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Immunodeficiency secondary to juvenile paracoccidioidomycosis: associated infections
M A Shikanai-Yasuda1, A A Segurado, W P Pinto
1Department of Infectious and Parasitic Diseases, Faculty of Medicine, University of Sao Paulo.
Abstract:
Four patients with acute paracoccidioidomycosis, hypoalbuminemia, ascites and associated infections are reported. They have been admitted to hospital 35 times, 4 of them due to active paracoccidioidomycosis, 14 to associated infections, 14 to ascites, edema and diarrhoea and 3 to herniorrhaphy. Two of them recovered after sepsis and central nervous system, muscular and subcutaneous cryptococcosis. The remaining two died. One had infectious diarrhoea (S. flexneri), peritoneal tuberculosis and sepsis (S. epidermidis); the other had bacterial meningitis, erysipelas, beta-hemolytic Streptococcus sepsis and miliary tuberculosis. Their immunodeficiency was attributed to enteric protein loss and/or malabsorption and malnutrition and was recognized by reduced response to delayed hypersensitivity skin tests in four patients and hypogammaglobulinemia in three of them. The authors discuss the need for prospective studies to be carried out, aiming at the mechanisms involved in secondary infections. Alternatives for maintaining the patients' adequate nutritional state should be investigated, to guarantee proper immune response and thus the ability to control intervening infections in patients with juvenile paracoccidioidomycosis.
Insights
This study reports on four patients with paracoccidioidomycosis who experienced severe complications including infections and malnutrition. Managing these complex cases requires further research into nutritional support and infection control.
Area of Science:
- Infectious Diseases
- Immunology
- Gastroenterology
Background:
- Paracoccidioidomycosis is a serious fungal infection.
- Patients can develop complications like hypoalbuminemia, ascites, and infections.
- Juvenile cases may present unique challenges.
Observation:
- Four patients with acute paracoccidioidomycosis, hypoalbuminemia, and ascites were admitted multiple times.
- Complications included sepsis, cryptococcosis, tuberculosis, and bacterial meningitis.
- Immunodeficiency was linked to protein loss, malabsorption, and malnutrition.
Findings:
- Two patients recovered after treatment for sepsis and fungal infections.
- Two patients died from severe, multiple infections including tuberculosis and bacterial sepsis.
- Reduced skin test responses and hypogammaglobulinemia indicated immunodeficiency.
Implications:
- Further prospective studies are needed to understand secondary infection mechanisms.
- Investigating nutritional support is crucial for immune response in paracoccidioidomycosis.
- Effective management strategies are vital for controlling infections in affected patients.