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Clinical manifestations and diagnosis of chronic paracoccidioidomycosis

Marcio Nucci, MD
Arnaldo L Colombo, MD
Section Editor
Carol A Kauffman, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Paracoccidioidomycosis is a systemic endemic mycotic disease caused by the thermally dimorphic fungi of the genus Paracoccidioides. Two species are recognized to cause paracoccidioidomycosis: Paracoccidioides brasiliensis and Paracoccidioides lutzii. The fungus has a geographic distribution limited to Central and South America, where paracoccidioidomycosis is the most frequent systemic endemic mycosis.

The clinical manifestations and diagnosis of chronic paracoccidioidomycosis will be reviewed here. The clinical manifestations and diagnosis of acute/subacute paracoccidioidomycosis as well as the mycology, epidemiology, and treatment of paracoccidioidomycosis are discussed separately. (See "Clinical manifestations and diagnosis of acute/subacute paracoccidioidomycosis" and "Mycology and epidemiology of paracoccidioidomycosis" and "Treatment of paracoccidioidomycosis".)


Following inhalation, Paracoccidioides spp typically cause asymptomatic pulmonary infection. If the infection is not contained by the host, the disease may evolve into one of two patterns: the chronic form, which represents reactivation of the primary infection and is most common, or the acute/subacute form [1]. (See "Clinical manifestations and diagnosis of acute/subacute paracoccidioidomycosis".)

Over 90 percent of cases of paracoccidioidomycosis are the chronic form, which may present months or years following the primary infection [2]. It most commonly affects men who work in agriculture, and are between 30 and 60 years of age [3]. (See "Mycology and epidemiology of paracoccidioidomycosis", section on 'Epidemiology'.)

Paracoccidioides spp can disseminate to any part of the body by the hematogenous or lymphatic routes. Thus, as with other systemic endemic fungal infections, any organ can be affected. Signs and symptoms usually progress slowly, and may be related to a single organ or to several organs. (See "Mycology and epidemiology of paracoccidioidomycosis", section on 'Pathogenesis'.)


