Clinical manifestations and diagnosis of acute/subacute paracoccidioidomycosis
- Marcio Nucci, MD
Marcio Nucci, MD
- Associate Professor, Department of Internal Medicine Federal University of Rio de Janeiro
- Head, Mycology Laboratory
- Hospital Universitario Clementino Fraga Filho
- Arnaldo L Colombo, MD
Arnaldo L Colombo, MD
- Professor of Medicine, Division of Infectious Diseases
- Head, Special Mycology Laboratory
- Federal University of São Paulo
Paracoccidioidomycosis is a systemic endemic mycotic disease caused by 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 acute/subacute (juvenile) paracoccidioidomycosis will be reviewed here. The clinical manifestations and diagnosis of chronic paracoccidioidomycosis, as well as the mycology, epidemiology, and treatment of paracoccidioidomycosis are discussed separately. (See "Clinical manifestations and diagnosis of chronic paracoccidioidomycosis" and "Mycology and epidemiology of paracoccidioidomycosis" and "Treatment of paracoccidioidomycosis".)
Only a minority of patients (<5%) eventually develop clinically manifested disease. Following inhalation, Paracoccidioides typically causes asymptomatic pulmonary infection that may be detected by a positive paracoccidioidin intradermal test. If the infection is not contained by the host, the disease may evolve into one of two patterns: the acute/subacute form, which can appear as early as 45 days after an exposure ; or the chronic form, which represents reactivation of the primary infection and is most common . (See "Clinical manifestations and diagnosis of chronic paracoccidioidomycosis".)
Acute/subacute paracoccidioidomycosis (also known as juvenile paracoccidioidomycosis) is almost always observed in children, adolescents, and adults under 30 years of age, and represents fewer than 10 percent of cases [3,4]. In children, it affects girls and boys in equal numbers. This is in contrast to the chronic form, which is much more frequent in adult men. (See "Mycology and epidemiology of paracoccidioidomycosis", section on 'Epidemiology'.)
Signs and symptoms — Dissemination of infection to the reticuloendothelial system results in lymphadenopathy, hepatosplenomegaly, and/or bone marrow dysfunction (eg, aplastic anemia) (table 1) . Constitutional signs such as fever and weight loss occur frequently. Less common features include bone and skin involvement (picture 1). In contrast to the chronic form, lung involvement is very unusual with the acute/subacute form.
- Buccheri R, Khoury Z, Barata LC, Benard G. Incubation Period and Early Natural History Events of the Acute Form of Paracoccidioidomycosis: Lessons from Patients with a Single Paracoccidioides spp. Exposure. Mycopathologia 2016; 181:435.
- Travassos LR, Taborda CP, Colombo AL. Treatment options for paracoccidioidomycosis and new strategies investigated. Expert Rev Anti Infect Ther 2008; 6:251.
- Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: an update. Clin Microbiol Rev 1993; 6:89.
- 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.
- Pereira RM, Bucaretchi F, Barison Ede M, et al. Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome. Rev Inst Med Trop Sao Paulo 2004; 46:127.
- Nogueira MG, Andrade GM, Tonelli E. Clinical evolution of paracoccidioidomycosis in 38 children and teenagers. Mycopathologia 2006; 161:73.
- de Camargo ZP. Serology of paracoccidioidomycosis. Mycopathologia 2008; 165:289.
- 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.
- 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.