Brazilian guidelines for the clinical management of paracoccidioidomycosis

Abstract

Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis (P. brasiliensis) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii (P. lutzii), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients' sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.

Fatal septic shock caused by Paracoccidioides brasiliensis phylogenetic species S1 in a young immunocompetent patient: a case report

“…The mononuclear phagocytic system is the main site of infection. The lymph nodes are involved in nearly 100% of acute PCM cases, followed by the liver, spleen, and skin 1,6 .…”

“…These range from chronic PCM (adult type), accounting for 80-90% of cases that are mostly among male farm workers and usually affecting the lungs and oral mucosa, to acute/subacute PCM (juvenile type) in young susceptible patients presenting a more severe clinical condition because of intense reticuloendothelial system involvement 1 . Although it has been hypothesized that Paracoccidioides lutzii is associated with severe clinical forms, P. brasiliensis has also been recently reported to cause serious and unusual clinical pictures 2,3 .…”

Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease

“…Some patients have persistent pulmonary complications including residual pulmonary nodules (coccidioidomas), fibrosis and cavities, with the concurrent risks of developing chronic pulmonary aspergillosis or pulmonary abscesses, or fistulae as long-term sequelae [7,12,13]. dor, Peru, and Venezuela [14,15]. It is usually seen in individuals working in rural areas (e.g., farmers).…”

Pulmonary Diseases in Refugees and Migrants in Europe

“…Paracoccidioidomycosis is endemic in certain parts of South America, especially in Brazil [64]. Outdoor activities such as agriculture are risk factors for infection.…”

“…The diagnosis can be made after identification of yeast forms in tissue samples or by culturing. Patients with mild to moderate disease are usually treated with itraconazole 200 mg daily for an average duration of 12 months [64]. Co-trimoxazole is recommended as an alternative treatment.…”