Paracoccidioidomycosis in childhood

Londero, A. T.; Melo, Ivanir S.

doi:10.1007/bf00436946

Cited by 42 publications

(31 citation statements)

References 9 publications

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“…Duration of symptoms before the diagnosis and the clinical manifestations of PCM were similar to other studies [2][3]6,9,11,[15][16][17] . Most of the clinical manifestations were related to the reticuloendothelial system, especially lymph node enlargement, hepatomegaly and splenomegaly.…”

Section: Discussionsupporting

confidence: 88%

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Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome

Pereira

Bucaretchi

Barison

et al. 2004

Rev. Inst. Med. trop. S. Paulo

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SUMMARY From February, 1981 to May, 2001, 63 children under 15 y old (ages 2 -15 y, median = 8 y, mean ± 1 SD = 8 ± 3 y) presenting 70 episodes of Paracoccidioidomycosis were admitted. The main clinical manifestations and laboratory features observed upon admission were: lymph node enlargement (87.1%), fever (75.7%), weakness (48.6%), pallor (41.4%), hepatomegaly (40%), splenomegaly (35.7%), anemia (90%), hypergammaglobulinemia (88.5%), eosinophilia (75.5%) and hypoalbuminemia (72.5%). Moderate to severe malnutrition was detected in 35.7% of the episodes (Gomez's criterion). Radiographic and technetium studies showed bone lesions in 20 of the episodes, most of them being multiple lytic lesions, involving both long (70%) and plain bones (30%). First line treatment consisted of an association of sulfametoxazole-trimethoprin, which was used, exclusively, in 50 episodes. Follow-up of hemoglobin levels, number of eosinophils in the peripheral blood, albumin and gammaglobulin serum levels revealed significant sequential improvement one and six months after hospital admission, being quite useful to evaluate treatment effectiveness. Six patients died (9.3%) and four developed sequelae (6.3%) . In conclusion, the juvenile and disseminated forms can be observed in about 70% of the episodes of PCM occurring in children younger than 15 y old, most of them presenting with a febrile lymphoproliferative syndrome associated to anemia, eosinophilia and hypergammaglobulinemia.

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Section: Discussionsupporting

confidence: 88%

“…The lack of published reports about this disease in children [2][3]6,9,11,[15][16][17]22 prompted us to report our experience with 63 children less than 15 y old who presented 70 episodes of PCM, admitted to the University Hospital of the State University of Campinas (UNICAMP), São Paulo, Brazil.…”

Section: Introductionmentioning

confidence: 99%

Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome

Pereira

Bucaretchi

Barison

et al. 2004

Rev. Inst. Med. trop. S. Paulo

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“…Infection is caused after inhalation of P. brasiliensis conidia, small propagules produced by the mycelia being able to reach the lungs. In 90 % of clinically active cases, PCM produces a chronic systemic and progressive disease, which progresses slowly and can take months or even years to develop, while the remaining 10 % of patients develop an acute form (Londero & Melo, 1983;Brummer et al, 1993;Restrepo et al, 2008;Marques, 2013;Restrepo & Tobon, 2010).…”

Section: Introductionmentioning

confidence: 99%

Human neutrophils produce extracellular traps against Paracoccidioides brasiliensis

et al. 2015

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Neutrophils play an important role as effector cells and contribute to the resistance of the host against microbial pathogens. Neutrophils are able to produce extracellular traps (NETs) in response to medically important fungi, including Aspergillus spp., Candida albicans and Cryptococcus gattii. However, NET production in response to Paracoccidioides brasiliensis has yet to be studied. We have demonstrated that human neutrophils produce NETs against both conidia and yeasts of P. brasiliensis. Although the NADPH oxidase inhibitor diphenyleneiodonium chloride (DPI) did not alter NET production against conidia, it partially suppressed NET formation against P. brasiliensis yeasts. Cytochalasin D or IFN-c did not affect the production of NETs against the fungus. Additionally, a mutant strain of P. brasiliensis with reduced expression of an alternative oxidase induced significantly higher levels of NETs in comparison with the WT strain. Finally, c.f.u. quantification of P. brasiliensis showed no significant differences when neutrophils were treated with DPI, DNase I or cytochalasin D as compared with untreated cells. These data establish that NET formation by human neutrophils appears to be either dependent or independent of reactive oxygen species production, correlating with the fungal morphotype used for stimulation. However, this mechanism was ineffective in killing the fungus.

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“…One review of pediatric juvenile paracoccidioidomycosis included patients with alveolar consolidation, interstitial infiltrate, micronodules, nodules and pleural effusion. (11) There have also been reports of an adult who presented with cortico-pleuritis (1) and a young individual who had empyema and bilateral pulmonary consolidation, P. brasiliensis being detected in the bronchoalveolar lavage fluid. (3) The acute injury caused by paracoccidioidomycosis can be located in the apex, the perihilar region, the juxtapleural region and the base of the lungs, or have a disseminated aspect.…”

Section: Introductionmentioning

confidence: 99%

“…(3) The acute injury caused by paracoccidioidomycosis can be located in the apex, the perihilar region, the juxtapleural region and the base of the lungs, or have a disseminated aspect. (3,11) Conversely, P. brasiliensis was isolated from the respiratory secretion of patients with the acute or subacute form of paracoccidioidomycosis, without there being any apparent injury on chest X-rays. (12) This suggests the existence of small pulmonary primary foci, not detectable on routine X-rays.…”

Section: Introductionmentioning

confidence: 99%

Complexo primário da paracoccidioidomicose e hipereosinofilia

Martínez¹,

Moya²

2009

J. bras. pneumol.

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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.

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Paracoccidioidomycosis in childhood

Cited by 42 publications

References 9 publications

Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome

Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome

Human neutrophils produce extracellular traps against Paracoccidioides brasiliensis

Complexo primário da paracoccidioidomicose e hipereosinofilia

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