Paracoccidioides brasiliensis

Paracoccidioides brasiliensis (paracoccidiomycosis)

Microbiology

• Dimorphic fungus with four phylogenetic lineages
• Disease is caused by P. brasiliensis and P. lutzii (newly discovered)
• Mariner's wheel of budding conidia

Epidemiology

• South and Central America, with Brazil being the largest endemic country
• Has been isolated from the feces of bats (Artibeus lituratus) and from internal organs of the nine-banded armadillo

Clinical Presentation

• Usually self-limited pulmonary infection
• Can cause acute/subacute pulmonary infection in children, adolescents, and immunocompromised individuals
  • Fever, weight loss, lymphadenopathy, and hepatosplenomegaly
  • Half have skin and mucosal lesions
• Can cause chronic disease in adults
  • Pulmonary infiltrates on CXR
  • Adrenal lesions with insufficiency are common
• However, may remain latent following infection, and reactivate later as pulmonary or disseminated disease

Diagnosis

• Serology
  • Antibodies
  • Antigen

Management

• Itraconazole 200 to 400 mg/day for 9 to 12 months
• If severe, consider amphotericin 1mg/kg/day
• ?Septra