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Co-existence of Integumentary Lesions and Lung X-ray Abnormalities in Patients with Paracoccidioidomycosis (PCM)

In paracoccidioidomycosis (PCM), the primary lung infection remains silent. In this study, attempts were done to define the primary target organ by correlating lung radiographic abnormalities with the time course of mucosal/skin lesions concurrently exhibited at diagnosis by 63 patients in whom microscopy and/or isolation of Paracoccidioides brasiliensis from respiratory secretions had been positive. Mucosal and skin lesions were found in 65.1% and 12.7% of the patients, respectively. Odynophagia and dysphagia were present in 38.1% each. All patients had lung interstitial infiltrates, and 31.7% had also alveolar lesions; fibrosis was recorded in 46% of them. An inverse correlation was shown for fibrosis and presence of either odynophagia or dysphagia. Cluster analyzes strongly supported two sets of patients: those with mucosal damage, odynophagia/dysphagia, and alveolo-interstitial infiltrates and those with dermal lesions, dyspnea, and lung fibrosis. These groups may represent novel stages in the natural course of PCM.

Received December 13, 2007. Accepted for publication May 10, 2008.

Acknowledgments: The authors thank the members of the Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas for cooperation in the diagnosis of the patients.

Financial support: This study was supported by the Corporación para Investigaciones Biológicas, Medellín, Colombia.

Disclosure: The authors report no conflicts of interest.

^* Address correspondence to Angela Restrepo, Corporación para Investigaciones Biológicas, Carrera 72A 78B-141, Medellín, Colombia. E-mail: angelares{at}geo.net.co

Authors’ addresses: Angela Restrepo, Corporación para Investigaciones Biológicas (CIB), Carrera 72A 78B-141, Medellín, Colombia, Tel: 574-441-0855, Fax: 574-441-5514, E-mail: angelares{at}geo.net.co. Angela M. Tobón, Corporació n para Investigaciones Biológicas (CIB), and Universidad Pontificia Bolivariana y Hospital La María, Carrera 72A 78B-141, Medellín, Colombia, Tel: 574-441-0855, Fax: 574-441-5514, E-mail: atobon{at}cib.org.co. Carlos A. Agudelo, Universidad Pontificia Bolivariana, Clínica Universitaria Bolivariana, and Hospital Pablo Tobón Uribe, Calle 78B 72A-109, Medellín, Colombia, Tel: 574-493-6300, E-mail: carlosagudelo{at}yahoo.com. Juan E. Ochoa, Corporación para Investigaciones Biológicas, Carrera 72A 78B-141, Medellín, Colombia, Tel: 574-441-0855, Fax: 574-441-5514, E-mail: jochoa{at}cib.org.co. David S. Rosero, Hospital Torrevieja, Alicante, Spain, E-mail: enero22{at}hotmail.com. Marta L. Osorio, Hospital La María, Calle 92CC 68A-48, Medellín, Colombia, Tel: 574-267-7511, E-mail: angelamtobon{at}hotmail.com. Luz E. Cano, Corporación para Investigaciones Biológicas and Escuela de Bacteriología y Laboratorio Clínico, Universidad de Antioquia, Carrera 72A 78B-141, Medellín, Colombia, Tel: 574-441-0855, Fax: 574-441-5514, E-mail: lcano{at}cib.org.co. Diego L. Alvarez, Facultad de Medicina, Universidad de Antioquia, Carrera 51D 62-29, Medellín, Colombia, Tel: 574-263-5411, E-mail: diegoluisalvarez{at}yahoo.com.

Reprint requests: Angela Restrepo, Corporación para Investigaciones Biológicas, Carrera 72A 78B-141, Medellín, Colombia, E-mail: angelares{at}geo.net.co.