This is a disease of unfamiliar name and even a little difficult to say aloud, but it is a rare mycosis caused by fungi. A simpler alternative to refer to the disease is by the name South American blastomycosis.
In the following text, we explain how it is possible to prevent and how to prevent transmission. Read on!
Contents
What is paracoccidioidomycosis?
Paracoccidioidomycosis (PCM), also known as South American blastomycosis, is a disease caused by the fungus Paracoccidioides brasiliensis . It is considered a systemic mycosis because it affects other regions and organs besides the skin.
It is a disease that can affect humans and also other species of wild and domestic animals, such as dogs. However, this type of infection is not common.
It is also known that the armadillo-chicken is considered a reservoir of the fungus.
Transmission occurs through the inhalation of fungal spores, which initially settle in the patient’s lungs. Most people who inhale the fungus do not get sick or show symptoms.
When the disease does happen, the patient initially manifests as acute pneumonia , which may spontaneously resolve.
It is not a disease that is contagious, that is, it is not transmitted from one person to another, not even through the sharing of personal objects.
For these reasons, prevention against this pathology is not simple, and there are no specific measures to contain transmission.
However, it is known that it is a common disease in rural regions, affecting mainly rural workers.
The symptoms caused by the disease, however, can vary according to the type and classification. In some people, the infection is asymptomatic.
In general, it causes skin lesions and symptoms similar to pneumonia, such as cough , fever and shortness of breath.
With proper diagnosis and treatment, there is remission and cure. However, in some cases, it can progress to more serious complications.
In the International Classification of Diseases ( ICD-10 ), paracoccidioidomycosis is found by code B41, in the following segments:
- B41.0 – Pulmonary paracoccidioidomicose ;
- B41.7 – Disseminated paracoccidioidomycosis ;
- B41.8 – Other forms of paracoccidioidomycosis;
- B41.9 – Paracoccidioidomycosis, unspecified.
Epidemiology
This type of disease has an incidence restricted to Latin America, with cases recorded from Mexico to Argentina, with the exception of Chile, Guyana, French Guiana, Suriname, Nicaragua, Belize and other islands located in Central America.
In Brazil, paracoccidioidomycosis is one of the most prevalent systemic mycoses, with a greater number of cases in the states of Rio de Janeiro, Minas Gerais and São Paulo.
Or what causes paracoccidioidomicose?
This disease is caused by a fungus called Paracoccidioides brasiliensis and transmission occurs when a person inhales fungal spores present in the air.
These spores are small structures produced by fungi for their proliferation.
When they come into contact with the patient’s airways, they settle in the lungs. There they grow and cause inflammation.
The Paracoccidioides brasiliensis is similar to fungi Histoplasma capsulatum, which causes histoplasmosis, a fungal infection which also ignites the lungs.
How does the transmission happen?
Transmission Paracoccidioides brasiliensis occurs through inhalation of conidia, spores that are produced by fungi, which are usually present in more humid and moldy soil.
Contamination can also occur through cuts in the skin or mucous membranes, but this transmission is considered extremely rare.
The people most vulnerable to inhaling these spores are professionals who work in areas where the soil may be contaminated by the fungus, such as people who perform agricultural activities, practice gardening, transport plant products, etc.
Groups of risk
Paracoccidioidomycosis may be more common in some groups. Generally, most patients are men, as they are more exposed to the fungus, and have a higher incidence in people aged 30 to 50 years.
Men
The disease is considered more prevalent in this group because it is associated with work in the field, which, in general, is occupied more by men than by women.
In addition, the woman’s body has a better immune response to the fungus, due to female sex hormones, which can prevent the cycle of the infectious agent in her body.
Age range
Although it also affects people in other age groups, the disease is still more prevalent in people between 30 and 50 years old.
Types
There are several ways of classifying paracoccidioidomycosis. According to the definition presented at the International Colloquium on Paracoccidioidomycosis , held in Medellin, in 1986, the disease can be divided into two types, the juvenile and adult forms .
Another way of dividing types of the disease is by area of the body most affected, as in the case of pulmonary , cerebral and cutaneous paracoccidioidomycosis .
Acute or juvenile form
It is the most frequent manifestation of the disease in people aged between 10 and 20 years. Usually, they have the acute form of the disease, in which the symptoms appear after a few weeks of contagion, which can affect various organs and systems.
This type of disease is responsible for 5% to 25% of cases of paracoccidioidomycosis, being more prevalent in children, adolescents and young adults. However, although it is more rare, it can also affect adults over the age of 30 and 40 years.
Chronic or adult form
In these cases of paracoccidioidomycosis, the most affected are people aged between 30 and 60 years, usually affecting rural workers, such as farmers.
It is responsible for most cases of the disease, with a prevalence of 74% to 96% among PCM cases.
It is a chronic form of the disease, with the evolution of symptoms after months or years after inhaling the fungi.
Pulmonary paracoccidioidomicose
This type is related to the cases in which the lungs are most affected by the disease. At the beginning of the infection, fungi can settle in these organs and there cause a picture similar to that of acute pneumonia.
