Paracoccidioidomycosis: clinical and epidemiologic studies of cases observed in the course of 25 years, in Mato Grosso do Sul, Brazil.
The clinical and epidemiological characteristics of paracoccidioidomycosis (PCM) as well as uncommon clinical manifestations and PCM associated with aids in the state of Mato Grosso do Sul were studied, resulting in five reports of cases observed during 25 years (1980-2004) at University Hospital of the Universidade Federal de Mato Grosso do Sul.The clinical and epidemiological features of 422 PCM cases attended at the University Hospital of the UFMS were studied. The mean age was 43.4 years old and the man:woman proportion was 10:1. The acute/subacute form (15.6% presented mainly with lymphadenopathy (95.4%) and the chronic form (86.4%) presented mainly involvement of the lungs (87.3%) and oropharynx (66.4%). Sulfamethoxazole/trimethoprim association was used in 90.3% of the patients. Sequelae were observed in 30.3% and death occurred in 7.6% of the cases. Twelve cases of PCM associated with aids were analyzed. The mean age was36.1 years old and most of the patients had a diagnosis other than PCM as the aidsdefining illness. Seven patients (58.3%) showed involvement of more than one extrapulmonaryorgan. The most often involved organs were: lymph nodes (83.3%), lung (58.3%), skin (50%) and oral mucous membrane (41.6%). Eight patients died with progressive PCM manifestations. These data reinforce that PCM behaves as anopportunistic disease in aids. The study of 13 cases of neuroPCM demonstrates that paresis (8/13), headache (5/13), and dizziness (4/13) were the most frequent neurological manifestations. Two patients had exclusive lesions in the central nervous system.The neuroimaging diagnosis showed predominance of multiple and round lesionswith annular enhancing after contrast injection. Lesions were seen in brain hemispheres (9/13), thalamus (9/13), cerebellum (4/13), brainstem (4/13) and spinal cord (4/13). The majority of cases presented good therapeutic response with sulfamethoxazole/trimethoprim.The study of 10 patients with osteoarticular PCM showed that the most frequent clinical manifestations were: pain (10/10), tumour (7/10) and redness (6/10) of the compromised region. Radiographs revealed osteolytic lesions in all patients and the majority presented with multiple and bilateral lesions. A case of erythema nodosum associated to PCM was diagnosed for the firsttime.
Advisor:Márcio Neves Bóia; Bodo Wanke
School:Faculdades Oswaldo Cruz
Source Type:Master's Thesis
Keywords:Paracoccidiodomicose Neuroparacoccidioidomicose Aids HIV Paracoccidioidomycosis Neuroparacoccidioidomycosis Central Nervous System Osteoarticular Bone Acquired Immunodeficiency Syndrome
Date of Publication:11/11/2005