ABSTRACT
Paracoccidioidomycosis is a subacute or chronic systemic mycosis caused by Paracoccidioides brasiliensis, a soil saprophyte and thermally dimorphic fungus. The disease occurs mainly in rural
workers in Latin America and is the most frequent endemic systemic mycosis in many
countries of South America, where almost 10 million people are believed to be infected.
Paracoccidioidomycosis should be regarded as a disease of travelers outside the endemic
area. The primary pulmonary infection is subclinical in most cases, and individuals
may remain infected throughout life without ever developing clinical signs. A small
proportion of patients present with clinical disease. The lungs are frequently involved,
and the pulmonary clinical manifestations must be differentiated from many other infectious
and noninfectious conditions. Diagnosis should be based on epidemiological, clinical,
and microbiological data. Effective treatment regimens are available to control the
fungal infection, but most patients develop fibrotic sequelae that may severely hamper
respiratory and adrenal function and the patient’s well-being.
KEYWORDS
Paracoccidioidomycosis - South American blastomycosis -
Paracoccidioides brasiliensis, systemic mycosis
REFERENCES
- 1
Lutz A.
Uma mycose pseudococcidica localizada na boca e observada no Brasil: contribuição
ao conhecimento das hyphoblastomycoses Americanas.
Bras Med.
1908;
22
141-144
- 2
Colombo A L, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M.
Epidemiology of endemic systemic fungal infections in Latin America.
Med Mycol.
2011;
49
(8)
785-798
Epub ahead of print
- 3 Wanke B, Londero A T. Epidemiology and paracoccidioidomycosis infection. In: Franco M,
da Silva Lacaz C, Restrepo-Moreno A, Del Negro G, eds. Paracoccidiodomycosis. Boca
Raton, FL: CRC Press; 1994: 109-117
- 4
Brummer E, Castaneda E, Restrepo A.
Paracoccidioidomycosis: an update.
Clin Microbiol Rev.
1993;
6
(2)
89-117
- 5 Colombo A, Queiroz-Telles F. Paracoccidioidomycosis. In: Mandell G D, Kauffman C A,
eds. Atlas of Infectious Diseases. 2nd ed. Philadelphia: Current Medicine; 2007:
53-70
- 6
Chu J H, Feudtner C, Heydon K, Walsh T J, Zaoutis T E.
Hospitalizations for endemic mycoses: a population-based national study.
Clin Infect Dis.
2006;
42
(6)
822-825
- 7
Blotta M H, Mamoni R L, Oliveira S J et al..
Endemic regions of paracoccidioidomycosis in Brazil: a clinical and epidemiologic
study of 584 cases in the southeast region.
Am J Trop Med Hyg.
1999;
61
(3)
390-394
- 8
Paniago AMM, Aguiar JIA, Aguiar E S et al..
Paracoccidioidomycosis: a clinical and epidemiological study of 422 cases observed
in Mato Grosso do Sul [in Portuguese].
Rev Soc Bras Med Trop.
2003;
36
(4)
455-459
- 9
Nucci M, Colombo A L, Queiroz-Telles F.
Paracoccidioidomycosis.
Curr Fungal Infect Rep.
2009;
3
15-20
- 10
Negroni R.
Paracoccidioidomycosis (South American blastomycosis, Lutz’s mycosis).
Int J Dermatol.
1993;
32
(12)
847-859
- 11
Restrepo A, Robledo M, Giraldo R et al..
The gamut of paracoccidioidomycosis.
Am J Med.
1976;
61
(1)
33-42
- 12
Londero A T, Severo L C.
The gamut of progressive pulmonary paracoccidioidomycosis.
Mycopathologia.
1981;
75
(2)
65-74
- 13
Restrepo A, Benard G, de Castro C C, Agudelo C A, Tobón A M.
Pulmonary paracoccidioidomycosis.
Semin Respir Crit Care Med.
2008;
29
(2)
182-197
- 14 Graybill J R, Anstead G M, Queiroz-Telles F. The diagnosis of endemic Mycoses.
