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FINDINGS: Findings include pulmonary infiltrates, lymphadenopathy, and ulcers of the skin and mouth. [CCDM, p. 393-4] Most infections are subclinical. Most symptomatic patients have chronic pulmonary disease with productive cough, weight loss, and dyspnea. [Guerrant, p. 918-20] Paracoccidioidomycosis can cause abdominal pain related to enlargement of the abdominal lymph nodes, liver, and spleen. [Merck Manual, p. 1535] Chest x-ray findings include infiltrates, nodules, cavitation, and hilar adenopathy. Patients may suffer from chest pain, productive cough, weight loss, fatigue, and fever. Infection of the adrenal glands was present in 95% of the cases in an autopsy series, and in a series of living patients, adrenal insufficiency was found in 48%. [ID, p. 2255-6] In about 65% of patients with active disease, the chest x-ray shows interstitial infiltrates. Some patients have hemoptysis. Ulcerations of the upper respiratory and GI tracts may cause dysphonia, dysphagia, diarrhea, and cachexia. [PPID, p. 3062-6] EPIDEMIOLOGY: Coffee growers in Brazil, Columbia, and Venezuela are affected. Other workers in contact with the soil in endemic areas (farmers, laborers, and construction workers) are also at increased risk. There are endemic areas throughout Central and South America. The ratio of male to female patients is 15:1. Patients often develop symptoms many years after exposure. The main two forms of the disease are chronic adult (85% of cases) and juvenile (15% of cases). In juvenile patients, the disease is more acute and severe, and the target organ is the reticuloendothelial system (lymph nodes, liver, and spleen). In the chronic adult form, the target organ is the lungs with dissemination to other organs. [CCDM; Guerrant; Merck Manual; PPID] |
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