Complexo primário da paracoccidioidomicose e hipereosinofilia

Abstract

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.

Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating

“…He was considered cured after four months of follow-up. 25 This report demonstrates that even young individuals, with an adequate nutritional status and low exposure to infecting sources may develop infection with symptoms corresponding to primal infection and a progressive evolution to paracoccidioidomycosis-disease.…”

“…Martinez & Moya (2009) report a case of primary pulmonary infection in a young physician, otherwise healthy, non-smoker, non-drinker, eminently urban (however living in an endemic area), presenting with pulmonary symptoms associated to fever, leukocytosis with hyper eosinophilia, radiologic and tomographic signs of apical pleural-pulmonary lesions as well as hilar lymph nodes. 25 Investigations for tuberculosis, histoplasmosis and HIV infection were all negative, however the serology for PCM was positive, with an initial title of 1/16, and later 1/512. The patient was treated with Itraconazole 200 mg/day, with significant improvement after one week.…”

Computed tomography findings of paracoccidiodomycosis in musculoskeletal system

“…P. brasiliensis infection is acquired by fungal microconidia inhalation ( 10 ) . The infectious form of the disease affects the inferior airways, resulting in the development of a primary pulmonary complex ( 2 , 7 , 9 , 11 , 12 ) . In this phase, lymphohematogenous dissemination of the agent may occur towards other organs and systems, depending on some factors such as number of inoculates, fungus pathogenicity and virulence, as well as integrity of the immunological system and possible genetic factors ( 2 ) .…”

“…In this phase, lymphohematogenous dissemination of the agent may occur towards other organs and systems, depending on some factors such as number of inoculates, fungus pathogenicity and virulence, as well as integrity of the immunological system and possible genetic factors ( 2 ) . Most of times, the primary infection recedes spontaneously, and pulmonary and/or fibrotic lymphatic lesions where the fungus may remain for many years in latent state ( 9 , 12 ) .…”

Paracoccidioidomycosis Epidemiological Features of a 1,000-Cases Series from a Hyperendemic Area on the Southeast of Brazil

“…3 Epidemiological surveys conducted by intradermal reaction with paracoccidioidin and case series reports suggest that Paracoccidioides brasiliensis infection occurs in the entire Brazilian territory. 4 However, it is rare to identify cases with acute infection by this fungi 5 or isolate P. brasiliensis from nature, 6 making it difficult to fully recognize areas of fungi acquisition. Alternatively, epidemiological studies of large series of cases may be useful for demarcation of endemic areas.…”