Pulmonary paracoccidioidomycosis in a nine year old girl

Ramos, Cecy D.; Londero, A. T.; Gal, Maria C. L.

doi:10.1007/bf00441436

Cited by 22 publications

(8 citation statements)

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“…Even in the juvenile patients who exhibit a more acute form of the disease, the incubation period may encompass months, with no precise indications to the origin of infection [46,48].…”

Section: Facts About the Human Hostmentioning

confidence: 99%

The ecology ofParacoccidioides brasiliensis: a puzzle still unsolved

1985

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Some aspects pertaining to the ecology of the dimorphic fungus, Paracoccidioides brasiliensis, are reviewed. The available facts concerning the interactions among the only known host (man), the environment (limited to certain Latin-American countries) and the parasite (with an unknown habitat), are analysed. Efforts are made to detect clue circumstances which may lead to discovery of the fungus micro-niche. An analysis of P. brasiliensis mycelial form reveals that such a form has the required capabilities to be the natural infectious form. Its requirements for a moist environment in vitro as well as the high relative humidity predominating in the heart of the endemic areas point towards the possibility of an aquatic---or at least, an extremely humid--habitat for P. brasiliensis.The last decade has seen important developments in our knowledge concerning various aspects of paracoccidioidomycosis, its etiologic agent, Paracoccidioides brasiliensis, and host-parasite interactions in the infection [18]. Nonetheless, the relationship between the fungus and its environment has escaped scientific analysis in spite of its sporadic isolation from soils [2, 43] and its presumed occurrence in a squirrel monkey [26]. So scanty are the new findings since the subject was masterfully reviewed by Borelli in 1972 [10], that it might appear premature to discuss the ecology of the fungus once more. However, a critical review of the current status of available information was considered worth undertaking. Such a review would serve to bring together widely scattered data, critically analyse the present findings and point to unexplored, promising areas for research.The consensus prevails that the habitat of P. brasiliensis is neither man nor the animals that surround him, but rather the soil of the endemic areas [33,34]. In contrast to what is known about other fungal pathogens such as Histoplasma capsulaturn and Coccidioides immitis [1], data concerning the microenvironment of P. brasiliensis are limited. This is rather peculiar since circumstances such as the restricted geographic distribution of the disease, and the apparent connection with only one host, man, should furnish clues to the problem. This is even more so when one

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“…Even in the juvenile patients who exhibit a more acute form of the disease, the incubation period may encompass months, with no precise indications to the origin of infection [46,48].…”

Section: Facts About the Human Hostmentioning

confidence: 99%

The ecology ofParacoccidioides brasiliensis: a puzzle still unsolved

1985

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“…(5) Another child, who was 6 years old and had frequent contact with the rural environment, had high fever, mild bilateral interstitial pulmonary infiltrate and marked hilar lymphadenomegaly. (6) In the following weeks, this child developed disseminated fungal disease, which led to the assumption that the initial findings represented the primary lymph node complex of P. brasiliensis infection.…”

Section: Introductionmentioning

confidence: 99%

“…(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. …”

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confidence: 99%

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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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“…Only 3 cases of primary pulmonary complex lesions have been retrospectively diagnosed in older patients on the basis of anatomicopathological findings [3][4][5]. There are also only a few reports of younger individuals who have presented with a pulmonary syndrome resembling a primary pulmonary lymph node complex [6][7][8]. It has been shown that even patients who have the acute form of PCM with no respiratory symptoms and with normal findings on chest radiographs may have their lungs colonized with the fungus [9].…”

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Contribution to the Natural History of Paracoccidioidomycosis: Identification of the Primary Pulmonary Infection in the Severe Acute Form of the Disease--A Case Report

Benard¹,

Kavakama²,

Mendes-Giannini

et al. 2005

Clinical Infectious Diseases

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Several aspects of the pathogenesis of paracoccidioidomycosis (PCM) have not yet been fully clarified. We describe a patient with an overwhelmingly acute form of PCM who presented with clinically apparent pulmonary infection that spontaneously subsided while yeast cells disseminated systemically. This case may help to explain the paradox of the absence of pulmonary involvement in the acute disseminated form of PCM.

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Pulmonary paracoccidioidomycosis in a nine year old girl

Abstract: A case of pulmonary paracoccidioidomycosis in a nine year old girl is reported. This is the first proven case of exclusive pulmonary paracoccidioidal lesions observed in a child. A review of the mycosis among children 0 to 10 years old is also presented.

Cited by 22 publications

References 4 publications

The ecology ofParacoccidioides brasiliensis: a puzzle still unsolved

The ecology ofParacoccidioides brasiliensis: a puzzle still unsolved

Complexo primário da paracoccidioidomicose e hipereosinofilia

Contribution to the Natural History of Paracoccidioidomycosis: Identification of the Primary Pulmonary Infection in the Severe Acute Form of the Disease--A Case Report

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