Paracoccidioidomycosis
Paracoccidioidomycosis is a rare fungal infection caused by the organism Paracoccidioides brasiliensis, primarily found in soil in coffee- and tobacco-growing regions of South and Central America. This infection mainly affects the lungs, potentially spreading to other body parts and leading to ulcerations. It occurs when spores of the fungus are inhaled, transitioning from mold in the environment to yeast form within the body. While individuals of any age can contract the disease, it predominantly affects healthy males engaged in outdoor activities, especially those working in agriculture. Symptoms of chronic pulmonary paracoccidioidomycosis include cough, difficulty breathing, fever, weight loss, and fatigue, along with possible mucosal and cutaneous lesions. Diagnosis may involve consultations with dermatologists and infectious disease specialists, utilizing tests like sputum cultures and tissue biopsies. Treatment typically includes antifungal medications, with oral itraconazole being the preferred option due to its effectiveness and lower toxicity. Although the disease can be severe if untreated, early intervention generally leads to a favorable prognosis. Prevention focuses on avoiding areas where the fungus is endemic.
Paracoccidioidomycosis
- ANATOMY OR SYSTEM AFFECTED:Lungs, respiratory system, skin, tissue
- ALSO KNOWN AS: South American blastomycosis
Definition
Paracoccidioidomycosis is a rare infection caused by Paracoccidiodes brasiliensis, a soil fungus. It is prevalent in the coffee- and tobacco-growing regions of South America and Central America. This type of infection primarily affects the lungs but may spread to other areas of the body and form ulcerations.
Causes
Brasiliensis is a dimorphic fungus that exists in mold or yeast form depending on the conditions. In the environment, the fungus exists as a mold that produces spores. Inhalation of the fungal spores causes a pulmonary infection. Once inside the body, the spores transform to yeast and disperse to other areas of the body (mouth, throat, skin, and lymph nodes). Human-to-human transmission of the disease is uncommon.
Risk Factors
All ages can be affected by the disease; however, the majority of cases involve healthy males with an outdoor occupation or hobby, especially agricultural workers, coffee and tobacco growers, and hunters. Other factors, such as malnutrition, smoking, and alcoholism, increase the chance of acquiring paracoccidioidomycosis. Younger and immunocompromised persons, including those with acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection, are more likely to have acute (severe) disease.
Symptoms
Symptoms of chronic pulmonary paracoccidioidomycosis include cough, difficulty breathing, fever, weight loss, and fatigue. As the disease progresses, mucosal, oral, and cutaneous lesions, usually on the face, appear and may be papular, nodular, ulcerative, or plaque-like. Ulcerations on the gums, tongue, lips, and palate are also common. Persons with a severe infection may have widespread disseminated disease with lesions causing inflammation of the intestines, liver, spleen, lymph nodes, or brain, and adrenal gland destruction and abdominal pain. Some persons can develop paracoccidioidomycosis many years after initial contact with the etiologic agent. Although symptoms can last for years, the disease is rarely fatal.
Screening and Diagnosis
Because paracoccidioidomycosis is rare, primary care physicians should inquire about the previous residence of the person seeking diagnosis. Consultation with a dermatologist for a skin biopsy and with an infectious disease specialist for diagnosis and treatment is recommended. Diagnostic tests may include sputum culture, tissue biopsy, various serological tests to detect antibodies, and chest radiography. Definitive diagnosis requires isolation, culture, and analysis of infected tissue under a microscope to detect brasiliensis.
Treatment and Therapy
Persons with paracoccidioidomycosis should be treated based on the severity of the disease. Infection is susceptible to sulfonamides, amphotericin B, and azole antifungals. Oral itraconazole is the drug of choice because of its availability, effectiveness, and decreased toxicity. Because of side effects, amphotericin B is recommended only for persons with severe disease.
Paracoccidioidomycosis has the potential to be fatal if left untreated or if the infection is severe. However, with early intervention, the prognosis for persons with chronic paracoccidioidomycosis is good.
Prevention and Outcomes
Because brasiliensis is a microscopic fungus, the best form of prevention is to avoid areas where it is prevalent.
Bibliography
Hospenthal, Duane R. “Paracoccidioidomycosis.” Available at http://emedicine.medscape.com/article/224628-overview.
Kauffman, Carol A. “Paracoccidioidomycosis.” In Cecil Medicine, edited by Lee Goldman and Dennis Ausiello. 23d ed. Philadelphia: Saunders/Elsevier, 2008.
"Paracoccidioidomycosis Basics." Centers for Disease Control and Prevention (CDC), 24 Apr. 2024, www.cdc.gov/paracoccidioidomycosis/about/index.html. Accessed 4 Feb. 2025.
Restrepo, A., A. M. Tobon, and C. A. Agudelo. “Paracoccidioidomycosis.” In Diagnosis and Treatment of Human Mycoses, edited by Duane R. Hospenthal and Michael G. Rinaldi. Totowa, N.J.: Humana Press, 2008.
Richardson, Malcolm D., and Elizabeth M. Johnson. Pocket Guide to Fungal Infection. 2d ed. Malden, Mass.: Wiley-Blackwell, 2006.