Paracoccidioidomycosis

Question 1

Paracoccidioidomycosis - epidemiology

Answer 1

Central and South America - largest burden in Brazil
15,000 cases since 1930
Armadillo = known reservoir

Question 2

Paracoccidioidomycosis - organism

Answer 2

Dimorphic fungus:
Thermic dimorphism = mold in cold [22-25c], yeast in beast [37c]

Question 3

Paracoccidioidomycosis - clinical

Answer 3

Oro-facial painful friable lesions
Respiratory involvement

Symptoms = lesions in mouth and throat, weight loss, lymphadenopathy, cough, fever, SOB, HSmegaly

Paediatric = tend to get acute/subacute form
-Peripheral eosinophilia, more disseminated infection

Chronic infection in 90% - typically 30-60yr old men
90% lung involvement

Question 4

Paracoccidioidomycosis - risk factors

Answer 4

T helper cell dysfunction
Smoking
Alcohol

Question 5

Paracoccidioidomycosis - diagnosis

Answer 5

Microscopy = KOH wet mount [multipolar budding yeast = Ship’s wheel]
Fungal culture = 20-30 days [Sabouraud dextrose agar or yeast extract]
Histopathology = methanimine silver stain or periodic acid Schiff stain
Serological testing

Question 6

Paracoccidioidomycosis - treatment

Answer 6

Amphotericin B [for any dimorphic fungues] for 2-4 weeks

Followed by:
Itraconazole 9-18 months OR Co-trimoxazole 18-24 months

Question 7

Paracoccidioidomycosis - complications

Answer 7

Difficult to eradicate
Residual pulmonary impairment - 50% fibrosis
Adrenal involvement = 15-50% adrenal dysfunction, 5% Addisonian
Neurological disease = raised ICP, epilepsy