Paracoccidioidomycosis and AIDS: an overview

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.