Introduction

-Paracoccidioidomycosis is a subacute or chronic systemic mycosis caused by Paracoccidioides brasiliensis

-It occurs in rural areas of South and Central America, thus known as South American blastomycosis

-It is a dimorphic fungus that exists as a mold in soil and as a yeast in tissue

-The mold produces chlamydospores and conidia which enter human body mainly by inhalation 

Symptoms & Signs 

Asymptomatic form: marked by long asymptomatic periods 

Pulmonary form: Cough, weight loss, pulmonary granulomas 

Mucocutaneous form: Oropharyngeal lesions are the most common sign on physical examination; they present as small granulomas or painful ulcers over the nose, conjunctivae, mouth, gingiva, lips, pharynx, larynx (dysphonia) or anus 

Lymphatic form: Lymphadenopathy, ulceration, draining sinuses 

Diagnosis 

Histology: Granulomas with central caseation with fibrosis 

Culture: A parent round yeast cell surrounded by large numbers of small buds described as ‘Ship captain’s wheel’ 

Serology: antigen detection, antibodies to paracoccidioidin 

Treatment 

Effective agents: Itraconazole (the drug of choice), Voriconazole, ketoconazole, trimethoprim-sulfamethoxazole and Amphotericin B