Abstract
Presented here is a case of chronic paracoccidioidomycosis that occurred in a Cuban female living in Austria and was first misdiagnosed as tuberculosis. The clinical picture was one of progressive pulmonary insufficiency with fever, weight loss and productive cough. Since antituberculous therapy was started but did not achieve a long-term clinical response, an intensive diagnostic work-up was performed. Paracoccidioides brasiliensis was then diagnosed by histopathology, serology, microbiology and molecular identification. Antifungal therapy was commenced immediately with amphotericin B (1 mg/kg/day) for 10 days, followed by voriconazole (200 mg/day po) for at least 3 months, and the lesions disappeared almost completely. This report presents the first published case of imported paracoccidioidomycosis in a female patient in Austria.
Similar content being viewed by others
References
Gow N, Nino-Vega G (2002) Paracoccidioides brasiliensis—the man-hater. Mycologist 16(Part 2):77–78
Kroll JJ, Walzer RA (1972) Paracoccidioidomycosis in the United States. Arch Dermatol 106:543–546
Silva-Vergara ML, Martinez R (1999) Role of the armadillo Dasypus novemcinctus in the epidemiology of paracoccidioidomycosis. Mycopathologia 144:131–133
Horré R, Schumacher G, Alpers K, Seitz HM, Adler S, Lemmer K, De Hoog GS, Schaal KP, Tintelnot K (2002) A case of imported paracoccidioidomycosis in a German legionaire. Med Mycol 40:213–216
Giraldo R, Restrepo A, Gutierrez F, Robledo M, Londoño F, Hernandez H, Sierra F, Calle G (1976) Pathogenesis of paracoccidioidomycosis: a model based on the study of 46 patients. Mycopathologia 58:63
Brummer E, Castañeda E, Restrepo A (1993) Paracoccidioidomycosis: an update. Clin Microbiol Rev 6:89–117
Restrepo A, Salazar ME, Cano LE, Stover EP, Feldman D, Stevens DA (1984) Estrogens inhibit mycelium-to-yeast transformation in the fungus Paracoccidioides brasiliensis: implications for resistance of females to paracoccidioidomycosis. Infect Immun 46:346–353
Borges-Walmsley MI, Chen D, Shu X, Walmsley AR (2002) The pathobiology of Paracoccidioides brasiliensis. Trends Microbiol 10(2):80–87
Restrepo A, Robledo M, Gutierrez F, et al (1970) Paracoccidioidomycosis. Am J Trop Med 19:68–76
Fountain F, Sutliff W (1969) Paracoccidioidomycosis in the United States. Am Rev Respir Dis 99:89–93
Gerrits van den Ende AHG, De Hoog GS (1999) Variability and molecular diagnostics of the neurotropic species Cladophialophora bantiana. Stud Mycol 43:151–162
Köhler C, Klotz M, Daus H, et al (1988) Viszerale Paracoccidioidomykose bei einem Goldgräber aus Brasilien [Visceral paracoccidioidomycosis in a gold-digger from Brazil]. Mycoses 31:395–403
Benoldi D, Alinova A, Pezzarossa E, et al (1985) Paracoccidioidomycosis (South American blastomycosis): a report of an imported case previously diagnosed as tuberculosis. Eur J Epidemiol 1:150–152
Ginarte M, Pereiro M Jr, Toribio J (2002) Imported paracoccidioidomycosis in Spain. Mycoses 46:407–411
Bowler S, Woodcock A, Da Costa P, Turner-Warwick M (1986) Chronic pulmonary paracoccidioidomycosis masquerading as lymphangitis carcinomatosa. Thorax 41:72–73
Stanisic M, Wegmann T, Kuhn E (1979) Südamerikanische Blastomykose (Parakokzidioidomykose) in der Schweiz. Schweiz Med Wochenschr 109:693–699
Chandler FW, Watts JC (1987) Pathologic diagnosis of fungal infections. ASCP Press, Chicago, pp 177–183
Balestra DJ, Hennigan SH, Ross GS, et al (1992) Clinical prediction of Pneumocystis pneumonia. Arch Intern Med 152:623–624
Manns BJ, Baylis BW, Urbanski SJ, et al (1996) Paracoccidioidomycosis: a case report and review. Clin Infect Dis 23:1026–1032
Loose DS, Stover EP, Restrepo A, et al (1983) Estradiol binds to a receptor-like cytosol binding protein and initiates a biological response in Paracoccidioides brasiliensis. Proc Natl Acad Sci USA 80:7659–7663
Aristizabal BH, Clemons KV, Stevens DA, et al (1998) Morphological transition of Paracoccidioides brasiliensis conidia to yeast cells: in vivo inhibition in females. Infect Immun 66:5587–5591
Aristizábal BH, Clemons KV, Byron JK, Minn Y, Stevens D (2002) Experimental Paracoccidioides brasiliensis infection in mice: influence of the hormonal status of the host on tissue responses. Med Mycol 40:161–168
Lortholary O, Denning DW, Dupont B (1999) Endemic mycosis: a treatment update. J Antimicrob Chemother 43:21–331
Restrepo A, Gomez I, Cano LE, et al (1983) Treatment of paracoccidioidomycosis with ketokonazole: a three-year experience. Am J Med 74(suppl B):48–52
Naranjo MS, Trujillo M, Múnera MI, Restrepo P, Gomez I, Restrepo A (1990) Treatment of paracoccidioidomycosis with itraconazole. J Med Vet Mycol 28:67–76
Kappe R (1999) Antifungal activity of the new azole UK-109, 496 (voriconazole). Mycoses 42:83–86
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mayr, A., Kirchmair, M., Rainer, J. et al. Chronic paracoccidioidomycosis in a female patient in Austria. Eur J Clin Microbiol Infect Dis 23, 916–919 (2004). https://doi.org/10.1007/s10096-004-1239-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-004-1239-9