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Endemic oral paracoccidioidomycosis: clinical presentation, management, and outcomes

2013; Elsevier BV; Volume: 19; Linguagem: Inglês

10.1016/j.ijid.2013.09.018

1878-3511

Luiz Fernando Barbosa de Paulo, Lucas Silva de Faria, Antônio Francisco Durighetto,

HIV/AIDS oral health manifestations

The general characteristics of nine patients with oral paracoccidioidomycosis (PCM) are discussed. All PCM patients were men, ranging in age from 25 to 75 years (mean 50 years). At the time of diagnosis, three patients reported urban activities and six were agricultural workers. None of the patients were HIV-positive. All nine patients had multiple oral lesions of some kind – so-called mulberry-like (Figure 1). Gingival lesions were the most common manifestation and were present in seven cases. The tongue and palate was affected in one patient, the lips and lymph nodes in three, the buccal mucosa in five, and the nose in four patients. Investigation of the lungs by conventional chest radiography was performed for all patients, with six of these showing positive findings. Biopsy specimens showed granuloma formation with multinucleated giant cells and a polymorphonuclear with vacuoles suggestive of infection. The presence of characteristic fungi was demonstrated with Gomori's methenamine silver stain. Medical therapy was adequately registered for eight cases. Itraconazole was prescribed at a daily dose of 100 mg for six of these patients and ketoconazole at a daily dose of 400 mg for the other two. Two patients developed recurrences, but there was no death attributable to PCM in the present cases. Paracoccidioidomycosis is a deep mycosis caused by Paracoccidioides brasiliensis, a dimorphic fungus infecting humans via inhalation.1Torres-Pereira C. Giovanini A.F. Stramandinoli R.T. Amenabar J.M. Piazzetta C.M. Oral paracoccidioidomycosis and pulmonary tuberculosis co-infection: relevance of oral biopsy in establishing the diagnosis and therapeutic approach.Int J Infect Dis. 2009; 13: 114-116Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 2Sargenti Neto S. Paulo L.F. Rosa R.R. Oral paracoccidioidomycosis as a differential diagnosis of oral cancer.Rev Soc Bras Med Trop. 2012; 45: 777Crossref PubMed Scopus (2) Google Scholar, 3Nogueira S.A. Caiuby M.J. Vasconcelos V. Halpern M. Gouveia C. Thorpe B. et al.Paracoccidioidomycosis and tuberculosis in AIDS patients: report of two cases in Brazil.Int J Infect Dis. 1998; 2: 168-172Abstract Full Text PDF PubMed Scopus (18) Google Scholar Oral granulomatous lesions are very common in PCM active infected patients and long-term follow-up is essential. A history of travel to South or Central America may be of help in the diagnosis of such lesions outside the endemic regions.1Torres-Pereira C. Giovanini A.F. Stramandinoli R.T. Amenabar J.M. Piazzetta C.M. Oral paracoccidioidomycosis and pulmonary tuberculosis co-infection: relevance of oral biopsy in establishing the diagnosis and therapeutic approach.Int J Infect Dis. 2009; 13: 114-116Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 2Sargenti Neto S. Paulo L.F. Rosa R.R. Oral paracoccidioidomycosis as a differential diagnosis of oral cancer.Rev Soc Bras Med Trop. 2012; 45: 777Crossref PubMed Scopus (2) Google Scholar, 3Nogueira S.A. Caiuby M.J. Vasconcelos V. Halpern M. Gouveia C. Thorpe B. et al.Paracoccidioidomycosis and tuberculosis in AIDS patients: report of two cases in Brazil.Int J Infect Dis. 1998; 2: 168-172Abstract Full Text PDF PubMed Scopus (18) Google Scholar Conflict of interest: No conflict of interest to declare.