Paracoccidioidomycosis and tuberculosis in AIDS patients: Report of two cases in Brazil

Abstract

AIDS is spreading rapidly in Brazil. Caused by the dimorphic fungus Paracoccidioides brasiliensis paracoccidioidomycosis (PBM) is one of the systemic mycoses most frequently diagnosed among immunocompetent individuals in Latin America. The condition is most commonly diagnosed among agricultural workers living in humid tropical and subtropical rural regions. According to Marques et al. the estimated incidence of PBM among Brazilian AIDS patients in 1992 was 0.09% and among the 26 reported cases there was a 29.4% mortality rate. Given the current increase in the heterosexual transmission of HIV and the simultaneous spread of HIV to more rural areas of Latin America there will probably be an increase in the number of people infected concurrently with HIV and P. brasiliensis who present with PBM as the first manifestation of AIDS. 2 cases are described in which PBM was found together with tuberculosis as the first manifestation of AIDS. Both patients were living in urban areas of Brazil at the time of diagnosis. One case was a 48 year old male painter complaining of persistent fever without chills for 1 month a rapidly growing cervical mass and a 7 kg weight loss over 45 days. The second case was a 28 year old man admitted for the evaluation and treatment of a draining cervical lymph node and skin lesions. He related that his disease began 5 months earlier presenting with fever and cervical lymphadenopathy.