Paracoccidioidomycosis (South American Blastomycosis): Treatment with Miconazole

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  • Division of Infectious Diseases, Departments of Medicine, Santa Clara Valley Medical Center, San Jose and Stanford University, Medical Center, Departments of Microbiology and Internal Medicine, University of Antioquia, Corporación de Investigaciones Biológicas, Stanford, California, Colombia

Six patients with multisystem paracoccidioidomycosis proven by serology and culture or smear were treated with relatively brief courses of intravenous miconazole. Two had relapsed following prior therapy; 6 had active pulmonary, 4 laryngeal, 2 oropharyngeal, 2 lymphoid, and 1 abdominal disease. Paracoccidioides brasiliensis was highly susceptible to miconazole in vitro; minimal inhibitory concentration was ⩽0.001 µg/ml. Clinical examination showed a prompt and objective response in all patients, confirmed by smear or culture and X-rays; in 4/6 serological response was shown. Side effects were minor. Two patients relapsed 3–5 mo after therapy; another had a rise in antibody 6 mo after therapy and was given maintenance oral sulfa. One remains in remission 7 mo after treatment; two given oral sulfa after response to miconazole remain in remission 4–6 mo after treatment. Paracoccidioidomycosis responds well to miconazole, but longer courses may be needed to prevent relapse.