Shikanai-Yasuda Maria Aparecida
Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Rev Inst Med Trop Sao Paulo. 2015 Sep;57 Suppl 19(Suppl 19):31-7. doi: 10.1590/S0036-46652015000700007.
Considered to be an emerging endemic mycosis in Latin America, paracoccidioidomycosis is characterized by a chronic course and involvement of multiple organs in immunocompromised hosts. Infection sequelae are mainly related to pulmonary and adrenal insufficiency. The host-parasite interaction results in different expressions of the immune response depending on parasite pathogenicity, fungal load and genetic characteristics of the host. A few controlled and case series reports have shown that azoles and fast-acting sulfa derivatives are useful treatment alternatives in milder forms of the disease. For moderate/severe cases, more prolonged treatments or even parenteral routes are required especially when there is involvement of the digestive tract mucosa, resulting in poor drug absorption. Although comparative studies have reported that shorter treatment regimens with itraconazole are able to induce cure in chronically-infected patients, there are still treatment challenges such as the need for more controlled studies involving acute cases, the search for new drugs and combinations, and the search for compounds capable of modulating the immune response in severe cases as well as the paradoxical reactions.
副球孢子菌病被认为是拉丁美洲一种新出现的地方性真菌病，其特征为病程慢性且在免疫功能低下宿主中累及多个器官。感染后遗症主要与肺和肾上腺功能不全有关。宿主与寄生虫的相互作用根据寄生虫致病性、真菌负荷和宿主的遗传特征导致免疫反应的不同表现。一些对照研究和病例系列报告表明，唑类药物和速效磺胺衍生物是该病较轻形式的有用治疗选择。对于中度/重度病例，尤其是当消化道黏膜受累导致药物吸收不良时，需要更长时间的治疗甚至胃肠外给药途径。尽管比较研究报告称，伊曲康唑较短疗程能够治愈慢性感染患者，但仍存在治疗挑战，例如需要更多涉及急性病例的对照研究、寻找新药物及其组合，以及寻找能够调节重症病例免疫反应的化合物以及反常反应。
