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Paracoccidioidomycosis
From WikEM
Contents
Background
- Fungal infection caused by Paracoccidioides brasiliensis
- Found in patients who have resided in Mexico, Central America, or South America
- Primary infection likely occurs via inhalation
Clinical Features
- Long asymptomatic period after initial infection common
- HIV+ patients more likley to have extra-pulmonary dissemination and/or rapid progression of disease
- SOB, cough
- Weight loss, malaise, fever
- Lymphadenopathy
- May ulcerate and form draining sinuses
- Mucosal ulcerations
- Cutaneous papules, which may ulcerate and enlarge
- +/- destructive ulceration of uvula, epiglottis, and/or vocal cords
- +/- hepatosplenomegaly
Differential Diagnosis
Evaluation
- Routine labs usually nonspecific
- CXR- may show interstitial infiltrates
- Definitive diagnosis made by visualizing yeast cells in tissue sample, sputum sample, or skin scrapings
- Serologic tests available in some areas of high endemicity
Management
- Itraconazole 100 mg PO BID- first line
- Second line/alternatives
- TMP-SMX (480/1200 mg) PO BID
- Voriconazole200 mg PO BID
- Amphotericin B IV for severe/life-threatening infection
