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An infectious disease of the skin, mucous membranes, lymph nodes, and internal organs caused by the fungus Paracoccidioides brasiliensis (formerly Blastomyces brasiliensis). The disease occurs only in South and Central America, most frequently in men aged 20 to 50, and especially in the coffee-growers of Brazil and Colombia. It has not been reported in patients with AIDS.
Symptoms and Signs
The disease is now believed to be acquired by the respiratory route with a primary focus of infection in the lung, although there are 4 forms. (1) The cutaneous form occurs most often on the face, frequently at the nasal and oral mucocutaneous borders. The typical lesion is a slowly expanding ulcer with a granular base and numerous pinpoint yellowish-white areas in which the fungus is abundant. Regional lymph nodes enlarge, become necrotic, and discharge necrotic material through the skin. (2) The lymphatic form is characterized by painless enlargement of the cervical, supraclavicular, or axillary lymph nodes. (3) In the visceral form, the liver, spleen, and abdominal lymph nodes enlarge. Abdominal pain may be the first symptom. (4) In the mixed form, cutaneous, lymphatic, and visceral lesions are present simultaneously.
Diagnosis
Culture and identification of P. brasiliensis from pus, biopsy, or other patient specimens are diagnostic. Diagnosis is suggested when forms that measure about 15 mu and have multiple buds are found on potassium hydroxide preparation.
Prognosis and Treatment
All forms are frequently progressive but rarely fatal. Treatment with amphotericin B (see General Therapeutic Principles, above) is effective; sulfonamides are suppressive but not curative. Ketoconazole (see General Therapeutic Principles, above) may be preferable on the basis of its efficacy, oral route of administration, and potential for prolonged duration of treatment. Most recently, itraconazole has been reported effective in resistant cases, but controlled, comparative studies have not been conducted.
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