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Paracoccidioides

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Summary

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Key Points

  • Paracoccidioides spp.
    • Includes P. brasiliensis, P. lutzii
    • Characteristics
      • Dimorphic yeasts
        • Mold in soil
        • Yeast in body
    • Transmission
      • Endemic to Latin America
      • Males affected > females
        • 13:1 ratio of men to women affected
        • Estradiol thought to be protective
      • Transmitted by inhalation of spores (MB)
      • Cannot be transmitted from person to person (unlike TB)
    • Presentation
      • Causes Paracoccidioidomycosis
        • Pneumonia
          • Acutely presents with fever, cough
          • May develop into chronic inflammatory lung disease
            • Pulmonary infiltrates and upper respiratory mucosal lesions
        • Anemia
          • Seen in nearly 90% of acute infections
        • Mucosal ulcers
          • More common in chronic infections
          • Mouth is affected, with painful hemorrhagic ulcers
        • Skin lesions
          • More common in chronic infections
          • Verrucous (vegetative) lesions are seen
        • CNS, liver, lymph node, and GI involvement are also seen
    • Diagnosis
      • Histopathology
        • Large round yeast surrounded with budding daughter cells, in a “captain’s wheel” formation
          • Much larger than RBC
        • Forms granulomas around yeast
      • Serological testing for antifungal antibodies is used for diagnosis
    • Treatment
      • Itraconazole for mild or moderate infection
        • Other azoles or TMP-SMX are second-line
      • Amphotericin B for severe infection or CNS involvement