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Clinical manifestations and diagnosis of acute/subacute 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 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 [1]; or the chronic form, which represents reactivation of the primary infection and is most common [2]. (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) [5]. 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.

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Literature review current through: Nov 2017. | This topic last updated: Jun 16, 2016.
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