Revista del Instituto de Medicina Tropical
versão impressa ISSN 1996-3696
INSFRAN, Isidro; PENAYO, Analía; TABOADA, Aurelia e BENITEZ, Gustavo. Paracoccidiodomycosis in patients with Acquired Immunodeficiency Syndrome. Rev. Inst. Med. Trop. [online]. 2009, vol.4, n.2, pp.31-35. ISSN 1996-3696.
Paracoccidioidomycosis is endemic in tropical and subtropical America. It is transmitted by inhalation of contaminated dust or dirt. Produces ulcerated mucosal lesions and / or skin, lymph node and / or lung. Can be generalized. Higher incidence was observed in men 30 to 50 years. The microbiological diagnosis is by biopsy. Case 1: Male, 30 years, Ya'u Yvy with AIDS. CD4: 8 cel./mm3 Viral Load: 254.389, on antiretroviral therapy (HAART) with stavudine (d4T), Lamivunina (3TC), Nevirapine (NVP), with 3 months of fever, headache 1 month, 15 days of cough, progressive dysphagia. Weight loss (PP) of 15 kg. On admission: Stable Gb: 2600 Hb: 9.5 Hct: 29.2 Na: 128. Rx. Thorax: radio-opaque image in the right upper lung field. Sputum, BAL: Paracoccidioides brasiliensis. Transbronchial biopsy: Pneumocystis sp. Treatment: Amphotericin B and TMP / SMX. Case 2: male, 33, of San Pedro, with 6 months of progressive dyspnea intensifies 10 days before admission, 5 months of wet cough. 22 days of fever with profuse sweating, internal 10 days, treated with cefotaxime 4 g / day for pneumonia. 8 days before diarrhea. PP 7 kg at admission: FC: 110 x FR: 32 x Tº: 39 º C, pale polipneico, suprasternal retractions. Right lung syndrome, stroke, left lung. Spill base and mid range. Abdomen very painful in HD, without defense or irritation, RHA (+). Gb: 16300 Ne: Luke 90: 8 Urea: 87, FA: 625, VDRL: 1.2. Dx is made. AIDS, with CD4 of 12, started HAART with d4T, 3TC, NVP. Pleural fluid: 8800, PMN, glucose 14 mg / dl, LDH 2648 Gram-negative, Rivalta (+) Ph: 6.9. Negative culture. Was placed pleural drainage tube. 3 Sputum: (+) for Paracoccidioides brasiliensis, negative for AFB. Tto: amphotericin B, persistent recurrence of pleural effusion and fever, is interpreted as a loculated empyema pleural vs TBC is derived to John Max Boetner where tto begin. antibacilar with good results, now with antibacilares and itraconazole. Comment: This entity is rare even in AIDS patients admitted to the IMT, as well as in other endemic areas for a variety of reasons still not well defined set. <50, for what could be included as a disease marker in endemic areas. In both patients, the CD4 count is <50, for what could be included as a disease marker in endemic areas
Palavras-chave : Paracoccidioides; Male.