What are the symptoms of Paracoccidioidomycosis (South American blastomycosis)?

From the Guidelines

Paracoccidioidomycosis typically presents with symptoms such as fever, weight loss, fatigue, and cough, which can progress to painful mouth ulcers, enlarged lymph nodes, and skin lesions. The disease can manifest in different forms, including acute/subacute forms, which are more common in children and immunocompromised individuals, and chronic forms, typically seen in adult males 1. The symptoms of paracoccidioidomycosis result from the body's inflammatory response to the Paracoccidioides brasiliensis fungus, which is usually acquired through inhalation of fungal spores from soil in endemic regions of Latin America, particularly Brazil, Colombia, and Venezuela. Some key symptoms include:

• Respiratory symptoms, such as chronic cough, chest pain, and difficulty breathing, which may mimic tuberculosis
• Mucosal involvement, leading to painful lesions in the mouth, nose, and gastrointestinal tract
• Skin lesions, which can appear as warty growths or ulcers
• Enlarged lymph nodes and hepatosplenomegaly (enlarged liver and spleen) in severe cases
• Neurological symptoms, if the central nervous system becomes involved 1. It is essential to note that the diagnosis of paracoccidioidomycosis should be based on microscopy, preferably using optical brighteners, and serological testing should only be done by reference laboratories, using reagents with known and published performance characteristics 1.

From the Research

Paracoccidiomycosis Symptoms

The symptoms of paracoccidioidomycosis are not explicitly listed in the provided studies. However, the following information can be gathered:

• Paracoccidioidomycosis is a systemic mycosis that can disseminate from the lungs to other parts of the body 2.
• It has different clinical manifestations that require differentiation with other diseases such as tuberculosis, Hodgkin disease, and squamous cell carcinoma 2.
• The disease can cause significant disability and death, especially among young adult rural workers in South America 3.

Treatment and Diagnosis

The diagnosis of paracoccidioidomycosis is made by finding the organism in a biopsy specimen and isolating it in fungal culture 2.

• Treatment options include:
  • Sulfamethoxazole-trimethoprim for mild forms 2, 4
  • Itraconazole for moderate cases 2, 4
  • Fluconazole and voriconazole for meningeal involvement 2
  • Amphotericin B for severe disease 2
• The therapeutic response to treatment can be affected by factors such as treatment adherence and coinfection with HIV 4.

Research and Development

Researchers are working to develop new antifungal agents against paracoccidioidomycosis, targeting enzymatic pathways absent in humans 5, 6.

• New compounds such as ajoene, azasterols, and derivatives are being studied for their antifungal properties 5.
• The development of new antifungal agents is necessary due to the limitations of current treatments, including toxicity, drug interactions, and reduced bioavailability 6.