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Abstract
South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.
Highlights
South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease, a chronic granulomatous disease caused by the dimorphic fungus Paracoccidioidis brasiliensis is the most prevalent systemic mycosis on South America (Brazil, Argentina, Colombia, and Venezuela) that usually affects healthy, middle-aged adults, most of them men involved in rural activities
The aim of this work was to evaluate the prevalence of Pb mycosis oral lesions in patients assisted at a public specialized oral diagnosis center, with special focus on the different clinical forms of these lesions, its location, patients’ occupation, deleterious habits, and diagnosis methodology
The statistical analysis was undertaken with the discrepancies between final diagnosis (Pb mycosis) and the initial diagnosis was done to verify if there was statistical difference between the diagnoses made by the professionals who referred the patients to our Center and those made by the undergraduate dental students who received the patients at our Center
Summary
South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease, a chronic granulomatous disease caused by the dimorphic fungus Paracoccidioidis brasiliensis is the most prevalent systemic mycosis on South America (Brazil, Argentina, Colombia, and Venezuela) that usually affects healthy, middle-aged adults, most of them men involved in rural activities This disease causes cutaneous and/ or respiratory tract mucosal lesions ranging from oral ulcerations, extensive laryngeal lesions and diffuse interstitial pulmonary involvement [1,2]. Pb mycosis presents a marked tendency to dissemination for any organ or system, such as lungs, lymph nodes, mucosa of the upper respiratory and digestive tracts, skin, adrenal glands, bones and joints, central nervous system, eyes, urogenital tract, and thyroid Due to such behavior, polymorphic manifestations are frequently observed, which impairs the establishment of a diagnosis by the clinical aspects. The oral lesions are suggestive of the disease and of easy diagnosis
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