entre paracoccidioidomicose e alcoolismo. Rev. Saúde públ. S. Paulo, 26: 12 -6 , 1992. A associação entre alcoolismo e paracoccidioidomicose foi avaliada pelo método de caso-controle, comparando-se o hábito de ingestão etílica de 70 doentes com o de outros 70 pacientes hospitalizados por razões diversas e pareados por sexo e idade. Os participantes foram interrogados de maneira padronizada sobre a quantidade, tipo e periodicidade da ingestão de bebidas alcoólicas, duração do consumo e também sobre manifestações de abuso e/ou dependência do álcool. Na forma crônica da micose foi observada proporção significativamente maior de doentes com ingestão média de álcool acima de 60 ml/dia (50,0% x 30,0%) e com preferência por aguardente de cana (89,4% x 68,3%) em relação ao grupo controle, além dos grandes bebedores (>100 ml/dia) mostrarem tendência de reativação da doença durante ou após seu tratamento. Na forma aguda/subaguda da paracoccidioidomicose verificou-se que 64,3% dos consumidores de bebidas alcoólicas já haviam tido um ou mais episódios de embriaguez etílica, versus 17,6% no grupo controle. Os dados sugerem que o alcoolismo seja fator predisponente da paracoccidioidomicose e talvez possa prejudicar sua cura, principalmente da forma crônica da infecção.

paracoccidioidomycosis is more poorly characterized, either due to the fact that it is uncommon in its acute or subacute form or due to the scarcity of cases of regressive forms or symptomatic infection. (3,4) The primary complex resulting from infection with P. brasiliensis has rarely been observed in children (5,6) or in immunocompromised adults.Here, we report the case of a young adult who presented with lung injury, hilar lymph node enlargement and hypereosinophilia as manifestations of the initial phase of this fungal infection. Case reportA 28-year-old white male, who was a physician and a resident of the city of Ribeirão Preto, Brazil, presented with a three-month history of daily fever (37.5-38.5°C). He also presented with intense nonproductive cough, chest pain IntroductionInfection with Paracoccidioides brasiliensis is acquired via the airways and occurs in endemic areas in South America. In most individuals, the infection resolves spontaneously, leaving a scarring lung or lymphatic injury where the fungus can remain latent.(1) Some of those infected develop a self-limiting disease (regressive form of paracoccidioidomycosis), which is poorly understood, or a generalized disease, which predominantly affects the lymphatic system, the macrophagic-monocytic system and the skin (acute or subacute form). In adults over 30 years of age, it is known that reactivation of latent foci of P. brasiliensis result in injury to the lungs, the oropharyngeal mucosa and other tissues (chronic form).(2)The chronic form of the lung disease is progressive and, on X-rays, typically appears as bilateral diffuse reticulomicronodular interstitial infiltrate. AbstractPrimary infection with Paracoccidioides brasiliensis has rarely been observed. A 28-year-old male patient presented with a three-month history of fever, respiratory symptoms and malaise. Chest X-rays revealed bilateral apical infiltrates, right pleuritis and hilar lymphadenomegaly. The patient presented with leukocytosis, severe eosinophilia and increasing titers of anti-P. brasiliensis antibodies in serum. To our knowledge, this is the first report of the primary pulmonary lymph node complex of paracoccidioidomycosis accompanied by hypereosinophilia and affecting a previously healthy adult.Keywords: Paracoccidioidomycosis; Eosinophilia; Lung diseases, fungal. ResumoA infecção primária por Paracoccidioides brasiliensis é observada raramente. Um paciente masculino de 28 anos de idade apresentou febre, sintomas respiratórios e indisposição durante três meses. Exames radiológicos evidenciaram infiltrado pulmonar apical bilateral, pleurite à direita e linfadenomegalia hilar. O paciente apresentava leucocitose, intensa eosinofilia e títulos crescentes de anticorpos séricos anti-P. brasiliensis. Até onde sabemos, este é o primeiro relato do complexo primário da paracoccidioidomicose, associado com hipereosinofilia, apresentado por um adulto previamente hígido.

SUMMARYThe aim of this retrospective study was to review all the notified cases of multidrug-resistant tuberculosis (MDR-TB) in São Paulo State (Brazil), as well as to describe and discuss the clinical, microbiological and radiologic aspects in a single reference center, within the same state, from 2000 to 2012. There were 1,097 notifications of MDR-TB in São Paulo State over this period, 70% affecting men aged on average 38 years (10-77). There was a significant fall in the MDR-TB mortality rate from 30% to 8% (2000-2003 versus 2009-2012). The same trend was observed in the cases studied at the reference center. The number of notified cases increased and death rate reduced from 37.5% (2000-2005) to 3.4% (2006-2012). Among the 48 drug-resistant TB cases, 17 non-tuberculous Mycobacteria were isolated in the sputum culture of nine patients, without any clinical significance. TB and fungus co-infection was diagnosed in 15% (7/48) of these cases: three with confirmed chronic pulmonary aspergillosis and four with positive serological markers for paracoccidioidomycosis. Overall, the reports show that MDR-TB diagnosis and cure rates have increased, while the mortality rate has decreased significantly in São Paulo State including in the studied reference center.