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==Overview==
==Overview==
Spores of ''Paracoccidioides spp.'' are transmitted via the respiratory route to the human host. Following transmission, ''Paracoccidiodes spp.'' particles invade the terminal bronchioles and alveoli where granulomas are formed, but can be inactive for approximately 40 years. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref> On microscopic histopathological analysis, a pilot's wheel-like appearance is a characteristic finding of PMC. <ref> Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2015</ref> <ref name=?> Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. ''CID''. 1996; 23: 1026-1032 </ref>
Spores of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' are commonly transmitted via the respiratory route to the human host. Following transmission, ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' particles invade the terminal bronchioles and alveoli where [[granulomas]] are formed, but can be inactive for up to 40 years.<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref> On microscopic histopathological analysis, a "pilot's wheel" or a "Mickey mouse ears-like" appearance is a characteristic finding of paracoccidioidomycosis (PCM).<ref>Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016</ref><ref name="?">Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. ''CID''. 1996; 23: 1026-1032 </ref><ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>


==Pathogenesis==
==Pathopysiology==
*Spores of ''Paracoccidioides spp.'' are transmitted via the respiratory route to the human host.
 
*Rarely in can be transmitted via skin trauma, where the fungus attaches the skin and mucous membranes. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref>
=== Transmission ===
*Following transmission, ''Paracoccidiodes spp.'' conidia and mycelial particles invade the terminal brochioles and alveoli and convert into yeast cells. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref>
*Spores of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp]].'' are transmitted via the respiratory route to the human host.
*The organisms response to the primo-infection is: bronchoalveolitis, which is normally asymptomatic.<ref name=?>Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*Rarely in can be transmitted via skin trauma, where the [[fungus]] attaches the skin and mucous membranes. Or via the digestive system, after consuming contaminated food.<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref><ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*After the primo-infection, the formation of granulomas start. Granulomas can be inactive for numerous years. <ref name=?>Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*Following transmission, ''[[Paracoccidioides brasiliensis|Paracoccidioides spp.]]'' conidia and mycelial particles invade the terminal bronchioles and alveoli where they convert into yeast cells.<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref>
*If the infection is active or gets activated, it can spread through lymphatic and hematic routes to other tissues. <ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969  }} </ref>
 
* Paracoccidioides spp. has developed different mechanisms which avoid getting caught inside mucus and therefore not being eradicated by mucigen cilliary cells. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref>
=== Pathogenesis ===
*The powerful adherence characteristic of the species provides a rapid takeover of host cells and consequently the avoidance of the immune system. <ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref>
*The organisms response to the primo-infection is: bronchoalveolitis, which is normally asymptomatic.<ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*Following the primary infection, [[granulomas]] may form. [[Granulomas]] can be inactive for several years.<ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
*If the infection is active or gets activated, it can spread through lymphatic and hematologic routes to other tissues such as: spleen, kidneys, adrenal glands, liver, bone, central nervous system, and airways.<ref name="pmid21738969">{{cite journal| author=Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA| title=Immunology of paracoccidioidomycosis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 3 | pages= 516-24 | pmid=21738969 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21738969 }} </ref><ref name="pmid22236894">{{cite journal| author=Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL et al.| title=Thoracic paracoccidioidomycosis: radiographic and CT findings. | journal=Radiographics | year= 2012 | volume= 32 | issue= 1 | pages= 71-84 | pmid=22236894 | doi=10.1148/rg.321115052 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22236894 }} </ref>  
* [[Paracoccidioides brasiliensis|''Paracoccidioides spp'']]''.'' have developed different mechanisms to avoid mucus and eradication by [[cilliary cells]].<ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref>
*The powerful adherence characteristic of the species provides a rapid takeover of host cells and consequently the avoidance of the immune system.<ref name="pmid26635779">{{cite journal| author=de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F et al.| title=Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis. | journal=Front Microbiol | year= 2015 | volume= 6 | issue=  | pages= 1319 | pmid=26635779 | doi=10.3389/fmicb.2015.01319 | pmc=PMC4658449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26635779  }} </ref>
 
==Genetics==
*The majority of patients in countries such as Colombia and Brazil, with high prevalence of PCM, had [[HLA-A9]], [[HLA-B13]], and HLA-B4 antigens.<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
*Chronic PCM is associated with patients that have C4B*-00 antigen of the [[Major histocompatibility complex|class III major histocompatibility complex]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>


==Associated Conditions==
==Associated Conditions==
Paracoccidioidomycosis is a opportunistic disease in Latin America. Associated conditions are:
 
