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Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome

Ricardo Mendes Pereira1, Fábio Bucaretchi, Eliana de Melo Barison

  • 1Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil. ricardom.p@uol.com.br

Revista Do Instituto De Medicina Tropical De Sao Paulo
|August 3, 2004
PubMed

Insights

This study on Paracoccidioidomycosis in children found that juvenile and disseminated forms are common, often presenting with fever, enlarged lymph nodes, anemia, and eosinophilia. Treatment with sulfametoxazole-trimethoprim showed significant improvement in lab markers within six months.

Area of Science:

  • Pediatric Infectious Diseases
  • Mycology
  • Clinical Medicine

Background:

  • Paracoccidioidomycosis (PCM) is a systemic fungal infection endemic in Latin America.
  • Juvenile and disseminated forms of PCM are frequently observed in children.
  • Understanding the clinical spectrum and treatment outcomes in pediatric populations is crucial.

Purpose of the Study:

  • To describe the clinical manifestations, laboratory findings, and treatment outcomes of Paracoccidioidomycosis in children under 15 years old.
  • To evaluate the effectiveness of sulfametoxazole-trimethoprim as a first-line treatment.
  • To identify prognostic factors and sequelae in pediatric PCM cases.

Main Methods:

  • Retrospective analysis of 70 episodes of PCM in 63 children (ages 2-15) admitted between 1981 and 2001.
  • Clinical and laboratory data collected upon admission, including physical examination, blood counts, and biochemical tests.
  • Radiographic and technetium studies for bone lesion assessment.
  • Treatment with sulfametoxazole-trimethoprim in 50 episodes, with follow-up of clinical and laboratory parameters.

Main Results:

  • Common presentations included lymph node enlargement (87.1%), fever (75.7%), anemia (90%), hypergammaglobulinemia (88.5%), and eosinophilia (75.5%).
  • Moderate to severe malnutrition was present in 35.7% of cases.
  • Bone lesions were observed in 20 episodes.
  • Sulfametoxazole-trimethoprim treatment led to significant improvement in hemoglobin, eosinophil, albumin, and gammaglobulin levels within six months.
  • Mortality rate was 9.3%, and 6.3% developed sequelae.

Conclusions:

  • Juvenile and disseminated forms of PCM are prevalent in children, often presenting as a febrile lymphoproliferative syndrome.
  • Anemia, eosinophilia, and hypergammaglobulinemia are key laboratory findings.
  • Sulfametoxazole-trimethoprim is an effective first-line treatment, with laboratory markers useful for monitoring therapeutic response.

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