Shikanai-Yasuda M A, Segurado A A, Pinto W P, Nicodemo A C, Sato M, Duarte A J, Del Negro G B, Hutzler R U, Shiroma M, Neto V A
Department of Infectious and Parasitic Diseases, Faculty of Medicine, University of Sao Paulo.
Mycopathologia. 1992 Oct;120(1):23-8. doi: 10.1007/BF00578498.
Four patients with acute paracoccidioidomycosis, hypoalbuminemia, ascites and associated infections are reported. They have been admitted to hospital 35 times, 4 of them due to active paracoccidioidomycosis, 14 to associated infections, 14 to ascites, edema and diarrhoea and 3 to herniorrhaphy. Two of them recovered after sepsis and central nervous system, muscular and subcutaneous cryptococcosis. The remaining two died. One had infectious diarrhoea (S. flexneri), peritoneal tuberculosis and sepsis (S. epidermidis); the other had bacterial meningitis, erysipelas, beta-hemolytic Streptococcus sepsis and miliary tuberculosis. Their immunodeficiency was attributed to enteric protein loss and/or malabsorption and malnutrition and was recognized by reduced response to delayed hypersensitivity skin tests in four patients and hypogammaglobulinemia in three of them. The authors discuss the need for prospective studies to be carried out, aiming at the mechanisms involved in secondary infections. Alternatives for maintaining the patients' adequate nutritional state should be investigated, to guarantee proper immune response and thus the ability to control intervening infections in patients with juvenile paracoccidioidomycosis.
报告了4例急性副球孢子菌病、低蛋白血症、腹水及合并感染的患者。他们共住院35次，其中4次因活动性副球孢子菌病，14次因合并感染，14次因腹水、水肿和腹泻，3次因疝修补术。其中2例在发生败血症以及中枢神经系统、肌肉和皮下隐球菌病后康复。其余2例死亡。1例患有感染性腹泻（福氏志贺菌）、结核性腹膜炎和败血症（表皮葡萄球菌）；另1例患有细菌性脑膜炎、丹毒、β溶血性链球菌败血症和粟粒性结核。他们的免疫缺陷归因于肠道蛋白丢失和/或吸收不良以及营养不良，4例患者对迟发型超敏皮肤试验反应降低以及3例患者低丙种球蛋白血症可证实这一点。作者讨论了开展前瞻性研究的必要性，旨在研究继发感染的相关机制。应研究维持患者适当营养状态的替代方法，以保证适当的免疫反应，从而确保控制青少年副球孢子菌病患者并发感染的能力。
