Paracoccidioidomycosis

Definition

Paracoccidioidomycosis is an infection caused by the fungus Paracoccidioides. This fungus lives in parts of Central and South America. Anyone who lives in or visits areas where Paracoccidioides lives can get paracoccidioidomycosis, but it most often affects men who work outdoors in rural areas.1

Symptoms

Many people who are infected with Paracoccidioides never develop symptoms.1,2 For people who develop symptoms, paracoccidioidomycosis usually affects the lungs and skin. Other symptoms include:3,4

  • Lesions in the mouth and throat
  • Weight loss
  • Swollen lymph nodes
  • Cough
  • Fever
  • Shortness of breath
  • Fatigue
  • Enlarged liver and spleen

The symptoms of paracoccidioidomycosis can be different for different groups of people.3,4 In adults, paracoccidioidomycosis usually affects the lungs and causes lesions in the mouth and throat. Children are more likely to have swollen lymph nodes and skin lesions.

Paracoccidioidomycosis can occur in healthy people and people with weakened immune systems. In people with weakened immune systems (for example, due to HIV/AIDS), the symptoms usually get worse more quickly.5

Risk and Prevention

Who gets paracoccidioidomycosis?

Anyone who lives in or visits areas where Paracoccidioides lives can get paracoccidioidomycosis, but it most often affects men who work outdoors in rural areas of Central and South America.1 In children, boys and girls are equally likely to get paracoccidioidomycosis. Most cases of paracoccidioidomycosis occur in Brazil, Venezuela, Colombia, and Argentina.1,2

How can I prevent paracoccidioidomycosis?

It’s difficult to avoid breathing in the fungus that causes paracoccidioidomycosis in areas where it’s common in the environment. Many people who breathe in this fungus never get sick from it.

Sources

People get paracoccidioidomycosis after breathing in the fungus Paracoccidioides from the environment in certain parts of Central and South America. Paracoccidioidomycosis does not spread from person to person. The exact time between inhaling the fungus and getting paracoccidioidomycosis is not known, but scientists believe that many people are exposed to the fungus as children in areas where it’s common in the environment.

The specific habitat of the fungus Paracoccidioides is also not exactly known, but it has been found in soil near armadillo burrows.1,6

Diagnosis and Testing

Healthcare providers use a patient’s symptoms as well as laboratory tests and imaging tests, such as a chest X-ray, to diagnose paracoccidioidomycosis.7 Often, a healthcare provider will perform a biopsy, which is a small sample from the body part that is affected. The sample is sent to a laboratory for a fungal culture or to be examined under the microscope. A blood test can also help diagnose paracoccidioidomycosis.

Treatment

Paracoccidioidomycosis can be treated with antifungal medicines such as itraconazole and amphotericin B.7 Another medicine often used to treat paracoccidioidomycosis is trimethoprim/sulfamethoxazole (TMP/SMX), which is also known as co-trimoxazole and by several different brand names, including Bactrim, Septra, and Cotrim. Patients usually need treatment for about one year.

Statistics

More than 15,000 cases of paracoccidioidomycosis have been recorded since 1930. Many more cases likely occur, however, because the disease is underrecognized.1 About 80% of recorded cases have occurred in Brazil.1,2 Paracoccidioidomycosis is probably rare in the United States, where it is not a reportable disease. Scientists estimate that less than 5% of patients with paracoccidioidomycosis die from the disease.2

References
  1. Martinez R. Epidemiology of Paracoccidioidomycosis. Rev Inst Med Trop Sao Paulo 2015;57 Suppl 19:11-20.
  2. Martinez R. New Trends in Paracoccidioidomycosis Epidemiology. J Fungi (Basel) 2017;3.
  3. Bellissimo-Rodrigues F, Bollela VR, Da Fonseca BA, Martinez R. Endemic paracoccidioidomycosis: relationship between clinical presentation and patients’ demographic features. Medical mycology : official publication of the International Society for Human and Animal Mycology 2013;51:313-8.
  4. Paniago AM, Aguiar JI, Aguiar ES, et al. [Paracoccidioidomycosis: a clinical and epidemiological study of 422 cases observed in Mato Grosso do Sul]. Rev Soc Bras Med Trop 2003;36:455-9.
  5. Morejon KM, Machado AA, Martinez R. Paracoccidioidomycosis in patients infected with and not infected with human immunodeficiency virus: a case-control study. Am J Trop Med Hyg 2009;80:359-66.
  6. Arantes TD, Theodoro RC, Teixeira Mde M, Bosco Sde M, Bagagli E. Environmental Mapping of Paracoccidioides spp. in Brazil Reveals New Clues into Genetic Diversity, Biogeography and Wild Host Association. PLoS neglected tropical diseases 2016;10:e0004606.
  7. Shikanai-Yasuda MA, Mendes RP, Colombo AL, et al. Brazilian guidelines for the clinical management of paracoccidioidomycosis. Rev Soc Bras Med Trop 2017;50:715-40.