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Literature review current through: Sep 2016. | This topic last updated: Sep 15, 2016.
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  1. Travassos LR, Taborda CP, Colombo AL. Treatment options for paracoccidioidomycosis and new strategies investigated. Expert Rev Anti Infect Ther 2008; 6:251.
  2. Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: an update. Clin Microbiol Rev 1993; 6:89.
  3. Restrepo A, Tobon AM, Agudelo CA. Paracoccidioidomycosis. In: Diagnosis and Treatment of Human Mycoses, 1st edition, Hospenthal, DR, Rinaldi, MG (Eds), Humana Press, Totowa, NJ 2008. p.331.
  4. Restrepo A, Benard G, de Castro CC, et al. Pulmonary paracoccidioidomycosis. Semin Respir Crit Care Med 2008; 29:182.
  5. Coutinho ZF, Wanke B, Travassos C, et al. Hospital morbidity due to paracoccidioidomycosis in Brazil (1998-2006). Trop Med Int Health 2015; 20:673.
  6. Restrepo A, Tobon AM. Paracoccidioides brasiliensis. In: Principles and Practice of Infectious Diseases, 6th ed, Mandell GL, Bennett JE, Dolin R (Eds), Elsevier, Philadelphia 2005. p.3062.
  7. Correa, AL, Franco, L, Restrepo, A. Paracoccidioidomicosis: Coexistencia de lesiones pulmonares y patologia pulmonar silente. Acta Med Colomb 1991; 16:304.
  8. Tobón AM, Agudelo CA, Osorio ML, et al. Residual pulmonary abnormalities in adult patients with chronic paracoccidioidomycosis: prolonged follow-up after itraconazole therapy. Clin Infect Dis 2003; 37:898.
  9. Bicalho RN, Santo MF, de Aguiar MC, Santos VR. Oral paracoccidioidomycosis: a retrospective study of 62 Brazilian patients. Oral Dis 2001; 7:56.
  10. Silva CO, Almeida AS, Pereira AA, et al. Gingival involvement in oral paracoccidioidomycosis. J Periodontol 2007; 78:1229.
  11. Godoy H, Reichart PA. Oral manifestations of paracoccidioidomycosis. Report of 21 cases from Argentina. Mycoses 2003; 46:412.
  12. Sant'Anna GD, Mauri M, Arrarte JL, Camargo H Jr. Laryngeal manifestations of paracoccidioidomycosis (South American blastomycosis). Arch Otolaryngol Head Neck Surg 1999; 125:1375.
  13. Ramos-E-Silva M, Saraiva Ldo E. Paracoccidioidomycosis. Dermatol Clin 2008; 26:257.
  14. Yamaga LY, Benard G, Hironaka FH, et al. The role of gallium-67 scan in defining the extent of disease in an endemic deep mycosis, paracoccidioidomycosis: a predominantly multifocal disease. Eur J Nucl Med Mol Imaging 2003; 30:888.
  15. Colombo AL, Faiçal S, Kater CE. Systematic evaluation of the adrenocortical function in patients with paracoccidioidomycosis. Mycopathologia 1994; 127:89.
  16. Paniago AM, de Oliveira PA, Aguiar ES, et al. Neuroparacoccidioidomycosis: analysis of 13 cases observed in an endemic area in Brazil. Trans R Soc Trop Med Hyg 2007; 101:414.
  17. Oñate JM, Tobón AM, Restrepo A. [Adrenal gland insufficiency secondary to paracoccidioidomycosis]. Biomedica 2002; 22:280.
  18. Amstalden EM, Xavier R, Kattapuram SV, et al. Paracoccidioidomycosis of bones and joints. A clinical, radiologic, and pathologic study of 9 cases. Medicine (Baltimore) 1996; 75:213.
  19. Doria AS, Taylor GA. Bony involvement in paracoccidioidomycosis. Pediatr Radiol 1997; 27:67.
  20. Severo LC, Kauer CL, Oliveira Fd, et al. Paracoccidioidomycosis of the male genital tract. Report of eleven cases and a review of Brazilian literature. Rev Inst Med Trop Sao Paulo 2000; 42:38.
  21. Cruz AA, Zenha F, Silva JT Jr, Martinez R. Eyelid involvement in paracoccidioidomycosis. Ophthal Plast Reconstr Surg 2004; 20:212.
  22. Dantas AM, Yamane R, Camara AG. South American blastomycosis: ophthalmic and oculomotor nerve lesions. Am J Trop Med Hyg 1990; 43:386.
  23. do Valle AC, Guimarães RR, Lopes DJ, Capone D. [Thoracic radiologic aspects in paracoccidioidomycosis]. Rev Inst Med Trop Sao Paulo 1992; 34:107.
  24. Barreto MM, Marchiori E, Amorim VB, et al. Thoracic paracoccidioidomycosis: radiographic and CT findings. Radiographics 2012; 32:71.
  25. Costa AN, Benard G, Albuquerque AL, et al. The lung in paracoccidioidomycosis: new insights into old problems. Clinics (Sao Paulo) 2013; 68:441.
  26. Blotta MH, Mamoni RL, Oliveira SJ, et al. Endemic regions of paracoccidioidomycosis in Brazil: a clinical and epidemiologic study of 584 cases in the southeast region. Am J Trop Med Hyg 1999; 61:390.
  27. de Camargo ZP. Serology of paracoccidioidomycosis. Mycopathologia 2008; 165:289.
  28. De Camargo Z, Unterkircher C, Campoy SP, Travassos LR. Production of Paracoccidioides brasiliensis exoantigens for immunodiffusion tests. J Clin Microbiol 1988; 26:2147.
  29. Moreto TC, Marques ME, de Oliveira ML, et al. Accuracy of routine diagnostic tests used in paracoccidioidomycosis patients at a university hospital. Trans R Soc Trop Med Hyg 2011; 105:473.
  30. Batista J Jr, de Camargo ZP, Fernandes GF, et al. Is the geographical origin of a Paracoccidioides brasiliensis isolate important for antigen production for regional diagnosis of paracoccidioidomycosis? Mycoses 2010; 53:176.
  31. Gegembauer G, Araujo LM, Pereira EF, et al. Serology of paracoccidioidomycosis due to Paracoccidioides lutzii. PLoS Negl Trop Dis 2014; 8:e2986.
  32. Marques da Silva SH, Colombo AL, Blotta MH, et al. Detection of circulating gp43 antigen in serum, cerebrospinal fluid, and bronchoalveolar lavage fluid of patients with paracoccidioidomycosis. J Clin Microbiol 2003; 41:3675.
  33. Marques da Silva SH, Queiroz-Telles F, Colombo AL, et al. Monitoring gp43 antigenemia in Paracoccidioidomycosis patients during therapy. J Clin Microbiol 2004; 42:2419.
  34. Dos Santos PO, Rodrigues AM, Fernandes GF, et al. Immunodiagnosis of paracoccidioidomycosis due to Paracoccidioides brasiliensis using a latex test: detection of specific antibody anti-gp43 and specific antigen gp43. PLoS Negl Trop Dis 2015; 9:e0003516.
  35. Motoyama AB, Venancio EJ, Brandão GO, et al. Molecular identification of Paracoccidioides brasiliensis by PCR amplification of ribosomal DNA. J Clin Microbiol 2000; 38:3106.
  36. Gomes GM, Cisalpino PS, Taborda CP, de Camargo ZP. PCR for diagnosis of paracoccidioidomycosis. J Clin Microbiol 2000; 38:3478.
  37. Nobrega de Almeida J Jr, Del Negro GM, Grenfell RC, et al. Matrix-assisted laser desorption ionization-time of flight mass spectrometry for differentiation of the dimorphic fungal species Paracoccidioides brasiliensis and Paracoccidioides lutzii. J Clin Microbiol 2015; 53:1383.
  38. Silva-Vergara ML, Teixeira AC, Curi VG, et al. Paracoccidioidomycosis associated with human immunodeficiency virus infection. Report of 10 cases. Med Mycol 2003; 41:259.
  39. Paniago AM, de Freitas AC, Aguiar ES, et al. Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12 cases observed in an endemic region in Brazil. J Infect 2005; 51:248.
  40. Morejón KM, Machado AA, Martinez R. Paracoccidioidomycosis in patients infected with and not infected with human immunodeficiency virus: a case-control study. Am J Trop Med Hyg 2009; 80:359.
  41. Shikanai-Yasuda MA, Conceição YM, Kono A, et al. Neoplasia and paracoccidioidomycosis. Mycopathologia 2008; 165:303.
  42. Zavascki AP, Bienardt JC, Severo LC. Paracoccidioidomycosis in organ transplant recipient: case report. Rev Inst Med Trop Sao Paulo 2004; 46:279.
  43. Shikanai-Yasuda MA, Duarte MI, Nunes DF, et al. Paracoccidioidomycosis in a renal transplant recipient. J Med Vet Mycol 1995; 33:411.