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Paracoccidioidomycosis -(ˌ)käk-ˌsid-ē-ˌȯid-ō-(ˌ)mī-ˈkō-sis

(South American Blastomycosis)

By Sanjay G. Revankar, MD, Professor of Medicine and Director, Infectious Disease Fellowship Program, Division of Infectious Diseases, Wayne State University School of Medicine ; Jack D. Sobel, MD, Dean and Distinguished Professor of Medicine, Wayne State University School of Medicine

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Paracoccidioidomycosis is infection caused by the fungus Paracoccidioides brasiliensis.

Paracoccidioidomycosis is caused by inhaling spores of the fungus, which grow in soil.

Paracoccidioidomycosis usually involves the lungs, skin, mouth, throat, and lymph nodes, although it sometimes appears in the liver or spleen. It occurs more often in agricultural workers. It is very common in South and Central America (particularly Brazil), where an estimated 10 million people are infected. It is rare in the United States.

Men aged 20 to 50 are typically affected. About 5 to 10% of cases occur in younger people (both sexes). About 5% of people with paracoccidioidomycosis also have HIV infection or AIDS.

Symptoms of Paracoccidioidomycosis

Most people who inhale the spores do not become ill. Symptoms, if they occur, usually occur years after the initial exposure.

Paracoccidioidomycosis usually resembles pneumonia, causing a cough, fever, shortness of breath, and difficulty breathing, and may resolve on its own.

The infection may spread from the lungs to other parts of the body. Painful sores may develop in the mouth and on the skin. Infected lymph nodes become swollen, and pus may drain from them, breaking through the skin but causing little pain. The lymph nodes most commonly infected are those in the neck and under the arms. The liver and spleen may enlarge. Sometimes symptoms last a long time, but the infection is rarely fatal.

When paracoccidioidomycosis occurs in younger people or in people with HIV infection or AIDS, the infection is more aggressive. It spreads widely, including to the bone marrow and other organs. People have a fever and lose weight. The lymph nodes, liver, and spleen enlarge, and anemia develops.

Diagnosis of Paracoccidioidomycosis

  • Examination and culture of samples of infected tissue

To diagnose paracoccidioidomycosis, a doctor takes tissue samples for examination under a microscope and for culture.

Treatment of Paracoccidioidomycosis

  • Itraconazole (an antifungal drug)

The antifungal drug itraconazole, given by mouth, is the treatment of choice for paracoccidioidomycosis.

Amphotericin B is also effective, but because of its side effects, it is reserved for very severe cases.