Introduction
-Paracoccidioidomycosis is a subacute or chronic systemic mycosis caused by Paracoccidioides brasiliensis
-It occurs in rural areas of South and Central America, thus known as South American blastomycosis
-It is a dimorphic fungus that exists as a mold in soil and as a yeast in tissue
-The mold produces chlamydospores and conidia which enter human body mainly by inhalation
Symptoms & Signs
Asymptomatic form: marked by long asymptomatic periods
Pulmonary form: Cough, weight loss, pulmonary granulomas
Mucocutaneous form: Oropharyngeal lesions are the most common sign on physical examination; they present as small granulomas or painful ulcers over the nose, conjunctivae, mouth, gingiva, lips, pharynx, larynx (dysphonia) or anus
Lymphatic form: Lymphadenopathy, ulceration, draining sinuses
Diagnosis
Histology: Granulomas with central caseation with fibrosis
Culture: A parent round yeast cell surrounded by large numbers of small buds described as ‘Ship captain’s wheel’
Serology: antigen detection, antibodies to paracoccidioidin
Treatment
Effective agents: Itraconazole (the drug of choice), Voriconazole, ketoconazole, trimethoprim-sulfamethoxazole and Amphotericin B