Paracoccidioidomycosis Flashcards

1
Q

Epidemiology of cases?

A

Most cases below 30yrs, mostly in males

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2
Q

What is the transmission?

A

Respiratory route, primary lung lesion sometimes through direct skin contact

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3
Q

How does juvenile parracocy present?

A

Lymphadenopathy, hepatoslpenomegaly, pancytopenia

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4
Q

What are the two main strains of paracoccy?

A

P. Brasiliensis
P. Lutzii

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5
Q

What is the main agent?

A

Paracoccidioides Braziliensis
This is a dimorphic fungus

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6
Q

What are the clinical forms of parracocy

A

Asymptomatic infection
Or Progressive forms: acute/subacture or juvenile form, chronic or adult type is unifocal or multifocal

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7
Q

What does acute form of disease look like?

A

Much less common
mean age 22
Rapid onset
Negative skin test
Fever, hepatospleonmegaly, skin and lymphadenopathy

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8
Q

What is the chronic form look like?

A

Older patients, much more slow growing
Positive skin test
Lung involvement

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9
Q

How does chronic adult multiform look?

A

Oral ulcers painful ++, infiltrate gums and teeth
Lymphadenopathy
Bilateral pulmonary infiltrates, usually sparing apex and lower lung fields

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10
Q

How does acute juvenile form look?

A

Skin lesions, on face Predominantly
Significant hepatospleonmegaly
Jaundice common

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11
Q

What is the pulmonary involvement?

A

Cavitary Lesions and pleural effusions less common
Bilateral infiltrates, sparing apex and bases

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12
Q

What is skin and muscosal form?

A

50% of patients develop muscosal Lesions- destructive and painful often causing tooth loss
Granulation with haemorrhagic dots
Classical of the chronic form
Skin lesions are less common in the chronic form

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13
Q

What does cutaneous involvement look like in juvenile form?

A

Paupules, pustules, nodules
Painful
Typically the face

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14
Q

What is CNS involvement in parracocy?

A

Hypodense focal lesions
More common in chronic form

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15
Q

What type of parracocy do HIV patients get?

A

Both acute and chronic form
Skin test is usually negative
High fatality

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16
Q

Link between HTLV-1 and histoplasmosis?

A

Atypical presentations and extensive disease

17
Q

Who get paracoccy?

A

Farmers
not people living in Lima, not travellers

18
Q

Leish ulcers vs paracoccy?

A

Extremely painful in paracoccy
Haemorrhagic dots
Leish commonly has nasal perforation

19
Q

How do you dx?

A

KOH stain mother cell with budding
Silver stain and PAS also used

20
Q

What do you see on histopath on acute vs chronic form?

A

Much more fungus and extensive necrosis seen in acute form

21
Q

Tx of Paracoccy?

A

For chronic adult form with no resp distress– start with Itraconazole
In acute form or adult form with extensive resp involvement– ampho B for at least 2 weeks and then once clinical improvement, switch to itraconazole