Infectious diseases department, Uberlândia Medical School, Minas Gerais State, Brazil.
Paediatr Respir Rev. 2009 Dec;10(4):161-5. doi: 10.1016/j.prrv.2009.08.001. Epub 2009 Sep 25.
Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidoides brasiliensis. The infection is endemic in subtropical areas of Latin America and has a high prevalence in Brazil. The disease is acquired by airborne inhalation of conidia and is frequently observed in adult male rural workers. The juvenile type of this mycosis is less prevalent (5-10% of clinical cases) and attacks both sexes. This clinical form occurs in children and adolescents and has a subacute course with fever, toxemia, loss of weight, adenopathy, hepatoesplenomegaly, anaemia and eosinophilia. Radiologic abnormalities in the lung fields may be seen. Mucous membrane lesions occasionally occur. The clinical presentation resembles severe tuberculosis, leukaemia or lymphoma. The diagnosis is confirmed by finding yeast-like elements of P. brasiliensis in microscopic examinations of wet preparations of specimens submitted for mycologic studies. The fungus grows slowly (20-30 days) and its isolation is difficult. Histologic and serologic studies may also assist in the diagnosis of this mycosis. Sulfonamides, ketoconazole, itraconazole, fluconazole and amphotericin B have been successfully used in the treatment of paracoccidioidomycosis. Itraconazole is the treatment of choice, being effective in more than 95% of cases. Co-trimoxazole is still frequently used especially in chronic progressive disease and as maintenance after a course of amphotericin B in severe cases of this mycosis.
球孢子菌病是一种由巴西副球孢子菌引起的系统性真菌感染。该感染在拉丁美洲亚热带地区流行,在巴西的发病率很高。疾病通过空气传播吸入的分生孢子获得,常见于成年男性农村劳动者。该真菌病的少年型(占临床病例的 5-10%)更不常见,影响两性。该临床类型发生于儿童和青少年,呈亚急性病程,伴有发热、毒血症、体重减轻、淋巴结病、肝脾肿大、贫血和嗜酸性粒细胞增多。肺部可能出现放射学异常。黏膜病变偶尔发生。临床表现类似于严重的肺结核、白血病或淋巴瘤。通过对送检进行真菌学研究的湿标本的显微镜检查,发现巴西副球孢子菌的酵母样元素即可确诊。真菌生长缓慢(20-30 天),且其分离困难。组织学和血清学研究也有助于该真菌病的诊断。磺胺类药物、酮康唑、伊曲康唑、氟康唑和两性霉素 B 已成功用于治疗球孢子菌病。伊曲康唑是首选治疗药物,对超过 95%的病例有效。复方磺胺甲噁唑仍经常使用,尤其是在慢性进行性疾病和严重病例中,在使用两性霉素 B 疗程后作为维持治疗。