Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Paracoccidioidomycosis 1133

■Other studies: serology can be helpful

➣agar gel immunodiffusion (ID) test can be 98% sensitive

➣does not give an indication about burden of disease

➣the complement fixation test can be followed for response to

therapy

➣can cross-react with Histoplasma antigens

■Other studies: skin testing is not useful

Imaging

■Chest X-ray: patchy and bilateral nodular infiltrates, usually sym-

metrical, spares the apices

Pathology

■If direct examination does not provide a diagnosis, may get biopsy

with Gomori staining

differential diagnosis

■Tuberculosis, histoplasmosis, leprosy, syphilis, mucocutaneous lei-

shmaniasis

management

General Measures

■General supportive care

specific therapy

Treatment Options

■Itraconazole for 6 months

➣Itraconazole cyclodextrin solution has increased bioavailabi-

lity

■Alternatives:

■For severe disease: Amphotericin B IV

■Others: sulfonamides (e.g., sulfadiazine)

■Others: ketoconazole for 6–12 months

Side Effects & Contraindications

■Itraconazole

➣Side effects: nausea, vomiting, anorexia, abdominal pain, rash;

rarely hypokalemia and hepatitis

➣Contraindications: end stage renal disease for cyclodextran

solution; lower cyclosporin dose when concomitantly given; may

dangerously increase serum levels of digoxin, astemizole and

loratidine, causing fatal arrhythmias