Infectious Disease Compendium

Paracoccidioides brasiliensis

Microbiology

A fungus. P. brasiliense and P. lutzii.

Epidemiologic Risks

Soil from Mexico (23 degrees north) to Argentina (34 degrees south) with Brazil the most endemic area. Armadillo burrows may be a source (Pubmed.)

There was a big outbreak after freeway construction that spewed paracocci laden soil into the air (PubMed).

There is a strain in dolphins that causes cutaneous disease.

Syndromes

Starts most often as a pneumonia, it can disseminate, especially to mucous membranes; it can occur in any organ if the patients luck is bad enough.

Treatment

Ketoconazole 200 to 400 mg/day for a minimum of 6 months and for as long as 12 to 18 months gives the best relapse rate. Voriconazole 200 po bid (after a lame loading dose of 400mg) or itraconazole 100 mg po bid for 6 months to a years are of equal efficacy (PubMed). Amphotericin B up to 1.8 grams, but needs follow up sulfa to prevent relapse. Sulfadiazine 4 grams a day for 3 to 5 years (it is the only fungus that responds to sulfa (except Pneumocystis).

Notes

It can remain dormant for years, only to reactivate when immunity declines (like AIDS).