In some patients, these symptoms show spontaneous remission, in others they can cause more serious complications, as it is a more persistent infection.
Within the treatment guidelines, follow-up is recommended even after the infection has healed to understand if these structures have not been damaged.
When complications occur, there may be respiratory failure and the presence of nodules, for example.
Cerebral paracoccidioidomicose
This type occurs when the Central Nervous System is compromised, due to the presence of fungi in the brain region.
It is a rarer condition and may be asymptomatic. Only about 3% of patients show signs of the disease.
In cerebral paracoccidioidomycosis, lesions or granulomas (small nodules) may form.
As a consequence of this disease, patients may experience symptoms such as headaches, speech problems, balance, awareness and motor coordination.
Cutaneous paracoccidioidomycosis
In this type, patients have skin lesions, especially near the mucous membranes of the nose and mouth.
However, this ringworm can also spread to the scalp, chest and upper limbs.
These lesions can form thicker plaques, which deform the patient’s skin.
Classification of paracoccidioidomycosis
Paracoccidioidomycosis can be classified according to the way it affects patients and the sequelae it can cause. It is divided into the following forms:
Regressive
In the so-called regressive form, the disease presents itself as benign and with few symptoms, in most cases, being only pulmonary manifestations.
In these patients, the infection has spontaneous regression, not depending on the treatment.
Progressive
It is characterized as the disease that has involvement of one or more organs, usually dealing with more severe cases, which can lead to death when there is no adequate treatment.
According to the patient’s age, symptoms and duration, the progressive type can be further divided into chronic progressive paracoccidioidomycosis and acute progressive paracoccidioidomycosis .
The acute form usually affects children and young people and is characterized by the presence of swelling of superficial lymph nodes, problems in the functioning of the digestive system and impaired bone health.
When it comes to chronic manifestation, it is usually adults who are affected. In this condition, all organs can be compromised, and damage to the Central Nervous System can occur.
In both manifestations, acute or chronic, the disease can manifest itself as mild, moderate and severe, according to the intensity of the symptoms.
Sequelar
These are the cases related to patients who remain with scars or who need to continue with more specific treatments due to complications, such as treatments for pulmonary, renal failure or malabsorption of nutrients.
What are the symptoms of paracoccidioidomycosis?
Some people infected with the fungus do not show any symptoms. However, in general, the disease usually causes symptoms similar to acute pneumonia, as it is an infection that affects the lungs.
During this period, the patient may present with fever, cough, shortness of breath and sweating.
Patients may also have other symptoms such as weight loss, presence of blood in the phlegm, burning and itching in mycoses, insomnia , dyspnoea, difficulty in swallowing (swallowing food) and pallor.
In the region of the mouth, they may present abnormal growth of the lips (macroqueilia) and swelling.
During the course of the disease, patients may experience symptoms that fit 3 different patterns. These conditions can occur simultaneously or in isolation.
Lymph node formation
Patients may experience an increase in lymph nodes in the neck (cervical region), armpits and above the clavicles.
These lymph nodes, although not causing pain, can form dead cells or tissues, which end up being drained through the skin.
Skin lesions
Generally, the infection caused by this fungus causes lesions on the skin (mycoses), especially around the nose and mouth (mucocutaneous regions).
These lesions can expand gradually, causing scarring and deformations on the patient’s face.
Focal lesions
Paracoccidioidomycosis can also cause an increase in other body structures, in addition to an increase in lymph nodes, as can occur in the liver, spleen and lymph nodes in the abdominal region.
How is the diagnosis?
The diagnosis of paracoccidioidomycosis can be made by a general practitioner and depending on the symptoms or complications presented by the patient, referral to other specialists may occur.
To confirm the disease, clinical and laboratory tests are carried out, with the analysis of the symptoms presented and tests to confirm the presence of the fungus in the body.
Exams
The disease is confirmed by tests that can identify the infection caused by the fungus P. brasiliensis.
For this, fresh exams (observation of live microorganisms), biopsy of injured tissues and imaging exams can be performed.
Mycological examination
The mycological examination consists of procedures that identify the presence of any microorganism in the patient. In the case of paracoccidioidomycosis, they are made to find the fungus P. brasiliensis.
Biological material is collected by sputum, scraping of the lesion or material present in the lymph nodes, in which a small tissue sample is collected. It can also be done from the biopsy of lesions.
Biopsy
Biopsy is a surgical procedure in which a sample of cells or tissues from the lesions (wounds) are collected for laboratory study. In the case of this disease, it is done to identify the presence of the infection and possible complications.
X-ray
As seen in the symptoms, the infection caused by the fungus can cause changes in the lungs and cause damage to the organs.
For diagnosis or after the disease is cured, the doctor may request an X-ray to see if there is any damage to the pulmonary structures.
This is a simple image exam, done through the use of X-ray , which allows the doctor to see if the infection has left sequelae in the patient’s lungs.
Is there a cure?
