Abstract
Introduction: paracoccidioidomycosis (PCM) is a polymorphic systemic granulomatous inflammatory disease determined by Paracoccidioides brasiliensis, one of the 10 leading causes of morbidity and mortality among the parasitic diseases endemic in Brazil. Objective: To identify the following aspects of PCM by ultrasound (US) and computed tomography (CT): abdominal changes, intensity and characteristics of the observed images, frequency of changes depending on clinical presentation, differences from other nosological entities. Patients and methods: This was a retrospective, observational, cross-sectional study carried out with 35 patients with PCM treated at the Hospital das Clinicas (HC) at the Universidade Federal de Minas Gerais (UFMG). Patients with tuberculosis, bronchial asthma, generalized chronic obstructive pulmonary disease, or in contact with silica or mines, as well as those with granulomatous diseases at any point in their current or past clinical history and detected through serology, anatomopathology or microbiological exams were excluded. Collected data were transcribed into SPSS for Windows® for statistical analysis. The studywas approved by the UFMG Ethics Committee (082/00). Results and conclusion: CT and U.S. showed involvement of abdominal organs in all forms of PCM, including lymphadenopathy (40%), hepatomegaly (37%), splenomegaly (37%) and adrenal involvement (17%). Gallbladder and retroperitoneal musculature involvement were also observed, along with ascites and pleural effusion. Lymph node calcification, adrenal involvement and ascites constituted evidence of high probability of PCM even though these findings are not enough to differentiate PCM from tuberculosis. Chronic and sequelae forms, abdominal involvement is more frequent than indicated by the clinical manifestations.
Highlights
Paracoccidioidomycosis (PCM) is a systemic granulomatous inflammatory disease, polymorphic, endemic in Latin America from Mexico to Argentina, with high prevalence in Brazil, Venezuela, and Colombia, determined by Paracoccidioides brasiliensis, a dimorphic fungus, which develops especially in temperate or hot, humid, with rainy summers and dry winters.1.2 This disease was described by Lutz in 1908, and initially named pseudo-coccidioidal hyphoblastomycosis to be differentiated from coccidioidomycosis.[1]
The disease is usually acquired in the childhood or youth, expressing itself in immunocompetent people as an infection through the inhalation of spores of P. brasiliensis, which reach the pulmonary alveoli forming an inflammatory focus and reaching the peribronchial lymph nodes and establishing the primary pulmonary complex.[2, 5, 8, 9]
The aim of this study was to describe the contribution from US and computed tomography (CT) in the evaluation of abdominal involvement in PCM; identify the structures involved; determine the intensity of the involved organs; determine the frequency of involvement of abdominal structures; describe the imaginological characteristics of alterations; and assess the possible alterations that differentiate this disease from other nosological entities and the prevalence of abdominal alterations depending on the clinical form
Summary
Paracoccidioidomycosis (PCM) is a systemic granulomatous inflammatory disease, polymorphic, endemic in Latin America from Mexico to Argentina, with high prevalence in Brazil, Venezuela, and Colombia, determined by Paracoccidioides brasiliensis, a dimorphic fungus, which develops especially in temperate or hot, humid, with rainy summers and dry winters.1.2 This disease was described by Lutz in 1908, and initially named pseudo-coccidioidal hyphoblastomycosis to be differentiated from coccidioidomycosis.[1] The PCM transmission between people or epidemic outbreaks is not known and its occurrence within a family is rare.[3,4,5] It is classified as an infection or illness with acute or subacute forms (juvenile type), moderate or severe or chronic (adult type), uni or multifocal, and light to moderate or severe.[6,77]. The most common form of inflammatory reaction to P. brasiliensis is the epithelioid granuloma; it can present recurrences and clinical diversity in reliance of previous episodes as to intensity, extent, and dissemination related to the fungus pathogenicity and variations of the patient’s immune response.[10,11,12]
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