Paracoccidioidomycosis: Difference between revisions

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{{Paracoccidioidomycosis}}
{{Paracoccidioidomycosis}}
{{About1|Paracoccidioides brasiliensis}}


'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{CMG}}
{{CMG}} {{AE}} {{DL}}
 
{{SK}} South American blastomycosis, Brazilian blastomycosis, Paraccocidioidal granuloma, Lutz-Splendore-de-Almeida disease, Almeida disease, PCM


==[[Paracoccidioidomycosis overview|Overview]]==
==[[Paracoccidioidomycosis overview|Overview]]==
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==[[Paracoccidioidomycosis causes|Causes]]==
==[[Paracoccidioidomycosis causes|Causes]]==


==[[Paracoccidioidomycosis differential diagnosis|Differentiating Paracoccidioidomycosis from other Diseases]]==
==[[Paracoccidioidomycosis differential diagnosis|Differentiating Paracoccidioidomycosis From Other Diseases]]==


==[[Paracoccidioidomycosis epidemiology and demographics|Epidemiology and Demographics]]==
==[[Paracoccidioidomycosis epidemiology and demographics|Epidemiology and Demographics]]==
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==Diagnosis==
==Diagnosis==
[[Paracoccidioidomycosis history and symptoms| History and Symptoms]] | [[Paracoccidioidomycosis physical examination | Physical Examination]] | [[Paracoccidioidomycosis laboratory findings|Laboratory Findings]] | [[Paracoccidioidomycosis CT|CT]] | [[Paracoccidioidomycosis other imaging findings|Other Imaging Findings]] | [[Paracoccidioidomycosis other diagnostic studies|Other Diagnostic Studies]]
[[Paracoccidioidomycosis diagnostic criteria| Diagnostic Criteria]] | [[Paracoccidioidomycosis history and symptoms| History and Symptoms]] | [[Paracoccidioidomycosis physical examination | Physical Examination]] | [[Paracoccidioidomycosis laboratory findings|Laboratory Findings]] | [[Paracoccidioidomycosis imaging findings|Imaging Findings]]


==Treatment==
==Treatment==
[[Paracoccidioidomycosis medical therapy|Medical Therapy]] |  [[Paracoccidioidomycosis surgery|Surgery]] | [[Paracoccidioidomycosis primary prevention|Primary Prevention]] | [[Paracoccidioidomycosis secondary prevention|Secondary Prevention]] | [[Paracoccidioidomycosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Paracoccidioidomycosis future or investigational therapies|Future or Investigational Therapies]]
[[Paracoccidioidomycosis medical therapy|Medical Therapy]] |  [[Paracoccidioidomycosis surgery|Surgery]] | [[Paracoccidioidomycosis primary prevention|Primary Prevention]] | [[Paracoccidioidomycosis secondary prevention|Secondary Prevention]] | [[Paracoccidioidomycosis future or investigational therapies|Future or Investigational Therapies]]


==Case Studies==
==Case Studies==
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==Related Chapters==
==Related Chapters==
* [[Paracoccidioided brasiliensis]]
* [[Paracoccidioides brasiliensis]]
 
== Treatment==
[[Sulphonamide]]s are the traditional remedies to paracoccidiodomycosis. They were introduced by Oliveira Ribeiro and used for more than fifty years with good results. The most used [[sulfa drugs]] in this infection are sulfadimethoxime, [[sulfadiazine]] and [[co-trimoxazole]]. This treatment is generally safe but several adverse effects can appear, the most severe of which are the [[Stevens Johnson Syndrome]] and [[agranulocytosis]]. It must be continued for up to 3 years to obtain cure and relapse and treatment failures aren't unusual.
 
Antifungal drugs like [[Amphotericin B]] or [[Ketoconazole]] are also effective in clearing the infection but they are very expensive compared with sulphonamides.
 
During therapy [[fibrosis]] can appear and a surgery be needed to correct this. Other possible complication is Addisonian crisis. The death rate is around ten percent.
 
===Antimicrobial Regimen===
*'''Paracoccidioidomycosis''' <ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
:* Preferred regimen (1):
::* Adults: [[Itraconazole]] 200 mg/day PO
::* Children: [[Itraconazole]] (<30/kg and >5 yr) 5-10 mg/kg/day PO
::*Note: Treatment duration based on organ involvement:
:::*Mild involvement: 6-9 months
:::*Moderate involvement: 12-18 months
:* Preferred regimen (2)
::* Adults: [[Trimethoprim/sulfamethoxazole]] (TMP/SMX)  TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV bid
::* Children: [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, bid
::* Note (1): Treatment duration based on organ involvement:
:::* Minor involvement: 12 months
:::* Moderate involvement: 18-24 months
::*Note (2): Preferred treatment in children due to larger experience.
::*Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.
:* Preferred regimen (3): [[Amphotericin B]] deoxycholate 1 mg/kg/day IV until patient improves and can be treated by the oral route.
::*Note: Preferred in severe forms of the disease.
:* Alternative regimen (4): [[Ketoconazole]] 200-400 mg/day PO for 9-12 months<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
:* Alternative regimen (5): [[Voriconazole]] initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
::* Note: Diminish the dose to 50% if weight is <40 kg.
 
==External links==
* {{MerckManual|13|158|e}}
* [http://www.mycology.adelaide.edu.au/Mycoses/Dimorphic_systemic/Paracoccidioidomycosis/ Overview] at University of Adelaide
 
 
{{Mycoses}}


[[es:Paracoccidioidomicosis]]
[[Category:Fungal diseases]]
[[it:Paracoccidioidomicosi]]
[[Category:Infectious diseases]]
[[pt:Paracoccidioidomicose]]
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Latest revision as of 21:39, 12 February 2016

Paracoccidioidomycosis Microchapters

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This page is about clinical aspects of the disease.  For microbiologic aspects of the causative organism(s), see Paracoccidioides brasiliensis.

For patient information click here

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

Synonyms and keywords: South American blastomycosis, Brazilian blastomycosis, Paraccocidioidal granuloma, Lutz-Splendore-de-Almeida disease, Almeida disease, PCM

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Paracoccidioidomycosis From Other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | Imaging Findings

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Future or Investigational Therapies

Case Studies

Case#1

Related Chapters

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