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Paracoccidioides brasiliensis and Paracoccidioides lutzii infections have only been found in patients who have resided in South or Central America or Mexico
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
Respiratory sequelae following pulmonary infection is common and correlates with the degree of lung involvement at diagnosis
Relapses following therapy can occur in up to 5% of patients
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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
Patients with HIV are more likely to have extrapulmonary dissemination and a more rapid clinical disease course
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Routine laboratory tests are nonspecific
Immunodiffusion serologic tests
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
Biopsy with Gomori staining may be helpful if direct examination of secretions does not reveal the organism
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Oral itraconazole, 100 mg twice daily
Trimethoprim-sulfamethoxazole, 480/1200 mg twice daily orally
Oral voriconazole, 200 mg twice daily, appears to be as effective as itraconazole
Amphotericin B, 0.7–1.0 mg/kg/d intravenously, is the drug of choice for severe and life-threatening infection
Amphotericin B lipid complex or liposomal amphotericin B, 3–5 mg/kg/d, are effective and safe for severe disease
Therapy with itraconazole should be used following initial control of severe infection with amphotericin B