In: Maertens J A, Marr K A, eds. Diagnosis of Fungal Infections. New York, NY: Informa
Healthcare USA; 2007: 291-353
- 15
San-Blas G, Niño-Vega G, Iturriaga T.
Paracoccidioides brasiliensis and paracoccidioidomycosis: molecular approaches to
morphogenesis, diagnosis, epidemiology, taxonomy and genetics.
Med Mycol.
2002;
40
(3)
225-242
- 16
Bialek R, Ibricevic A, Fothergill A, Begerow D.
Small subunit ribosomal DNA sequence shows Paracoccidioides brasiliensis closely related
to Blastomyces dermatitidis.
J Clin Microbiol.
2000;
38
(9)
3190-3193
- 17
Kasuga T, White T J, Koenig G et al..
Phylogeography of the fungal pathogen Histoplasma capsulatum.
Mol Ecol.
2003;
12
(12)
3383-3401
- 18
Bagagli E, Theodoro R C, Bosco SMG, McEwen J G.
Paracoccidioides brasiliensis: phylogenetic and ecological aspects.
Mycopathologia.
2008;
165
(4-5)
197-207
- 19
Theodoro R C, Bagagli E, Oliveira C.
Phylogenetic analysis of PRP8 intein in Paracoccidioides brasiliensis species complex.
Fungal Genet Biol.
2008;
45
(9)
1284-1291
- 20
Untereiner W A, Scott J A, Naveau F A, Sigler L, Bachewich J, Angus A.
The Ajellomycetaceae, a new family of vertebrate-associated Onygenales.
Mycologia.
2004;
96
(4)
812-821
- 21
Bagagli E, Bosco SMG, Theodoro R C, Franco M.
Phylogenetic and evolutionary aspects of Paracoccidioides brasiliensis reveal a long
coexistence with animal hosts that explain several biological features of the pathogen.
Infect Genet Evol.
2006;
6
(5)
344-351
- 22 Queiroz-Telles F. Paracoccidioides brasiliensis: ultrastructural findings. In:
Franco M, ed. Paracoccidioidomycosis. Boca Raton, FL: CRC Press; 1994: 27-47
- 23
San-Blas G, Niño-Vega G, Iturriaga T.
Paracoccidioides brasiliensis and paracoccidioidomycosis: molecular approaches to
morphogenesis, diagnosis, epidemiology, taxonomy and genetics.
Med Mycol.
2002;
40
(3)
225-242
- 24
Negroni P.
The Paracoccidioides brasiliensis lives saprophytically in the soil of Argentina [in
Spanish].
Prensa Med Argent.
1966;
53
(39)
2381-2382
- 25
Restrepo A.
The ecology of Paracoccidioides brasiliensis: a puzzle still unsolved.
Sabouraudia.
1985;
23
(5)
323-334
- 26
Ferreira M S, Freitas L H, Lacaz Cda S et al..
Isolation and characterization of a Paracoccidioides brasiliensis strain from a dogfood
probably contaminated with soil in Uberlandia, Brazil.
J Med Vet Mycol.
1990;
28
(3)
253-256
- 27
Silva-Vergara M L, Martınez R, Chadu A, Madeira M, Freitas-Silva G, Leite Maffei C M.
Isolation of a Paracoccidioides brasiliensis strain from the soil of a coffee plantation
in Ibiá, State of Minas Gerais, Brazil.
Med Mycol.
1998;
36
(1)
37-42
- 28
Bagagli E, Sano A, Coelho KIR et al..
Isolation of Paracoccidioides brasiliensis from armadillos (Dasypus noveminctus) captured
in an endemic area of paracoccidioidomycosis.
Am J Trop Med Hyg.
1998;
58
(4)
505-512
- 29
Franco M, Bagagli E, Scapolio S, da Silva Lacaz C.
A critical analysis of isolation of Paracoccidioides brasiliensis from soil.
Med Mycol.
