Volume 79, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


In paracoccidioidomycosis (PCM), the primary lung infection remains silent. In this study, attempts were done to define the primary target organ by correlating lung radiographic abnormalities with the time course of mucosal/skin lesions concurrently exhibited at diagnosis by 63 patients in whom microscopy and/or isolation of from respiratory secretions had been positive. Mucosal and skin lesions were found in 65.1% and 12.7% of the patients, respectively. Odynophagia and dysphagia were present in 38.1% each. All patients had lung interstitial infiltrates, and 31.7% had also alveolar lesions; fibrosis was recorded in 46% of them. An inverse correlation was shown for fibrosis and presence of either odynophagia or dysphagia. Cluster analyzes strongly supported two sets of patients: those with mucosal damage, odynophagia/dysphagia, and alveolo-interstitial infiltrates and those with dermal lesions, dyspnea, and lung fibrosis. These groups may represent novel stages in the natural course of PCM.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Blotta MH, Mamoni RL, Oliveira SJ, Nouer SA, Papaiordanou PM, Goveia A, Camargo ZP, 1999. Endemic regions of paracoccidioidomycosis in Brazil: a clinical and epidemiologic study of 584 cases in the southeast region. Am J Trop Med Hyg 61 : 390–394. [Google Scholar]
  2. Brummer E, Castañeda E, Restrepo A, 1993. Paracoccidioidomycosis: an Update. Clin Microbiol Rev 6 : 89–117. [Google Scholar]
  3. Lacaz CS, Porto E, Martin JEC, Heins-Vaccari EM, Melo NT, 2002. Paracoccidioidomicose. Lacaz CS, Porto E, Martins JEC, Heins-Vaccari EM, Melo NT, eds. Lacaz Tratado de Micologia Medica. 9th edition. San Paulo: Sarvier Publishers, 639–729.
  4. Londero AT, Melo IS, 1988. Paracoccidioidomicose. J Brazil Med 55 : 96–115. [Google Scholar]
  5. Negroni R, 1993. Paracoccidioidomycosis (South American blastomycosis, Lutz mycosis). Int J Dermatol 12 : 847–859. [Google Scholar]
  6. Restrepo Moreno A, 2003. Paracoccidioidomycosis. Dismukes WE, Pappas PG, Sobel J, eds. Clinical Mycology. New York: Ford University Press, 328–345.
  7. Londero AT, 1986. Paracoccidioidomicose: Patogenia, formas clinicas, manifestacões pulmonares e diagnostico. J Pneumol (Brazil) 12 : 41–57. [Google Scholar]
  8. Restrepo A, Tobón AM, 2005. Paracoccidioides brasiliensis. Mandell GL, Bennett JE, Dollin R, eds. Principles and Practice of Infectious Diseases. 6th edition. Philadelphia: Elsevier, 3062–3068.
  9. Angulo Ortega A, Pollak L, 1971. Paracoccidioidomycosis. Baker RD, ed. The Pathological Anatomy of the Mycosis. Human Infections with Fungi, Actinomycetes and Algae. Berlin: Springer-Verlag, 507–560.
  10. Campos EP, Padovani CR, Cataneo AM, 1991. Paracoccidioidomycosis: radiologic and pulmonary study in 58 cases. Rev Inst Med Trop S Paulo 33 : 267–276. [Google Scholar]
  11. Correa AL, Restrepo A, Franco L, Gómez I, 1991. Paracoccidioidomicosis: coexistencia de lesiones extrapulmonares y patología pulmonar silente. Descripción de 64 pacientes. Acta Med Colomb 16 : 304–308. [Google Scholar]
  12. Gónzalez Ochoa A, Domínguez Soto L, 1957. Blastomicosis sudamericana. Casos mexicanos. Rev Inst Salubr Enf Trop 17 : 97–104. [Google Scholar]
  13. Funari M, Kavakama J, Shikanai Yasuda M, Castro LG, Bernard G, Rocha MS, Cerri GG, Muller NL, 1999. Chronic pulmonary paracoccidioidomycosis (South American blastomycosis): high-resolution CT findings in 41 patients. AJR Am J Roentgenol 173 : 59–64. [Google Scholar]
  14. Machado Filho J, Lisboa Miranda J, 1960. Considerações relativas à la blastomicose sulamericana. O Hospital (Brazil) 58 : 431–449. [Google Scholar]
  15. Restrepo A, Trujillo M, Gómez I, 1989. Inapparent lung involvement in patients with the subacute juvenile type of paracoccidioidomycosis. Rev Inst Med Trop S Paulo 31 : 18–22. [Google Scholar]
  16. Tobón AM, Agudelo CA, Osorio ML, Alvarez DL, Arango M, Cano LE, Restrepo A, 2003. Residual pulmonary abnormalities in adult patients with chronic paracoccidioidomycosis: Prolonged follow-up after itraconazole therapy. Clin Infect Dis 37 : 898–904. [Google Scholar]
