Treatment of paracoccidioidomycosis with itraconazole.

Forty-seven patients with active paracoccidioidomycosis were treated with itraconazole. The majority of the patients (45) had the chronic adult form of the disease while the remaining exhibited the juvenile form. All of the patients received itraconazole, 100 mg day-1, with the exception of two for whom the clinical condition necessitated a larger dose. The mean duration of therapy was 6 months, with a range of 3-24 months. Clinically, the skin and mucous membrane lesions as well as abdominal pain, auscultatory alterations and dysphonia improved markedly during treatment with a concomitant increase in weight. However, other symptoms (cough, expectoration and dyspnoea) persisted as sequelae in some cases. As expected adrenal insufficiency also persisted. The radiological lesions showed a gradual decrease of both scattered and confluent infiltrates, present in 67% of patients before, and in 13% at the end of treatment. On the other hand, fibrosis became more evident at the termination of therapy, increasing from 62% of patients at the beginning of therapy to 81% at the end. The mycological tests (direct examination and cultures) became negative during the first month of treatment in 42 patients (87%). A decline in specific antibody titres was observed in 72% of patients by the end of treatment. Evaluation of therapy by means of a scoring system indicated complete resolution of the disease in one patient (2%), marked improvement in 42 (89%) and minor improvement in four (8.5%); none of the patients showed a deterioration of their disease during therapy. Of fifteen patients who were followed up for 12 months post-therapy none showed clinical relapse during this period. The results of this study confirm the efficacy of itraconazole in the treatment of paracoccidioidomycosis.