2000;
38
(3)
185-191
- 30
Bagagli E, Franco M, Bosco SdeM, Hebeler-Barbosa F, Trinca L A, Montenegro M R.
High frequency of Paracoccidioides brasiliensis infection in armadillos (Dasypus novemcinctus):
an ecological study.
Med Mycol.
2003;
41
(3)
217-223
- 31
Mok W Y, Netto C F.
Paracoccidioidin and histoplasmin sensitivity in Coari (state of Amazonas), Brazil.
Am J Trop Med Hyg.
1978;
27
(4)
808-814
- 32
de Andrade JAF, de Andrade T M, Lacaz CdaS et al..
Survey on paracoccidioidin in a population of Bahia (Brazil)[in Portuguese].
Rev Inst Med Trop Sao Paulo.
1984;
26
(1)
1-6
- 33
Hay R J, Rose P, Jones T R.
Paracoccidioidin sensitization in Guyana—a preliminary skin test survey in hospitalized
patients and laboratory workers.
Trans R Soc Trop Med Hyg.
1987;
81
(1)
46-48
- 34
Bittencourt J I, de Oliveira R M, Coutinho Z F.
Paracoccidioidomycosis mortality in the State of Paraná, Brazil, 1980/1998.
Cad Saude Publica.
2005;
21
(6)
1856-1864
- 35
Coutinho Z F, Silva D, Lazera M et al..
Paracoccidioidomycosis mortality in Brazil (1980-1995).
Cad Saude Publica.
2002;
18
(5)
1441-1454
- 36
Ono M A, Itano E N, Mizuno L T, Mizuno E H, Camargo Z P.
Inhibition of Paracoccidioides brasiliensis by pesticides: is this a partial explanation
for the difficulty in isolating this fungus from the soil?.
Med Mycol.
2002;
40
(5)
493-499
- 37
Queiroz-Telles F.
Influence of alternating coffee and sugar cane agriculture in the incidence of paracoccidioidomycosis
in Brazil.
Biomedica.
2008;
28
(Suppl 1)
129
- 38
Restrepo A, Salazar M E, Cano L E, Stover E P, Feldman D, Stevens D A.
Estrogens inhibit mycelium-to-yeast transformation in the fungus Paracoccidioides
brasiliensis: implications for resistance of females to paracoccidioidomycosis.
Infect Immun.
1984;
46
(2)
346-353
- 39
Aristizabal B H, Clemons K V, Stevens D A, Restrepo A.
Morphological transition of Paracoccidioides brasiliensis conidia to yeast cells:
in vivo inhibition in females.
Infect Immun.
1998;
66
(11)
5587-5591
- 40
dos Santos W A, da Silva B M, Passos E D, Zandonade E, Falqueto A.
Association between smoking and paracoccidioidomycosis: a case-control study in the
State of Espírito Santo, Brazil [in Portuguese].
Cad Saude Publica.
2003;
19
(1)
245-253
- 41
Paniago A M, de Freitas A C, Aguiar E S et al..
Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12
cases observed in an endemic region in Brazil.
J Infect.
2005;
51
(3)
248-252
- 42
Shikanai-Yasuda M A, Conceição Y M, Kono A, Rivitti E, Campos A F, Campos S V.
Neoplasia and paracoccidioidomycosis.
Mycopathologia.
2008;
165
(4-5)
303-312
- 43
Zavascki A P, Bienardt J C, Severo L C.
Paracoccidoidomycosis in organ transplant: case report.
Rev Inst Med Trop Sao Paulo.
2004;
46
(5)
279-281
- 44
Ricci G, Mota F T, Wakamatsu A, Serafim R C, Borra R C, Franco M.
Canine paracoccidioidomycosis.
Med Mycol.
2004;
42
(4)
379-383
- 45
Benard G.
An overview of the immunopathology of human paracoccidioidomycosis.
Mycopathologia.
2008;
165
(4-5)
209-221
- 46
Goldani L Z, Sugar A M.
