Shikanai-Yasuda Maria Aparecida, Mendes Rinaldo Pôncio, Colombo Arnaldo Lopes, Queiroz-Telles Flávio de, Kono Adriana Satie Gonçalves, Paniago Anamaria M M, Nathan André, Valle Antonio Carlos Francisconi do, Bagagli Eduardo, Benard Gil, Ferreira Marcelo Simão, Teixeira Marcus de Melo, Silva-Vergara Mario León, Pereira Ricardo Mendes, Cavalcante Ricardo de Souza, Hahn Rosane, Durlacher Rui Rafael, Khoury Zarifa, Camargo Zoilo Pires de, Moretti Maria Luiza, Martinez Roberto
Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.
Rev Soc Bras Med Trop. 2017 Sep-Oct;50(5):715-740. doi: 10.1590/0037-8682-0230-2017. Epub 2017 Jul 12.
Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis ( P. brasiliensis ) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii ( P. lutzii ), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients' sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.
副球孢子菌病是一种发生在拉丁美洲的系统性真菌疾病，与农村环境和农业活动有关。然而，由于缺乏强制报告制度，副球孢子菌病的发病率和患病率被低估了。如果副球孢子菌病没有得到早期和充分的诊断与治疗，这种地方性真菌感染可能会导致严重的后遗症。虽然已知巴西副球孢子菌（P. brasiliensis）复合体是副球孢子菌病的病原体，但在朗多尼亚州（该病已达到流行程度）以及中西部和帕拉州，已报告了一种新的物种——卢氏副球孢子菌（P. lutzii）。准确诊断以及获得与患者血清反应的抗原仍然是重大挑战。因此，本指南旨在通过提供基于证据的床边患者管理建议，更新巴西关于副球孢子菌病的首个共识。该共识总结了病因学、生态流行病学、分子流行病学和免疫病理学数据，重点关注临床、微生物学和血清学诊断以及临床类型和后遗症的管理，以及合并症和免疫抑制患者的情况。该共识还包括对门诊治疗、严重疾病形式、特殊人群和资源匮乏地区疾病患病率的讨论，对预防和控制措施的简要回顾，当前的挑战及建议。
