Paracoccidioidomycosis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac

Overview

Among all infected patients 5% are acute with a more rapid and severe progression compared to the chronic subtype. Acute PMC primarily affects the reticuloendothelial system organs.^[1]^[2] Meanwhile, chronic paracoccidioidomycosis represents 90% of infected patients and has a slower progression. Patients with chronic PCM frequently develops pulmonary symptoms.^[3]^[4] Complications that can develop as a result of PCM are chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, bullae, pulmonary hypertension, dyspnea, adrenal gland insufficiency, dysphonia, laryngeal lesions (such as glottis estenosis), microstomia, seizures, and motor deficiency.^[2]^[4]^[5] The prognosis of paracoccidioidomycosis is good with adequate treatment. Without treatment, death is due to PCM related complications.^[6]

Natural History

Latent Paracoccidioides Infection

Latent paracoccidioides infection can be adquired in the first decade of life.
Patienes with latent PCM infection do not manifest symptoms.^[7]

Acute/Subacute/Juvenile

Acute PCM occurs in children and young adults. It constitutes only 3-5% of PCM disease.^[1]
Symptoms take place weeks or months after the transmission.^[1]
The reticuloendothelial system organs and gastrointestinal tract are usually involved at this stage of the disease.^[1]
Acute PCM starts with nonspecific symptoms such as fever, weight loss, weakness, anorexia, pallor, etc.
Patients may also report swollen lymph nodes in different body regions (cervical, axilar, paravertebral and retroperitoneal ganglia). Digestive, osteoarticular and cutaneous signs and symptoms may also be present.
Pulmonary manifestations in the acute for are rare.^[3]

Chronic/Adult

Chronic paracoccidioidomycosis represents 90% of the disease.
The symptoms of chronic PCM usually start to progress in the third decade of life, even though the organism can be acquired in the first decade of life.^[3]
The symptoms of paracoccidioidomycosis typically develop 20-30 years after exposure to Paracoccidioides spp.
PCM symptoms develop slowly through the years.
Patients develop pulmonary symptoms (90%), with or without nonespecific symptoms. Nevertheless, other symptoms can occur such as cutaneous or mucosal lesions (51-82%).^[7]^[8]
Paracoccidioides can enter the bloodstream and disseminate to CNS and cause neuroparacoccidioidomycosis.^[9]

Complications

Acute paracoccidioidomycosis complications include

Bone marrow failure

Chronic paracoccidioidomycosis complications include

Chronic obstructive pulmonary disease (COPD)
Pulmonary fibrosis
Bullae
Pulmonary hypertension
Dyspnea
Adrenal gland insufficiency
Dysphonia
Laryngeal lesions (such as glottis estenosis)
Microstomia
Seizures
Motor deficiency^[2]^[4]^[5]

Prognosis

The prognosis varies with the type of infection; chronic PCM have the most favorable prognosis with adequate treatment.
Juvenile PCM has higher mortality rates than adult PCM.^[2]
Deaths can occur because of late diagnosis, dissemination of the disease (multifocal) or development of complications.^[6]

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL; et al. (2012). “Thoracic paracoccidioidomycosis: radiographic and CT findings”. Radiographics. 32 (1): 71–84. doi:10.1148/rg.321115052. PMID 22236894.
↑ ^2.0 ^2.1 ^2.2 ^2.3 Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. ‘Clin. Microbiol. Rev.1993;6(2):89-117
↑ ^3.0 ^3.1 ^3.2 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
↑ ^4.0 ^4.1 ^4.2 Wanke B, Aidê M. Chapter 6 – Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249
↑ ^5.0 ^5.1 Francesconi F, da Silva MT, Costa RL, et al. Long-term outcome of neuroparacoccidioidomycosis treatment. Rev Soc Bras Med Trop. 2011;44(1):22-25
↑ ^6.0 ^6.1 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
↑ ^7.0 ^7.1 Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA (2011). “Immunology of paracoccidioidomycosis”. An Bras Dermatol. 86 (3): 516–24. PMID 21738969.
↑ Morón C, Ivanov M, Verea M, Pecotche D. Paracoccidioidomicosis, presentación de la casuística de diez años y revisión de la literatura. Arch. Argent. Dermatol. 2012; 62: 92-97
↑ Passl R, Staudacher M, Szalay S, Kobienia G, Martinek H (1975). “[Problems and surgical therapy in the neglected Paget-Schroetter syndrome]”. Hefte Unfallheilkd (126): 170–1. PMID 1234146.

[pmid22236894-1] 1.0 ^1.1 ^1.2 ^1.3 Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL; et al. (2012). “Thoracic paracoccidioidomycosis: radiographic and CT findings”. Radiographics. 32 (1): 71–84. doi:10.1148/rg.321115052. PMID 22236894.

[aaa-2] 2.0 ^2.1 ^2.2 ^2.3 Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. ‘Clin. Microbiol. Rev.1993;6(2):89-117

[a-3] 3.0 ^3.1 ^3.2 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56

[b-4] 4.0 ^4.1 ^4.2 Wanke B, Aidê M. Chapter 6 – Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249

[c-5] 5.0 ^5.1 Francesconi F, da Silva MT, Costa RL, et al. Long-term outcome of neuroparacoccidioidomycosis treatment. Rev Soc Bras Med Trop. 2011;44(1):22-25

[kkk-6] 6.0 ^6.1 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20

[pmid21738969-7] 7.0 ^7.1 Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA (2011). “Immunology of paracoccidioidomycosis”. An Bras Dermatol. 86 (3): 516–24. PMID 21738969.

[?-8] Morón C, Ivanov M, Verea M, Pecotche D. Paracoccidioidomicosis, presentación de la casuística de diez años y revisión de la literatura. Arch. Argent. Dermatol. 2012; 62: 92-97

[pmid1234146-9] Passl R, Staudacher M, Szalay S, Kobienia G, Martinek H (1975). “[Problems and surgical therapy in the neglected Paget-Schroetter syndrome]”. Hefte Unfallheilkd (126): 170–1. PMID 1234146.

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