Paracoccidioidomycosis and AIDS: an overview.
Clin Infect Dis.
1995;
21
(5)
1275-1281
- 47
Paniago A M, de Freitas A C, Aguiar E S et al..
Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12
cases observed in an endemic region in Brazil.
J Infect.
2005;
51
(3)
248-252
- 48 Franco M, Mendes R P, Moscardi-Bacchi M et al.. Paracoccidioidomycosis. In: Hay R J,
ed. Clinical Tropical Medicine and Communicable Diseases. Ist ed. London: Bailliere
Tindall; 1989: 185-220
- 49
Quagliato Júnior R, Grangeia TdeA, Massucio R A, De Capitani E M, Rezende SdeM, Balthazar A B.
Association between paracoccidioidomycosis and tuberculosis: reality and misdiagnosis.
J Bras Pneumol.
2007;
33
(3)
295-300
- 50
Funari M, Kavakama J, Shikanai-Yasuda M A et al..
Chronic pulmonary paracoccidioidomycosis (South American blastomycosis): high-resolution
CT findings in 41 patients.
AJR Am J Roentgenol.
1999;
173
(1)
59-64
- 51
Gomes E, Wingeter M A, Svidzinski T I.
Clinical-radiological dissociation in lung manifestations of paracoccidioidomycosis
[in Portuguese].
Rev Soc Bras Med Trop.
2008;
41
(5)
454-458
- 52
Funari M, Kavakama J, Shikanai-Yasuda M A et al..
Chronic pulmonary paracoccidioidomycosis (South American blastomycosis): high-resolution
CT findings in 41 patients.
AJR Am J Roentgenol.
1999;
173
(1)
59-64
- 53
Souza Jr A S, Gasparetto E L, Davaus T, Escuissato D L, Marchiori E.
High-resolution CT findings of 77 patients with untreated pulmonary paracoccidioidomycosis.
AJR Am J Roentgenol.
2006;
187
(5)
1248-1252
- 54
Marchiori E, Valiante P M, Mano C M et al..
Paracoccidioidomycosis: high-resolution computed tomography-pathologic correlation.
Eur J Radiol.
2011;
77
(1)
80-84
- 55
Gasparetto E L, Escuissato D L, Davaus T et al..
Reversed halo sign in pulmonary paracoccidioidomycosis.
AJR Am J Roentgenol.
2005;
184
1932-1934
- 56
Tobón A M, Agudelo C A, Osorio M L et al..
Residual pulmonary abnormalities in adult patients with chronic paracoccidioidomycosis:
prolonged follow-up after itraconazole therapy.
Clin Infect Dis.
2003;
37
(7)
898-904
- 57
Cano L E, Restrepo A.
Predictive value of serologic tests in the diagnosis and follow-up of patients with
paracoccidioidomycosis.
Rev Inst Med Trop Sao Paulo.
1987;
29
(5)
276-283
- 58
de Camargo Z P, de Franco M F.
Current knowledge on pathogenesis and immunodiagnosis of paracoccidioidomycosis.
Rev Iberoam Micol.
2000;
17
(2)
41-48
- 59
Wheat L J, Garringer T, Brizendine E, Connolly P.
Diagnosis of histoplasmosis by antigen detection based upon experience at the histoplasmosis
reference laboratory.
Diagn Microbiol Infect Dis.
2002;
43
(1)
29-37
- 60
Gómez B L, Figueroa J I, Hamilton A J et al..
Antigenemia in patients with paracoccidioidomycosis: detection of the 87-kilodalton
determinant during and after antifungal therapy.
J Clin Microbiol.
1998;
36
(11)
3309-3316
- 61
Marques da Silva S H, Colombo A L, Blotta M H, Lopes J D, Queiroz-Telles F, Pires
de Camargo Z.
Detection of circulating gp43 antigen in serum, cerebrospinal fluid, and bronchoalveolar
lavage fluid of patients with paracoccidioidomycosis.
J Clin Microbiol.