*HIV/AIDS: Endemic areas of ''Paracoccidioides spp''. in Brazil have the majority of HIV/AIDS patients.<ref name=?>Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;Vol 6(2):89-117</ref> Nevertheless, the incidence of HIV/AIDS and paracoccidioidomycosis is minimum, this may be because the prophylaxis (trimetropin-sulfamethoxazole) used for ''Pneumocystis jiroveci'' is the one of the possible treatments for PCM. <ref name=?>Amoroso A. A Man With Newly Diagnosed HIV/AIDS With Unusual Severe Opportunistic Infection and No AIDS-Defining Disease. ''CID''. 2014;58:1484-1485</ref>
==== Paracoccidiodomycosis has been associated with: ====
*Carcinoma: The majority of patients with carcinoma and PCM, have the same organ or adjacent tissues involved. A risk factor for carcinoma is chronic inflammation with squamous metaplasia, which has been described in 33% cases of PCM in a study. <ref name=?>Da Silva G, Bittencourt C, De Mattos F, Da Silva J, Prolla J Severo L. Association between paracoccidioidomycosis and cancer. ''J. bras. pneumol.'' 2010;36(3), 356-362 </ref>
* '''Concomitant infections'''
*Transplants: The small amount of cases may be because of the use of trimetropin-sulfamethoxazole as prophylaxis for ''Pneumocystis jiroveci'', which is one of the possible treatments for PCM. <ref name=?> Zavascki A, Bienardt J, Severo L. Paracoccidioidomycosis in organ transplant recipient: case report. ''Rev. Inst. Med. trop. S. Paulo'' 2004;46(5), 279-281 </ref>
**The most important infectious disease that can be found concomitant with PCM is pulmonary [[tuberculosis]] ([[Tuberculosis|TB]]). [[Tuberculosis|TB]] can hold up the diagnosis of PCM, because they have similar clinical manifestations. Other infectious diseases associated with PCM because they have the same risk factors are: [[leishmaniasis]], [[leprosy]], [[Chagas disease|Chagas disease]] and [[strongyloidiasis]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
*Carpal Tunnel Syndrome: Only seen in Immunosupressed patients. <ref name="pmid3414040">{{cite journal| author=Lytkin MI, Petlenko VP| title=[A methodological analysis of the theory of traumatic disease]. | journal=Voen Med Zh | year= 1988 | volume=  | issue= 4 | pages= 11-4 | pmid=3414040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3414040  }} </ref>
 
* '''Cancer'''
**The majority of patients with [[carcinoma]] and PCM, have the same organ or adjacent tissues involved. A risk factor for [[carcinoma]] is chronic inflammation with [[squamous metaplasia]], which has been described in 33% cases of PCM in a study.<ref name="ccc">Da Silva G, Bittencourt C, De Mattos F, Da Silva J, Prolla J Severo L. Association between paracoccidioidomycosis and cancer. ''J. bras. pneumol.'' 2010;36(3), 356-362 </ref>
 
==== Paracoccidioidomycosis is also considered an opportunistic infection in Latin America. Associated conditions are: ====
* '''HIV/AIDS''':
**Endemic areas of ''[[Paracoccidioides brasiliensis|Paracoccidioides spp]]''. in Brazil have the majority of [[HIV AIDS|HIV/AIDS]] patients.<ref name="aaa">Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev''.1993;Vol 6(2):89-117''</ref> Nevertheless, the incidence of [[HIV AIDS|HIV/AIDS]] and paracoccidioidomycosis is minimum, this may be because the prophylaxis ([[Trimethoprim-Sulfamethoxazole|trimethoprim-sulfamethoxazole]]) used for ''[[Pneumocystis jiroveci]]'' is the one of the possible treatments for PCM.<ref name="bbb">Amoroso A. A Man With Newly Diagnosed HIV/AIDS With Unusual Severe Opportunistic Infection and No AIDS-Defining Disease. ''CID''. 2014;58:1484-1485</ref>
 
* '''Cancer''':
**The majority of patients have been diagnosed at the same time (40%) or after the neoplasm diagnostic (60%). PCM is highly associated with solid organ and [[Hematological malignancies|hematologic neoplasias]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref>
*'''Organ Transplantation''':
**PCM has been described in cases of [[renal transplantation]].<ref name="kkk">Martinez, R.Epidemiology of Paracoccidioidomycosis. ''Rev. Inst. Med. trop. S. Paulo.'' 2015;57(19), 11-20</ref> The small amount of cases may be because of the use of [[Trimethoprim-Sulfamethoxazole|trimethoprim-sulfamethoxazole]] as [[prophylaxis]] for ''[[Pneumocystis jiroveci]]'', which is one of the possible treatments for PCM.<ref name="ddd">Zavascki A, Bienardt J, Severo L. Paracoccidioidomycosis in organ transplant recipient: case report. ''Rev. Inst. Med. trop. S. Paulo'' 2004;46(5), 279-281 </ref>
 
