Paracoccidioidomycosis natural history, complications and prognosis

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

Overview

Acute paracoccidioidomycosis (PCM) affects 5% of the patients, and it has a more rapid and severe evolution. Acute PMC primarily compromises the reticuloendothelial system organs.[1][2] Meanwhile, chronic paracoccidioidomycosis represents 90% of the patients and has a slower evolution. Chronic PCM frequently develops pulmonary symptoms which can leave severe sequela.[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 treatment. Without treatment, PCM will result in death due to disease complications. The presence of late diagnosis and sequelae is associated with a particularly poor prognosis among patients with PCM.[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]

Complications

Paracoccidioidomycosis develops sequelae frequently:

Prognosis

  • Acute PCM is most a critical condition as it has a rapid evolution. 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. ↑ 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. ↑ 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. ↑ 3.0 3.1 3.2 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
  4. ↑ 4.0 4.1 4.2 Wanke B, Aidê M. Chapter 6 - Paracoccidioidomycosis. J. bras. pneumol. 2009; 35(12):1245-1249
  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
  6. ↑ 6.0 6.1 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
  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
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