Anyone who lives in or visits areas where Paracoccidioides lives can get paracoccidioidomycosis. Scientists estimate that less than 5% of patients with paracoccidioidomycosis die from the disease.
Worker from Brazil
Fever, lymph nodes, looking ill
Dry cough, dyspnea
Tooth loss, gingiva won’t heal
Path shows budding pilot’s wheel Link to author
- Dimorphic fungus Paracoccidioides
- Commonest route is inhalational
- Also known as Almeida disease, Lutz-Splendore-Almeida disease, Lutz’s mycosis, paracoccidioidal granuloma, South American blastomycosis
- Commoner in Men in outdoor rural occupations
- Mexico, Central and South America (most Brazil).
- Grows in the soil form in humid regions with a medium to a high rainy season, mild temperatures, and the presence of forests and rivers
- Habit of using twigs to clean teeth gives oral lesions
- Neutrophils and alveolar macrophages will tend to form granulomas depending on the immunological state of the patient and the T helper (TH) lymphocytes' response
- Fatigue, weight loss, cough
- Prominent lymph nodes and enlarged Liver and spleen
- Bone marrow involvement with anaemia
- Lesions in mouth and throat - Gingival ‘mulberry’ lesions
- Pulmonary disease with cough and dyspnoea and fibrosis
- CNS involvement may result in meningoencephalitis
- FBC, U&E, Ca, LFTs, CRP. CXR
- Biopsy of affected area will show fungal elements reveals spherical thick-walled yeast cells of variable size, with peripheral buds protruding from a central cell (pilot's wheel). It is often described as multipolar budding yeast with daughter cells resembling a “Mickey mouse head” or a “steering wheel.”
- Culture: Sabouraud dextrose agar. takes 20-30 days to grow so not helpful
- Histologic findings: Methenamine silver stain or periodic acid Schiff stain are used to identify fungal elements in tissue samples. Lymph nodes may exhibit caseous necrosis. In the juvenile form, a diffuse tissue reaction is characteristic.
- Blood tests: Quantitative immunodiffusion testing is the most widely available assay in endemic regions and represents a reliable method with 84.3% sensitivity and 98.9% specificity.
- Lung Biopsy: Shows Yeast forms with Giant cells and Granuloma formation
Complications to prevent
- Pulmonary fibrosis. Malnourishment, anaemia
- Addison syndrome
- Bacterial or other fungal pathogen infections
Management: get expert help
- Para coccidioidomycosis does not spread from person to person
- First line: Itraconazole 100-400 mg OD
- Also: Voriconazole 400 mg BD on the first day then 200 mg BD
- Also: Ketoconazole 200-400 mg/day in adults for a course of 6 to 18 months
- Also: Amphotericin B or Trimethoprim/sulfamethoxazole (TMP/SMX) but needs 24 months or Sulfadiazine up to 4 g/day in adults
- Patients usually need treatment for about one year.