* '''Carpal Tunnel Syndrome''':
**Only seen in Immunosupressed patients.<ref name="pmid3414040">{{cite journal| author=Lytkin MI, Petlenko VP| title=[A methodological analysis of the theory of traumatic disease]. | journal=Voen Med Zh | year= 1988 | volume=  | issue= 4 | pages= 11-4 | pmid=3414040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3414040 }} </ref>
 
==Gross Pathology==
*[[Granulomas]] merge and form different shape [[nodules]] which can be seen macroscopically in the lungs. With time, the [[nodules]] tend to necrose and then cavitate.<ref name="pmid19608361">{{cite journal| author=Marchiori E, Valiante PM, Mano CM, Zanetti G, Escuissato DL, Souza AS et al.| title=Paracoccidioidomycosis: high-resolution computed tomography-pathologic correlation. | journal=Eur J Radiol | year= 2011 | volume= 77 | issue= 1 | pages= 80-4 | pmid=19608361 | doi=10.1016/j.ejrad.2009.06.017 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19608361 }} </ref>


==Microscopic Pathology==
==Microscopic Pathology==
Paracoccidiodes spp. most important "characteristic is its dimorphism thermally driven. At 37ºC, a yeast-like form is produced whereas at 25ºC is a filamentous fungus. At 37ºC the colonies are white or cream with variable texture. Spherical cell produce piriform microconidia by synchronous budding forming the characteristic “steering wheels” of this fungus. At 25ºC slowly growing mycelial phase is developed with white to brownish colonies. Microscopically, conidia are usually absent, intercalary chlamydospores cells might be present. If seen, conidia may show a  'bicorn cocked hat’ appearance and barrel-shaped conidia are common to both species. P. lutzii frequently produces elongated, rod-shaped conidia, which is sufficiently distinctive to be used for species diagnosis." <ref> Paracoccidioides spp. LIFE-Leading International Fungal Education.http://www.life-worldwide.org/fungal-diseases/paracoccidioides-brasiliensis. Accessed on January 14, 2015</ref>
* The most important microscopically characteristic is the '''“ship’s wheel”''' or '''“Mickey mouse ears'''” appereance<ref name="paper">Vargas J, Vargas R. Paracoccidiodomicosis. ''Rev. enferm. infecc. trop.''2009(1):49-56</ref>
<gallery>
Image:527_lores.jpg|Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.<ref>Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016</ref>
Image:498_lores.jpg|Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.<ref>Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016</ref>
Image:Paracoccidioidomycosis-37.jpg|This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.<ref>Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016</ref>
</gallery>


==References==
==References==
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[[Category:Fungal diseases]]
[[Category:Fungal diseases]]
[[Category:Infectious diseases]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac

Overview

Spores of Paracoccidioides spp. are commonly transmitted via the respiratory route to the human host. Following transmission, Paracoccidioides spp. particles invade the terminal bronchioles and alveoli where granulomas are formed, but can be inactive for up to 40 years.[1] On microscopic histopathological analysis, a "pilot's wheel" or a "Mickey mouse ears-like" appearance is a characteristic finding of paracoccidioidomycosis (PCM).[2][3][4]

Pathopysiology

Transmission

  • Spores of Paracoccidioides spp. are transmitted via the respiratory route to the human host.
  • Rarely in can be transmitted via skin trauma, where the fungus attaches the skin and mucous membranes. Or via the digestive system, after consuming contaminated food.[1][4]
  • Following transmission, Paracoccidioides spp. conidia and mycelial particles invade the terminal bronchioles and alveoli where they convert into yeast cells.[1]

Pathogenesis

  • The organisms response to the primo-infection is: bronchoalveolitis, which is normally asymptomatic.[4]
  • Following the primary infection, granulomas may form. Granulomas can be inactive for several years.[4]
  • If the infection is active or gets activated, it can spread through lymphatic and hematologic routes to other tissues such as: spleen, kidneys, adrenal glands, liver, bone, central nervous system, and airways.[1][5]
  • Paracoccidioides spp. have developed different mechanisms to avoid mucus and eradication by cilliary cells.[6]
  • The powerful adherence characteristic of the species provides a rapid takeover of host cells and consequently the avoidance of the immune system.[6]

