Paracoccidioidomycosis

Paracoccidioidomycosis – General Information

Paracoccidioidomycosis is a chronic disease which is characterized by a progressive systemic mycosis. It usually affects people in the subtropical areas of the Central and South America. The most common sign of this disorder is the appearance and fast development of a pulmonary infection; in addition, the reports have shown that, in most of the cases, the infection also affects the skin, the mucous membranes and the lymph nodes. The agent which usually leads to the appearance of Paracoccidioidomycosis is a dimorphic fungus, insulated from the soil. In some rare cases, the animals can also be affected; on the other hand, the bats can serve as intermediate hosts for this fungus. Once the fungus is inside the human body, it firstly affects the lungs and then it spreads to other organs, using the lymphatic system and the venous system. The fungus can also affect the intestines. The good part about this disorder is the fact that is does not transmit from a person to another. 

The frequency rate of this disease is higher in the rural parts of Africa, Asia and America; the reports have shown that the frequency rate is between 2 and 4 cases in a 10,000 people. However, during the last years, this disease seems to affect less and less people, due to the measures which were taken by the authorities in the affected regions. Paracoccidioidomycosis usually affects adults, mostly men (hunters and farmers), as they are more exposed than women. However, the estrogen in the women’s body can act as an inhibitor for this fungus. 

Paracoccidioidomycosis – Symptoms

In most of the cases, this disease presents no significant signs and symptoms and it progresses slowly; however, when it affects younger people, it is more severe and it evolves more quickly. The chronic form of Paracoccidioidomycosis, which usually affects adults, is characterized by the fact that the first signs and symptoms appear several years after the sufferer’s first contact with the fungus. The lung infection, which is the first complication which appears, leads to the development of one or more of the following symptoms: dyspenia, cough, fever, malaise and weight loss. Other pulmonary problems which can appear include bullae, pulmonary fibrosis and severe emphysematous changes which can finally result in pulmonary hypertension. If the mucous membrane is affected, the pulmonary infection can lead to dysphonia, dysphagia and granulomatous plaques. Gingival involvement can result in tooth loss, especially in the case of those sufferers with a weak general health condition. In addition to these problems, the patients can also experience oral lesions, associated with pharyngeal ulcers, nasal ulcers, mandibular lymph enlargement and cervical lymph enlargement. As the disease evolves, the sufferers can present cutaneous lesions, characterized by the appearance of ulcers, crusted papules, plaques, nodules and verrucous lesions. In some rare cases, the patients have also presented lesions of the adrenal glands, of the nervous system, of the spinal cord or of the long bones, such as the humeri and the ribs. In the case of acute Paracoccidioidomycosis which affects children, the patients experience multiple skin lesions, weight loss, malaise, fever and hepato-splenomegaly.

Paracoccidioidomycosis - Treatment

If you notice the appearance of one or more of the signs and symptoms presented above, you should consult a doctor as soon as possible in order to obtain a sure diagnosis and to benefit from the best way of treatment. The most common test includes a specimen biopsy, as this kind of test can reveal cells with quite a large diameter. However, when the disease affects young people, the reactions are completely diffuse and the diagnosis cannot be established for sure. Apart from this microbiological examination, the doctor can also choose to perform a serologic diagnosis, especially in the case of those patients located in endemic areas. The most common test is immunodiffusion, which provides information about the presence of antibodies in the organism. In addition, a complementary fixation test gives further details about the patient’s response to the appearance and development of Paracoccidioidomycosis. On the other hand, a skin examination or a CSF study does not offer reliable information.

If the doctor considers it necessarily, he can also recommend the possible patient to perform a chest radiography; if the disease is in a late stage, the doctor may discover some lesions, due to the appearance of some interstitial complications. The lesions are usually located in the basal and central portion of the lungs, even though they can also affect the apices. If the sufferer does not receive any treatment for Paracoccidioidomycosis, he may even experience a right ventricular hypertrophy. The first measures which must be taken in the case of those people who are diagnosed with Paracoccidioidomycosis is to assure that they receive all the supportive care they need in order to improve their psychological problems and to make sure that they choose a healthy life-style; this way, the sufferers will accept to improve their diet and to receive rest, things which will correct their anemia. After these measures are taken, the doctor will probably start the administration of drugs, antifungal agents, such as triazoles, imidazoles and sulfoamides. Triazoles, such as fluconazoles and itraconazoles, should however be administrated in high doses on order to show any effects. Imidazole, on the other hand, is more effective but it presents a greater toxicity and it can cause alterations of the sex hormones and other severe hepatic dysfunctions. Sulfonamides must be administrated for a long period of time, usually between 3 and 4 years. In addition to these substances, the doctor can also choose to administrate the patient amphotericin B, a drug which is given intravenously and presents great temporarily effects.

However, the most important thing when treating people who suffer from Paracoccidioidomycosis is how they choose to change their life-style. If the disease is not treated in due time, it can result in the appearance of some severe complications, such as pulmonary fibrosis or the Addison syndrome. Those who are diagnosed with Paracoccidioidomycosis should be recommended to consult not only their personal doctor, but a specialist as well; they should choose to visit a dermatologist or an infectious disease specialist, especially when they have to follow a long treatment with drugs which present a high toxicity.