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| ==Related Chapters== | | ==Related Chapters== |
| * [[Paracoccidioides brasiliensis]] | | * [[Paracoccidioides brasiliensis]] |
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| == Treatment==
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| [[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.
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| Antifungal drugs like [[Amphotericin B]] or [[Ketoconazole]] are also effective in clearing the infection but they are very expensive compared with sulphonamides.
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| 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.
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| ===Antimicrobial Regimen===
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| *'''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>
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| :* Preferred regimen (1):
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| ::* Adults: [[Itraconazole]] 200 mg/day PO
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| ::* Children: [[Itraconazole]] (<30/kg and >5 yr) 5-10 mg/kg/day PO
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| ::*Note: Treatment duration based on organ involvement:
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| :::*Mild involvement: 6-9 months
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| :::*Moderate involvement: 12-18 months
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| :* Preferred regimen (2)
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| ::* Adults: [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV bid
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| ::* Children: [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, bid
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| ::* Note (1): Treatment duration based on organ involvement:
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| :::* Minor involvement: 12 months
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| :::* Moderate involvement: 18-24 months
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| ::*Note (2): Preferred treatment in children due to larger experience.
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| ::*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.
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| :* Preferred regimen (3): [[Amphotericin B]] deoxycholate 1 mg/kg/day IV until patient improves and can be treated by the oral route.
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| ::*Note: Preferred in severe forms of the disease.
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| :* 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>
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| :* 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>
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| ::* Note: Diminish the dose to 50% if weight is <40 kg.
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| ==External links==
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| * {{MerckManual|13|158|e}}
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| * [http://www.mycology.adelaide.edu.au/Mycoses/Dimorphic_systemic/Paracoccidioidomycosis/ Overview] at University of Adelaide
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| {{Mycoses}}
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| [[es:Paracoccidioidomicosis]]
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| [[it:Paracoccidioidomicosi]]
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| [[pt:Paracoccidioidomicose]]
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