Treatment of 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 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, and paracoccidioidomycosis is the most frequent systemic endemic mycosis in this region. Primary infection is usually transient and almost always devoid of clinical manifestations. 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, and the acute/subacute form .
The treatment of paracoccidioidomycosis will be reviewed here. The mycology, epidemiology, clinical manifestations and diagnosis of paracoccidioidomycosis are discussed separately. (See "Mycology and epidemiology of paracoccidioidomycosis" and "Clinical manifestations and diagnosis of acute/subacute paracoccidioidomycosis" and "Clinical manifestations and diagnosis of chronic paracoccidioidomycosis".)
Paracoccidioides spp are sensitive to most antifungal agents, including amphotericin B, the azoles (ketoconazole, fluconazole, itraconazole, voriconazole and posaconazole), terbinafine, and even sulfonamides . Of these agents, itraconazole has been studied most extensively and is used most commonly. Sulfonamides, such as trimethoprim-sulfamethoxazole, are used in some cases but require prolonged therapy to prevent relapse. Amphotericin B is reserved for patients with severe disease.
Despite the fact that paracoccidioidomycosis has a high incidence and morbidity in Central and South America, few studies have been conducted to define its optimal treatment. Only two randomized trials have been published, neither of which had sufficient power to assess response or cure rates [3,4].
Itraconazole — Itraconazole has been used extensively in the treatment of paracoccidioidomycosis and results in high response rates.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ANTIFUNGAL AGENTS
- - Efficacy
- - Toxicity
- - Pharmacokinetics
- - Toxicity
- - Efficacy
- - Toxicity
- Amphotericin B
- - Efficacy
- - Toxicity
- Other drugs
- CHOICE OF THERAPY
- Mild to moderate
- Central nervous system involvement
- DURATION AND MONITORING
- Serologic testing
- Laboratory studies
- PARADOXICAL REACTIONS
- SUMMARY AND RECOMMENDATIONS