Infectious Disease Compendium

Paracoccidioides brasiliensis

Microbiology

A fungus. P. brasiliense and P. lutzii and two others (PubMed).

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).

Where there are coffee trees there is Paracoccidioides. Paracocci should be one of the Starbuck coffee sizes.

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).

Last update: 05/05/18