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{{Infobox_Disease |
__NOTOC__
  Name          = {{PAGENAME}} |
{{Paracoccidioidomycosis}}
  Image          = Paracoccidioides brasiliensis 01.jpg |
  Caption        = [[Paracoccidioides brasiliensis]] |
  DiseasesDB    = 29815 |
  ICD10          = {{ICD10|B|41||b|35}} |
  ICD9          = {{ICD9|116.1}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = med |
  eMedicineTopic = 1731 |
  MeshID        = D010229 |
}}


{{CMG}}
{{About1|Paracoccidioides brasiliensis}}


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


{{SI}}
{{CMG}} {{AE}} {{DL}}


'''Paracoccidioidomycosis''' (also known as '''Lutz-Splendore-Almeida disease''' or '''Brazilian blastomycosis''') is a [[mycosis]] caused by the [[fungus]] ''[[Paracoccidioides brasiliensis]]''. Sometimes called ''South American blastomycosis'', paracoccidioidomycosis is caused by a different fungus than that which causes [[blastomycosis]].
{{SK}} South American blastomycosis, Brazilian blastomycosis, Paraccocidioidal granuloma, Lutz-Splendore-de-Almeida disease, Almeida disease, PCM


== Agent==
==[[Paracoccidioidomycosis overview|Overview]]==
''P. brasiliensis'' is a thermally-dimorphic fungus distributed in [[Brazil]] and [[South America]]. The habitat of the infectious agent is not known but appears to be aquatic. In [[biopsies]] the fungus appears as a polygemulating<!-- not a real word? --> yeast with a pilot's wheel-like appearance.


== Disease==
==[[Paracoccidioidomycosis historical perspective|Historical Perspective]]==
Paracoccidioidomycosis is a [[systemic mycosis]] caused by the dimorphic fungus Paracoccidioides. It frequently involves [[mucous membrane]]s, [[lymph node]]s, bone and lungs and requires some degree of host [[immunosuppression]].


Primary infection is thought to be autolimited and almost asymptomatic as [[histoplasmosis]] or Valley Fever. In young people, there is a progressive form of the disease (akin of tuberculous [[septicemia]] in tuberculous priminfection) with high prostrating fever, generalized [[lymphadenopathy]] and pulmonary involvement with milliary lesions. This juvenile form has a more severe prognosis even with treatment. The most common form is the so called adult form of paracoccidioidomycosis that is almost certainly a reactivation of the disease.
==[[Paracoccidioidomycosis classification|Classification]]==


Painful lesions with a violaceous hue in lips and oral mucosa are common as is cervical lymphadenitis teeming with polygemulating yeasts in the biopsy. In this form, differential diagnosis must be made with mucocutaneous [[leishmaniasis]], [[yaws]] and [[Tuberculosis|TB]].
==[[Paracoccidioidomycosis pathophysiology|Pathophysiology]]==


[[Pulmonary]] involvement is also common, it starts as [[lobar pneumonia]] or [[pleurisy]] but without remission at ninth day; the patient remains [[febrile]], [[cough]]s, [[loses weight]] and the [[X rays]] reveal milliary shadows throughout lung fields. Other organs can be involved, like bones, [[meninges]], arteries and [[spleen]] but this is very rare.
==[[Paracoccidioidomycosis causes|Causes]]==


Diagnosis is made with a biopsy of affected tissue, this shows the characteristic helm-shaped yeasts and culture shows the agent. Serology is also used in endemic areas.
==[[Paracoccidioidomycosis differential diagnosis|Differentiating Paracoccidioidomycosis From Other Diseases]]==


== Treatment==
==[[Paracoccidioidomycosis epidemiology and demographics|Epidemiology and Demographics]]==
[[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.
==[[Paracoccidioidomycosis risk factors|Risk Factors]]==


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.
==[[Paracoccidioidomycosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


==External links==
==Diagnosis==
* {{MerckManual|13|158|e}}
[[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]]
* [http://www.mycology.adelaide.edu.au/Mycoses/Dimorphic_systemic/Paracoccidioidomycosis/ Overview] at [[University of Adelaide]]


{{Mycoses}}
==Treatment==
[[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]]


[[es:Paracoccidioidomicosis]]
==Case Studies==
[[it:Paracoccidioidomicosi]]
[[Paracoccidioidomycosis case study one|Case#1]]
[[pt:Paracoccidioidomicose]]
 
{{WikiDoc Help Menu}}
==Related Chapters==
{{WikiDoc Sources}}
* [[Paracoccidioides brasiliensis]]
 
[[Category:Fungal diseases]]
[[Category:Infectious diseases]]

Latest revision as of 21:39, 12 February 2016

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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

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