2003;
41
(8)
3675-3680
- 62
Marques da Silva S H, Queiroz-Telles F, Colombo A L et al..
Monitoring gp43 antigenemia in Paracoccidioidomycosis patients during therapy.
J Clin Microbiol.
2004;
42
2419-2424
- 63
Tuder R M, el Ibrahim R, Godoy C E, De Brito T.
Pathology of the human pulmonary paracoccidioidomycosis.
Mycopathologia.
1985;
92
(3)
179-188
- 64
Stevens D A, Vo P T.
Synergistic interaction of trimethoprim and sulfamethoxazole on Paracoccidioides brasiliensis.
Antimicrob Agents Chemother.
1982;
21
(5)
852-854
- 65
Dillon N L, Sampaio S A, Habermann M C et al..
Delayed results of treatment of paracoccidioidomycosis with amphotericin B plus sulfamides
versus amphotericin B alone.
Rev Inst Med Trop Sao Paulo.
1986;
28
(4)
263-266
- 66
Diaz M, Negroni R, Montero-Gei F Pan-American Study Group et al.
A Pan-American 5-year study of fluconazole therapy for deep mycoses in the immunocompetent
host.
Clin Infect Dis.
1992;
14
(Suppl 1)
S68-S76
- 67
Dietze R, Fowler Jr V G, Steiner T S, Pecanha P M, Corey G R.
Failure of amphotericin B colloidal dispersion in the treatment of paracoccidioidomycosis.
Am J Trop Med Hyg.
1999;
60
(5)
837-839
- 68
Naranjo M S, Trujillo M, Munera M I, Restrepo P, Gomez I, Restrepo A.
Treatment of paracoccidioidomycosis with itraconazole.
J Med Vet Mycol.
1990;
28
(1)
67-76
- 69
Shikanai-Yasuda M A, Benard G, Higaki Y et al..
Randomized trial with itraconazole, ketoconazole and sulfadiazine in paracoccidioidomycosis.
Med Mycol.
2002;
40
(4)
411-417
- 70
Queiroz-Telles F, Goldani L Z, Schlamm H T, Goodrich J M, Espinel-Ingroff A, Shikanai-Yasuda M A.
An open-label comparative pilot study of oral voriconazole and itraconazole for long-term
treatment of paracoccidioidomycosis.
Clin Infect Dis.
2007;
45
(11)
1462-1469
- 71
Lutsar I, Roffey S, Troke P.
Voriconazole concentrations in the cerebrospinal fluid and brain tissue of guinea
pigs and immunocompromised patients.
Clin Infect Dis.
2003;
37
(5)
728-732
- 72
Tobon A, Agudelo C A, Restrepo A.
Posaconazole for the treatment of paracoccidioidomycosis: first clinical results.
Biomedica.
2008;
28
(Suppl 1)
205
- 73
Moraes C S, Queiroz-Telles F, Marchiori E, Escuissato D L.
Review of lung radiographic findings during treatment of patients with chronic paracoccidioidomycosis.
Radiol Bras.
2006;
39
175-179
- 74
Naranjo T W, Lopera D E, Diaz-Granados L R, Duque J J, Restrepo A M, Cano L E.
Combined itraconazole-pentoxifylline treatment promptly reduces lung fibrosis induced
by chronic pulmonary paracoccidioidomycosis in mice.
Pulm Pharmacol Ther.
2011;
24
(1)
81-91
- 75
Marques A F, da Silva M B, Juliano M A, Travassos L R, Taborda C P.
Peptide immunization as an adjuvant to chemotherapy in mice challenged intratracheally
with virulent yeast cells of Paracoccidioides brasiliensis.
Antimicrob Agents Chemother.
2006;
50
(8)
2814-2819
Flavio Queiroz-TellesM.D. Ph.D.
Department of Public Health, Hospital de Clinicas, Federal University of Parana, Rua
General Carneiro
181, Curitiba–PR–Brazil 80060-900
eMail: queiroz.telles@uol.com.br