  17. Tuder RM, el Ibrahim R, Godoy CE, De Brito T, 1982. Pathology of the human pulmonary paracoccidioidomycosis. Mycopathologia 92 : 179–188. [Google Scholar]
  18. Yamaga LY, Benard G, Hironaka FM, Castro LG, Funari MG, de Castro CC, Guertzenstein C, Watanable T, Buchpiguel C, Cerri GG, Shikanai Yasuda MA, 2003. The role of gallium-67 scan in defining the extent of disease in an endemic deep-mycosis, paracoccidioidomycosis, a predominant multifocal disease. Eur J Nucl Med Mol Imaging 30 : 888–894. [Google Scholar]
  19. Borrero J, Restrepo A, Robledo M, 1965. Blastomicosis sudamericana de forma pulmonar pura. Antioquia Méd (Colombia) 15 : 503–516. [Google Scholar]
  20. Igarashi T, Kurose T, Itabashi K, Nakano I, Okamoto K, Sano A, Kimura K, Kaki H, 2004. A case of chronic pulmonary paracoccidioidomycosis. Nihon Kokyuki Gakkai Zassi 42 : 629–633. [Google Scholar]
  21. Borelli D, 1971. Algunos aspectos ecológicos de la paracoccidioidomicosis. Dermatol Venezolana 10 : 1190–1201. [Google Scholar]
  22. Gonzalez Ochoa A, 1972. Theories regarding the portal of entry of Paracoccidioides brasiliensis. Proceedings First International Symposium on Paracoccidioidomycosis Scientific Publication N° 254. Washington DC: PAHO, 278–280.
  23. Restrepo A, McEwen JG, Castañeda E, 2001. The habitat of Paracoccidiodes brasiliensis: how far from solving the riddle? Med Mycol 39 : 232–241. [Google Scholar]
  24. Lacaz CS, 1955–1956. South American blastomycosis. An Fact Med S Paulo 29 : 1–20. [Google Scholar]
  25. Mackinnon JE, 1959. Blastomicosis sudamericana experimental evolutiva obtenida por vía pulmonar. An Fac Med Montevideo 4 : 355–358. [Google Scholar]
  26. McEwen JG, Bedoya V, Patiño MM, Salazar ME, Restrepo A, 1987. Experimental murine paracoccidioidomycosis induced by the inhalation of conidia. J Med Vet Mycol 25 : 165–175. [Google Scholar]
  27. Roldán JC, Tabares AM, Gómez BL, Aristizábal BE, Cock AM, Restrepo A, 2001. The oral route in the pathogenesis of paracoccidioidomycosis: An experimental study in BALB/c mice infected with Paracoccidioides brasiliensis conidia. Mycopathologia 151 : 57–62. [Google Scholar]
  28. Severo LC, Geyer AT, Londero AT, Porto NS, Rizzon CFC, 1979. The primary pulmonary lymph node complex in paracoccidioidomycosis. Mycopathology 67 : 115–118. [Google Scholar]
  29. Wanke B, Andrade EM, Lima Neto JA, Ferreira FC, 1983. Paracoccidoidomicose pulmonar assintomática e regressiva, com posterior disseminação. Relato de um caso. Rev Soc Brasil Med Trop 16 : 162–167. [Google Scholar]
  30. Benard G, Kavakama J, Mendes Giannini MJS, Kono A, Duarte AJ, Shikanai Yasuda MA, 2005. Contribution to the natural history of paracoccidioidomycosis: identification of the primary pulmonary infection in the severe acute form of the disease: a case report. Clin Infect Dis 40 : e1–e4. [Google Scholar]
  31. Zar JH, 1999. Contingency tables. Zar JH, ed. Biostatistical Analysis. 4th edition. Upper Saddle River, NJ: Prentice Hall, 486–517.
  32. Hair J, Anderson R, Tatham R, Black W, 1999. Análisis de cluster. Hosmer DW, Lemeshow S, eds. Análisis Multivariante. 5th ed. Madrid: Prentice Hall, 491–546.
  33. Severo LC, Geyer AT, Londero AT, Porto NS, Rizzon CFC, 1979. The primary pulmonary lymph node complex in paracoccidioidomycosis. Mycopathology 67 : 115–118. [Google Scholar]
  34. Santos JWA, Michel GT, Londero AT, 1997. Paracoccidioidoma: case record and review. Mycopathologia 137 : 83–85. [Google Scholar]
  35. Angulo Ortega A, 1975. Lesiones numulares pulmonares de origen inflamatorio: Paracoccidioidomas. Tórax (Venezuela) 11 : 25–34. [Google Scholar]
  36. Angulo Ortega A, 1972. Calcifications in paracoccidioidomycosis: are they the morphological manifestation of subclinical infection? Proceedings of the First Pan American Symposium on Paracoccidioidomycosis, Pan American Health Organization, Scientific Publication No. 254, Medellín, Colombia, 25–27, 1972.

Data & Media loading...

  • Received : 13 Dec 2007
  • Accepted : 10 May 2008

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error