Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 36-10: Paracoccidioidomycosis (South American Blastomycosis) + Key Features Download Section PDF Listen +++ ++ Paracoccidioides brasiliensis and Paracoccidioides lutzii infections have only been found in patients who have resided in Mexico, Central and South America Long asymptomatic periods enable persons to travel far from endemic area before symptoms occur Primary infection is probably acquired through inhalation An acute form of the disease affects predominately younger patients and involves the mononuclear phagocytic system resulting in progressive lymphadenopathy A more chronic form affects mostly adult men and involves the lung, skin, mucous membranes, and lymph nodes + Clinical Findings Download Section PDF Listen +++ ++ Weight loss, pulmonary complaints, or mucosal ulcerations are most common symptoms Extensive coalescent ulcerations may eventually result in destruction of the epiglottis, vocal cords, and uvula Extension to the lips and face may occur Lymph node enlargement May follow mucocutaneous lesions, eventually ulcerating and forming draining sinuses It is the presenting symptom in some patients Hepatosplenomegaly may be present HIV-infected patients are more likely to have extra-pulmonary dissemination and a more rapid clinical disease course + Diagnosis Download Section PDF Listen +++ ++ Routine laboratory tests are nonspecific Immunodiffusion serologic tests positive in > 80% of cases Complement fixation titers correlate with progressive disease and fall with effective therapy Diagnosis is confirmed by finding P brasiliensis as spherical cells with many buds arising from it If direct examination of secretions does not reveal the organism, biopsy with Gomori silver staining may be helpful + Treatment Download Section PDF Listen +++ ++ Oral itraconazole, 100 mg twice daily Treatment of choice Response is usually seen within the first month, with effective control within 2–6 months Trimethoprim-sulfamethoxazole (480 mg + 1200 mg) twice daily orally is as effective as itraconazole and less costly, but associated with more adverse effects and longer time to clinical cure Oral voriconazole, 200 mg twice daily, appears to be as effective as itraconazole Amphotericin B, 0.7–1.0 mg/kg/day intravenously, is the drug of choice for severe and life-threatening infection Amphotericin B lipid complex, 3–5 mg/kg/day, has been shown to be effective and safe for severe disease