Yes , paracoccidioidomycosis can be cured. Although it can cause complications in patients when there is no adequate diagnosis and treatment, it is possible to have remission of the disease and symptoms when these procedures are performed correctly.
For the patient’s condition to be considered cured, he must have clinical improvement of the symptoms and show no signs of the disease on imaging and mycological exams.
It is therefore important that the patient undergo examinations at an interval of 6 months after treatment to confirm the cure.
Treatment
The treatment of paracoccidioidomycosis is based on the administration of medications that help to fight fungal infection. Generally, the substances used are oral, but severe cases may require the use of drugs by injection.
This treatment can be divided into two types, attack treatment and continuity treatment .
The attack, in this case, is the control of the signs and symptoms of the disease in a more immediate way.
It also aims to reduce parasitic infection as soon as possible, to improve the patient’s immunity. Thus, the focus is to treat the patient’s clinical conditions immediately, while the infection caused by the fungi is controlled.
Continuity treatment, on the other hand, is done over the long term, as a maintenance therapy.
It is a follow-up to ensure that the patient has a cure for the disease, reducing the risk of recurrence of the infection.
In patients with complications, other types of treatments may be necessary, which is evaluated by the doctor who accompanies the case.
In general, with treatment, the patient usually has a clinical improvement after about 2 to 3 months.
If after completion of treatment, tests show that the infection has resolved, the patient is considered cured. When there is no clinical and radiological cure, treatment should be continued.
Medicines
The drugs used to treat paracoccidioidomycosis have antifungal action and, therefore, help to fight infection.
Depending on the case, oral or intravenous use may be prescribed, also varying the time of treatment and dosage. The main ones are:
- Amphotericin B (intravenous);
- Cetoconazol (via oral);
- Fluconazol (via oral);
- Itraconazol (via oral);
- Sulfametoxazol + Trimetoprima (via oral).
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Prognosis
The prognosis depends on the diagnosis and treatment. The earlier the investigation of the disease, the better the response to treatment. In such cases, the prognosis is good.
If there are any pulmonary complications, the disease can be cured, but patients may have irreversible sequelae.
The same happens in patients who start treatment and do not finish it, which can cause the disease to develop into a chronic condition, increasing the chances of complications.
In such cases, paracoccidioidomycosis can lead the patient to death.
However, it is known that this is not a disease of compulsory notification, not having much data in relation to its incidence, prevalence and cases of death.
Complications
When the patient does not receive treatment properly, some more serious complications can occur.
Because it is a systemic ringworm, the disease can affect several parts of the body, in addition to causing skin lesions.
The main complications are associated with lung, adrenal, skin damage, weight loss and problems with swallowing. Among them are:
Estomatitis
One of the complications that can occur is stomatitis , an inflammation that affects the oral region. It is commonly caused by viral infections, but it can also occur in the face of fungal infections.
The patient, in general, has fever, pain and lesions in the mouth, which also causes difficulty in swallowing (process of swallowing food).
Respiratory failure
In some cases, paracoccidioidomycosis causes lung involvement and, even with the treatment and cure of the infection, further damage to these organs can occur.
Thus, patients may have respiratory failure as a complication.
That is why it is essential to follow up after treatment and exams to visualize the pulmonary structures.
Neurological complications
Although rare (affects about 3% of patients), neurological complications can occur. In such cases, granulomas (nodules that form in response to inflammation) can form in the brain.
It is a serious complication, because if it compromises the functioning of the Central Nervous System, it can interfere with speech, balance, motor coordination and patient awareness.
In addition, it is still possible to cause seizures and progress to a case of meningitis (inflammation of the meninges, structures that protect the brain).
Adrenal involvement
It can happen in patients with a chronic condition of the disease, where necrosis (cell death) and formation of fibrous tissues of the adrenal glands occurs, glands that are part of the endocrine system and are responsible for producing steroid hormones.
This complication affects the levels of cortisol and aldosterone in the body and can cause darkening of the skin and mucous membrane of the gums as a symptom.
Skin problems
Ringworm caused by this disease can spread to regions such as the scalp, chest, face and upper limbs, in addition to affecting the region around the mouth and nose.
They may initially appear as small papules and evolve into larger ulcerative lesions (that is, as a rough, raised scar).
They resemble plaques or warts in some cases, causing deformation on the patient’s face.
Prevention of paracoccidioidomycosis
There is no exact form of prevention against paracoccidioidomycosis, which is one of the reasons for not being a disease of constant epidemiological surveillance.
It is known, however, that it is not a disease that can be transmitted from person to person or by sharing objects.
The higher risk of inhaling the fungus is greater in rural areas and in people working in plantations, gardens etc.
Therefore, it is recommended to maintain good personal hygiene and use of protective equipment, such as gloves, boots or masks. However, it is not a guarantee of prevention.
Although it is not a disease considered compulsory to report, it is one of the most common fungal mycoses, capable of causing severe sequelae in patients. Therefore, it is essential to know the symptoms and be aware of the treatment.
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