0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
1132 ParacoccidioidomycosisPARACOCCIDIOIDOMYCOSIS
RICHARD A. JACOBS, MD, PhDhistory & physical
History
■Caused byParacoccidioides brasiliensis, a dimorphic fungus
➣Very narrow geographic zone of infection; from Mexico to
Argentina with Brazil at the center of the endemic area
➣Cases reported in the US, Canada, Asia and Europe, but patients
were previous residents of endemic country
➣The route of transmission is still debated; generally most agree
that the respiratory route is most likely
■No person-to-person transmission has been established
■Significant for long periods of latency (as long as 30 years)
Signs & Symptoms
■Primary infection is usually asymptomatic
■Two main forms: pulmonary and mucocutaneous
➣Pulmonary disease:
➣Dyspnea is common, cough may not be productive of sputum
➣Patients may also present with weight loss, fever and malaise
mimicking tuberculosis
➣Mucocutaneous disease:
➣Ulceration in the nasopharynx or oropharynx may be the first
symptom
➣Facial or nasal mucosal ulcers may coalesce with destruction of
uvula and vocal cords
➣May present with odynophagia or dysphonia, lymphadenopathy
(especially cervical) may ulcerate and form draining sinuses
➣Pediatric disease:
➣more subacute symptoms; fewer respiratory complaints, can be
more severe
■HIV patients:
➣presentation similar to pediatric disease
tests
Laboratory
■Other studies: sputum or exudates may by diagnostic in over 90%
patients
➣At 37 degrees, seen as ovoid yeast cell with numerous cells around
the mother cell in a “pilot wheel” or “ship wheel” formation