Description, Causes and Risk factors:
Almeida disease is a chronic, granulomatous, and progressive disease that mainly attacks the lungs, mucosa of the mouth and nose, and neighboring teguments, with frequent spread to the lymph nodes, adrenal glands, and other viscera. In fact it seems as though there is not anywhere in your body that is safe from the fungi once it gains entry either through the lungs or through traumatic implantation. The incubation period can range from 1 month up to a year, but usually has a long latency period. Almeida disease is not contagious from person to person. Incidence and prevalence of the mycosis are difficult to determine, because notification of its occurrence is not compulsory.
Alternative Names: Almeida disease, South American blastomycosis, Lutz-Splendore-Almeida disease, paracoccidioidal granuloma, paracoccidioidomycosis, Brazilian blastomycosis.
Paracoccidioides brasiliensis is a dimorphic fungus that is found in the environment as a saprophyte on plants and soil. Paracoccidioidomycosis is a deep granulomatous systemic mycosis, whose etiological agent is a dimorphic fungus denominated Paracoccidioides brasiliensis. The main antigen of this fungus is glycoprotein 43 (gp43) and the immunologic response is primarily cellular. Macrophages are responsible for primary cellular mechanisms that can prevent parasitic invasion of host tissues. The lung is the primary site of infection, and the fungus is able to disseminate to many organs, spawning secondary lesions that frequently occur in mucous membranes, lymph nodes, and skin. However, these sites can be affected without any previous lung infection. In such cases it has been postulated Paracoccidioides brasiliensis was inoculated directly into tissue. Oral infection exhibits ulcers with a granular appearance similar to the surface of a mulberry. The main symptoms associated with oral infection are itching, pain, and burning. Cervical lymphadenopathy is also reported.
Clinically, the disease may exhibit acute, subacute, and chronic patterns; the latter being the most prevalent. The acute form progresses rapidly with intense involvement of the reticuloendothelial system and affects young individuals, whereas the chronic pattern predominates in adult men and can take years to develop. Lung damage may be asymptomatic even when extensive lesions are revealed by radiographs of the thorax. Lung infection can progress and simulate tuberculosis. Paracoccidioides brasiliensis spreads via both the lymphatic and hematogenic systems.
Mucocutaneous paracoccidioidomycosis: The mouth and nose are the most usual mucosal sites of infection. Painful ulcerated lesions develop on the gums, tongue, lips or palate and can progress over weeks or months. Perforation of the palate or nasal septum may occur. Cutaneous lesions often appear on the face around the mouth and nose, although patient with severe infection can have widespread lesions.
Lymphonodular paracoccidioidomycosis: Lymphadenitis is common in younger patients. Cervical and submandibular chains are the most obvious manifestation and lymph nodes may progress to form abscesses with draining sinuses.
Disseminated paracoccidioidomycosis: Haematogenous spread of P. brasiliensis can result in widespread disseminated disease; including lesions of the small or large intestine, hepatic lesions, adrenal gland destruction, osteomyelitis, arthritis, endophthalmitis and meningoencephalitis or focal cerebral lesions.
Pulmonary paracoccidioidomycosis: Most cases have an indolent onset and patients present with chronic symptoms such as cough, fever, night sweats, malaise and weight loss. Chest x-rays are characteristic but not diagnostic. The infection must be distinguished from histoplasmosis and tuberculosis.
The infection produces ulcers and lesions. Lesions can be onthe skin, nose, mouth, digestive tract, producing ulcers, swelling,pain, nausea, vomiting, headache, and fever. If the lesions are inthe lungs then the symptoms include coughing, shortage of breath,chest pain, and weight loss. This can progress to respiratory failureand death.
Differential diagnoses include syphilis, psoriasis, and lymphoma.
Diagnosis depends on where the lesion is located and uses microscopy,blood agar culture, serology, skin test, and chest radiography.Confirmation by histological examination is always necessary. The serologicaltests also have a prognostic value in which persistent highervalues may predict a worse clinical response.
Microscopic examination of wet preparations of pus from draining lymph nodes, sputum, biopsies from ulcers and other clinical material can permit the diagnosis of paracoccidioidomycosis if the characteristic large, round cells with multiple peripheral buds are seen. However these are usually present as single cells or chains of cell and often cannot be differentiated from other fungal pathogens, such as C. neoformans or B. dermatitidis.The definitive diagnosis of paracoccidioidomycosis depends on isolation of the fungus in culture. Mould colonies can be obtained after incubation at 30 degree Centigrade for two to three weeks on glucose peptone (Sabouraud's) agar supplemented with cycloheximide. Cultures should be retained for 4 weeks before being discarded. If more rapid identification is required then initial mould culture can be subjected to an exoantigen test.The complement fixation and immunodiffusion tests using purified or recombinant antigens of P. brasiliensis are useful for diagnosis of paracoccidioidomycosis and monitoring the response to treatment. These are most helpful in cases with occult lesions in deep organs.
The cure rate depends on the type of drug used, dosage, and timing of use. Various drugs are available for treating paracoccidioidomycosis and, owing the increase of the infection by the opportunistic fungus in people who are immunodepressed or immunosuppressed new antifungal agents have been developed for treating this and other mycoses.
Disclaimer: The following tests, drugs and medications, surgical procedures are in some way related to, or used in the treatment. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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