Genetics

Associated Conditions

Paracoccidiodomycosis has been associated with:

  • Concomitant infections
    • The most important infectious disease that can be found concomitant with PCM is pulmonary tuberculosis (TB). TB can hold up the diagnosis of PCM, because they have similar clinical manifestations. Other infectious diseases associated with PCM because they have the same risk factors are: leishmaniasis, leprosy, Chagas disease and strongyloidiasis.[7]
  • Cancer
    • The majority of patients with carcinoma and PCM, have the same organ or adjacent tissues involved. A risk factor for carcinoma is chronic inflammation with squamous metaplasia, which has been described in 33% cases of PCM in a study.[8]

Paracoccidioidomycosis is also considered an opportunistic infection in Latin America. Associated conditions are:

  • Carpal Tunnel Syndrome:
    • Only seen in Immunosupressed patients.[12]

Gross Pathology

  • Granulomas merge and form different shape nodules which can be seen macroscopically in the lungs. With time, the nodules tend to necrose and then cavitate.[13]

Microscopic Pathology

  • The most important microscopically characteristic is the “ship’s wheel” or “Mickey mouse ears” appereance[4]
  • Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[14]

    Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[14]

  • Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[15]

    Histopathology of paracoccidioidomycosis. Budding cells of Paracoccidioides brasiliensis: ships wheel appearance. Methenamine silver stain.[15]

  • This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.[16]

    This is a Lowenstein-Jensen slant culture of the fungus Paracoccidioides brasiliensis grown at 37°C.[16]

References

  1. ↑ 1.0 1.1 1.2 1.3 Fortes MR, Miot HA, Kurokawa CS, Marques ME, Marques SA (2011). "Immunology of paracoccidioidomycosis". An Bras Dermatol. 86 (3): 516–24. PMID 21738969.
  2. ↑ Paracoccidioidomycosis. Wikipedia.https://en.wikipedia.org/wiki/Paracoccidioidomycosis. Accessed on January 12, 2016
  3. ↑ Manns B.J, Baylis B.W, Urbanski S.J, Gibb A.P, Rabin H.R. Paracoccidioidomycosis: Case Report and Review. CID. 1996; 23: 1026-1032
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Vargas J, Vargas R. Paracoccidiodomicosis. Rev. enferm. infecc. trop.2009(1):49-56
  5. ↑ Barreto MM, Marchiori E, Amorim VB, Zanetti G, Takayassu TC, Escuissato DL; et al. (2012). "Thoracic paracoccidioidomycosis: radiographic and CT findings". Radiographics. 32 (1): 71–84. doi:10.1148/rg.321115052. PMID 22236894.
  6. ↑ 6.0 6.1 de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula E Silva AC, Da Silva Jde F; et al. (2015). "Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis". Front Microbiol. 6: 1319. doi:10.3389/fmicb.2015.01319. PMC 4658449. PMID 26635779.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 Martinez, R.Epidemiology of Paracoccidioidomycosis. Rev. Inst. Med. trop. S. Paulo. 2015;57(19), 11-20
  8. ↑ Da Silva G, Bittencourt C, De Mattos F, Da Silva J, Prolla J Severo L. Association between paracoccidioidomycosis and cancer. J. bras. pneumol. 2010;36(3), 356-362
  9. ↑ Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: An Update. 'Clin. Microbiol. Rev.1993;Vol 6(2):89-117
  10. ↑ Amoroso A. A Man With Newly Diagnosed HIV/AIDS With Unusual Severe Opportunistic Infection and No AIDS-Defining Disease. CID. 2014;58:1484-1485
  11. ↑ Zavascki A, Bienardt J, Severo L. Paracoccidioidomycosis in organ transplant recipient: case report. Rev. Inst. Med. trop. S. Paulo 2004;46(5), 279-281
  12. ↑ Lytkin MI, Petlenko VP (1988). "[A methodological analysis of the theory of traumatic disease]". Voen Med Zh (4): 11–4. PMID 3414040.
  13. ↑ Marchiori E, Valiante PM, Mano CM, Zanetti G, Escuissato DL, Souza AS; et al. (2011). "Paracoccidioidomycosis: high-resolution computed tomography-pathologic correlation". Eur J Radiol. 77 (1): 80–4. doi:10.1016/j.ejrad.2009.06.017. PMID 19608361.
  14. ↑ Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016
  15. ↑ Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016
  16. ↑ Paracoccidioidomycosis. CDC Public Health Image Library (PHIL).http://phil.cdc.gov/phil/details.asp. Accessed on January 20, 2016
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