Paracoccidioides brasiliensis: Difference between revisions

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Paracoccidioides brasiliensis
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Revision as of 19:19, 14 August 2019

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