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DOI: 10.1055/s-0031-1295724
Pulmonary Paracoccidioidomycosis
Publication History
Publication Date:
13 December 2011 (online)

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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 4
Brummer E, Castaneda E, Restrepo A.
Paracoccidioidomycosis: an update.
Clin Microbiol Rev.
1993;
6
(2)
89-117
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 9
Nucci M, Colombo A L, Queiroz-Telles F.
Paracoccidioidomycosis.
Curr Fungal Infect Rep.
2009;
3
15-20
Reference Ris Wihthout Link
- 10
Negroni R.
Paracoccidioidomycosis (South American blastomycosis, Lutz’s mycosis).
Int J Dermatol.
1993;
32
(12)
847-859
Reference Ris Wihthout Link
- 11
Restrepo A, Robledo M, Giraldo R et al..
The gamut of paracoccidioidomycosis.
Am J Med.
1976;
61
(1)
33-42
Reference Ris Wihthout Link
- 12
Londero A T, Severo L C.
The gamut of progressive pulmonary paracoccidioidomycosis.
Mycopathologia.
1981;
75
(2)
65-74
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 17
Kasuga T, White T J, Koenig G et al..
Phylogeography of the fungal pathogen Histoplasma capsulatum.
Mol Ecol.
2003;
12
(12)
3383-3401
Reference Ris Wihthout Link
- 18
Bagagli E, Theodoro R C, Bosco SMG, McEwen J G.
Paracoccidioides brasiliensis: phylogenetic and ecological aspects.
Mycopathologia.
2008;
165
(4-5)
197-207
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 22 Queiroz-Telles F. Paracoccidioides brasiliensis: ultrastructural findings. In: Franco M, ed. Paracoccidioidomycosis. Boca Raton, FL: CRC Press; 1994: 27-47
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 24
Negroni P.
The Paracoccidioides brasiliensis lives saprophytically in the soil of Argentina [in
Spanish].
Prensa Med Argent.
1966;
53
(39)
2381-2382
Reference Ris Wihthout Link
- 25
Restrepo A.
The ecology of Paracoccidioides brasiliensis: a puzzle still unsolved.
Sabouraudia.
1985;
23
(5)
323-334
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 35
Coutinho Z F, Silva D, Lazera M et al..
Paracoccidioidomycosis mortality in Brazil (1980-1995).
Cad Saude Publica.
2002;
18
(5)
1441-1454
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 45
Benard G.
An overview of the immunopathology of human paracoccidioidomycosis.
Mycopathologia.
2008;
165
(4-5)
209-221
Reference Ris Wihthout Link
- 46
Goldani L Z, Sugar A M.
Paracoccidioidomycosis and AIDS: an overview.
Clin Infect Dis.
1995;
21
(5)
1275-1281
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 64
Stevens D A, Vo P T.
Synergistic interaction of trimethoprim and sulfamethoxazole on Paracoccidioides brasiliensis.
Antimicrob Agents Chemother.
1982;
21
(5)
852-854
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 72
Tobon A, Agudelo C A, Restrepo A.
Posaconazole for the treatment of paracoccidioidomycosis: first clinical results.
Biomedica.
2008;
28
(Suppl 1)
205
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
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