prensa méd. argent ; 104(2): 59-63, 20180000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1370592


Leishmaniasis, a parasitic disease produced by a protozoan of the genus Leishmania, is triggered by the bite of an infected sandfly. It is endemic in tropical and subtropical areas of the Americas, places of poor socioeconomic health conditions and malnutrition. These conditions favor the entry of other pathogens such as the dimorphic fungus Paracoccidioides brasiliensis, responsible for Paracoccidioidomycosis (PCM), deep mycosis of inhalatory entry that initially affects the lungs; then skin, mucous membranes, lymph nodes and adrenal glands. The association of reported cases of Leishmaniasis and Paracoccidiodoimicosis in the same patient is infrequent. We point out the importance of the multidisciplinary approach for the correct diagnosis and treatment.

Humans , Male , Aged , Paracoccidioidomycosis/diagnosis , Socioeconomic Factors , Leishmaniasis, Mucocutaneous/immunology , Amphotericin B/therapeutic use , Itraconazole/therapeutic use , Endemic Diseases/prevention & control , Malnutrition
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
Pesqui. bras. odontopediatria clín. integr ; 18(1): 3846, 15/01/2018. tab, ilus
Article in English | LILACS, BBO | ID: biblio-965614


Objective: To determine the frequency and clinical forms of oral manifestations associated to Paracoccidioidomycosis (PCM) and Histoplasmosis. Material and Methods: 481 medical records of outpatients referred to the Medical Mycology Department were reviewed since 2009 to 2016. Data were analyzed using descriptive statistical methods. Results: 47 (9.77%) cases had oral manifestations, 29 (61.70%) were associated to PCM and 18 (38.29%) to histoplasmosis. For PCM, male-female ratio was 8:1 and 1:1 for histoplasmosis. The average age for PCM was 48 years old and 53 for histoplasmosis. All the PCM patients had more than 1 oral structure affected: 44.82% were gingival lesions and 27.58% palate. In patients with histoplasmosis, 6 (33.33%) were lesions affecting palate and 6 (33.33%) involving tongue. For both entities, painful ulcers and granulomatous-like lesions were the most prevalent clinical forms; however, we observed a wide range of other oral manifestations. Regarding PCM patient's comorbidities, 3 (10.34%) cases had HIV/AIDS, 8 (27.58%) histoplasmosis and 2 (6.89%) carcinomas. Whereas the comorbidities of patients with histoplasmosis, 2 (11.11%) had HIV/AIDS and 1 (5.55%) had carcinoma. Conclusion: In endemic countries for both mycoses, dentists must be aware of patients with mouth lesions, take advantage of epidemiologic clues that suggest risk factors and be acquainted with all the current diagnostic tests in order to make a quick diagnosis and treatment in highly suspicious cases.

Humans , Male , Female , Adult , Middle Aged , Oral Manifestations , Paracoccidioidomycosis/diagnosis , Histoplasmosis/diagnosis , Histoplasmosis/etiology , Mycoses/diagnosis , Retrospective Studies , Data Interpretation, Statistical