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Paracoccidioidomycosis and AIDS: an overview
1Evans Memorial Department of Clinical Research, Boston University Medical Center Hospital, Massachusetts 02118, USA.
Abstract:
The scarcity of reported cases of paracoccidioidomycosis and AIDS remains unexplained. We review the details of the 27 cases reported in the medical literature. Paracoccidioidomycosis occurs in patients with advanced AIDS who are not receiving prophylaxis for Pneumocystis carinii pneumonia with trimethoprim-sulfamethoxazole, which is also effective against Paracoccidioides brasiliensis. Clinical manifestations include prolonged fever, weight loss, generalized lymphadenopathy, splenomegaly, hepatomegaly, and skin rash. Diagnosis can often be made by direct microscopic examination and culture of the fungus from skin and lymph node specimens and occasionally from sputum, blood, spinal fluid, and bone marrow specimens. Since antibodies to P. brasiliensis are occasionally detected, the diagnosis should not be ruled out for patients whose serology is negative. Despite specific therapy with different regimens, the overall mortality of paracoccidioidomycosis among patients with AIDS is high (30%). The prognosis can be improved by earlier diagnosis and aggressive therapy with amphotericin B, followed by lifelong immunosuppressive therapy with trimethoprim-sulfamethoxazole. Health care providers caring for human immunodeficiency virus-infected patients who live or have resided in areas in which paracoccidioidomycosis is endemic must be aware of the possibility that this systemic mycosis may occur and have potentially severe consequences.
Insights
Paracoccidioidomycosis is a rare fungal infection in patients with advanced Acquired Immunodeficiency Syndrome (AIDS). Early diagnosis and aggressive treatment, including amphotericin B and lifelong trimethoprim-sulfamethoxazole, can improve outcomes for this severe systemic mycosis.
Area of Science:
- Infectious Diseases
- Mycology
- Immunology
Background:
- Paracoccidioidomycosis (PM) and Acquired Immunodeficiency Syndrome (AIDS) co-infections are rarely reported, with only 27 cases documented in medical literature.
- The reasons for this scarcity remain unclear, prompting a review of existing cases to understand the clinical presentation and management.
Purpose of the Study:
- To analyze the clinical characteristics, diagnostic methods, and treatment outcomes of paracoccidioidomycosis in patients with advanced AIDS.
- To highlight the importance of recognizing this opportunistic infection in endemic areas.
Main Methods:
- A comprehensive review of 27 reported cases of paracoccidioidomycosis in patients with AIDS.
- Analysis of clinical manifestations, diagnostic procedures, and therapeutic regimens.
Main Results:
- Paracoccidioidomycosis in AIDS patients presents with prolonged fever, weight loss, lymphadenopathy, splenomegaly, hepatomegaly, and skin rash.
- Diagnosis is often achieved through direct microscopy and fungal culture from various specimens; serology may be negative.
- Despite treatment, the mortality rate for paracoccidioidomycosis in AIDS patients is high (30%).
Conclusions:
- Paracoccidioidomycosis occurs in advanced AIDS patients, particularly those not on Pneumocystis pneumonia prophylaxis with trimethoprim-sulfamethoxazole.
- Prompt diagnosis and aggressive therapy with amphotericin B, followed by lifelong suppressive trimethoprim-sulfamethoxazole, can improve prognosis.
- Healthcare providers must maintain awareness of this systemic mycosis in HIV-infected individuals from endemic regions.