PARACOCCIDIOIDOMYCOSIS

Paracoccidioidomycosis, caused by the dimorphic fungus P. brasiliensis, is the most frequently diagnosed systemic mycosis in Latin America and is geographically restricted to it. As travel throughout the endemic areas increases, more and more autochthonous cases may be seen outside Latin America. The primary pulmonary infection, acquired by young people living in the endemic areas, usually is regressive heals or becomes latent. The disease develops as a progressive primary infection in young people (acute disseminated juvenile forms) or by reactivation of a quiescent lesion or exogenous reinfection in adults (chronic pulmonary and disseminated adult forms). Lung lesions, almost always present, are extremely pleomorphic, dynamic, and may be found in variable stages. A granulomatous inflammation is the basis of the lesions, which include pneumonitis, cavitation, infiltration, and healing. The chronic pulmonary infection usually has an obstructive component and sometimes emphysema. The clinical and radiologic appearance of these lesions is accordingly variable. Extrapulmonary dissemination usually involves the mucous membranes, lymph nodes, and skin, but any organ or tissue may be involved. Direct examination of clinical specimens and special methenamine silver stain can easily disclose the fungus. Cultures or animal inoculation are also useful. Serology is useful for the diagnosis and for the evaluation of the response to treatment. Sulfonamides, amphotericin B, and ketoconazole are the drugs available for the treatment of this mycosis. Our personal data show that sulfonamide derivatives remain the best choice in underdeveloped regions, because therapy usually requires long periods and they have similar efficacy and lower costs than other drugs. Itraconazole, a new triazole derivative, showed promising results. Other newer antifungal drugs are under evaluation.