Parâmetros clínicos relevantes para o diagnóstico diferencial entre leishmaniose cutâneo-mucosa e paracoccidioidomicose

Abstract

We retrospectively evaluated the medical records of 15 patients diagnosed with leishmaniasis and of 28 patients diagnosed with paracoccidioidomycosis presenting with involvement of the oral-nasal-pharyngeal mucosa seen at Escola Paulista de Medicina from 1986 through 1990. These patients were compared in regard to the following variables: sex, age, time since disease onset, location of lesion, and clinical complaints. Sex, time since disease onset, lesion at the nasal septum, palate, tongue, and lips, and history of oral pain, dysphagia/odynophagia, and nasal obstruction were significantly different in the two groups of patients. The authors point out to the relevance of these findings in the differential clinical diagnosis of leishmaniasis and paracoccidioidomycosis.

Differentiation of mucosal lesions in mucocutaneous leishmaniasis and paracoccidioidomycosis

“…Furthermore, children and young adults with paracoccidioidomycosis may be more likely to present the acute/subacute form of the disease, which affects mainly the lymphohematopoietic system, with a lower involvement of mucocutaneous regions [ 15 , 16 ]. Demographic characteristics were similar to those found previously [ 6 ], providing further evidence of epidemiological overlap between the diseases, and further underscoring the value of the establishment of clinical parameters for differentiating these two infections.…”

“…Paracoccidioidomycosis is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis and related species, infecting humans by way of inhalation of its filamentous structures, which are generally deposited in contaminated soil [ 4 , 5 ]. Mucocutaneous leishmaniasis and paracoccidioidomycosis share similarities in their clinical presentations as infectious diseases with respect to the mucosal lesions [ 6 ]. In both diseases, the ulcers may affect the oral, nasal, pharyngeal and laryngeal regions [ 7 ].…”

“…Besides the clinical manifestations, leishmaniasis and paracoccidioidomycosis also partially overlap in their territorial distributions [ 6 ], with both being endemic in similar regions of Latin America [ 2 , 4 ]. Health professionals, even in non-endemic countries, must be acutely aware of the differential diagnosis of orofacial lesions, especially because of the increase in travel to endemic areas [ 10 ].…”

Hard palate perforation: an unusual finding in paracoccidioidomycosis

“…SCC was ruled out because of the histology findings. ATL seemed to be a possible associated disease, because of the overlapping epidemiologic and clinical findings 6 . Furthermore, enzyme‐linked immunoabsorbent assay (ELISA) for ATL antibodies tested positive.…”

“…In the present case, the only positive criterion for ATL was a positive ELISA test. Good clinical response to ketoconazole (KCZ) and the lack of other criteria 6 excluded the possibility of associated ATL.…”