The lung in paracoccidioidomycosis: new insights into old problems

Authors

  • Andre Nathan Costa Universidade de São Paulo; Faculdade de Medicina; Pulmonary Division; Heart Institute (InCor)
  • Gil Benard Universidade de São Paulo; Faculdade de Medicina; Dermatology Division; Hospital das Clínicas
  • Andre Luis Pereira Albuquerque Universidade de São Paulo; Faculdade de Medicina; Pulmonary Division; Heart Institute (InCor)
  • Carmem Lucia Fujita Universidade de São Paulo; Faculdade de Medicina; Hospital das Clínicas
  • Adriana Satie Kono Magri Universidade de São Paulo; Faculdade de Medicina; Department of Infectious and Parasitic Diseases
  • João Marcos Salge Universidade de São Paulo; Faculdade de Medicina; Pulmonary Division; Heart Institute (InCor)
  • Maria Aparecida Shikanai-Yasuda Universidade de São Paulo; Faculdade de Medicina; Department of Infectious and Parasitic Diseases
  • Carlos Roberto Ribeiro Carvalho Universidade de São Paulo; Faculdade de Medicina; Pulmonary Division; Heart Institute (InCor)

DOI:

https://doi.org/10.1590/clin.v68i4.76785

Abstract

OBJECTIVES: Chronic paracoccidioidomycosis can diffusely affect the lungs. Even after antifungal therapy, patients may present with residual respiratory abnormalities due to fungus-induced lung fibrosis. METHODS: A cross-sectional analysis of 50 consecutive inactive, chronic paracoccidioidomycosis patients was performed using high resolution computed tomography, pulmonary function tests, ergospirometry, the six-minute walk test and health-related quality of life questionnaires. RESULTS: Radiological abnormalities were present in 98% of cases, the most frequent of which were architectural distortion (90%), reticulate and septal thickening (88%), centrilobular and paraseptal emphysema (84%) and parenchymal bands (74%). Patients typically presented with a mild obstructive disorder and a mild reduction in diffusion capacity with preserved exercise capacity, including VO2max and six-minute walking distance. Patient evaluation with the Saint-George Respiratory Questionnaire showed low impairment in the health-related quality of life, and the Medical Research Council questionnaire indicated a low dyspnea index. There were, however, patients with significant oxygen desaturation upon exercise that was associated with respiratory distress compared with the non-desaturated patients. The initial counterimmunoelectrophoresis of these patients was higher and lung emphysema was more prominent; however, there were no differences in the interstitial fibrotic tomographic abnormalities, tobacco exposure, functional responses, exercise capacity or quality of life. CONCLUSIONS: Inactive, chronic paracoccidioidomycosis patients show persistent and disseminated radiological abnormalities by high resolution computed tomography, short impairments in pulmonary function and low impacts on aerobic capacity and quality of life. However, there was a subset of individuals whose functional impairment was more severe. These patients present with higher initial serology and more severe emphysema, stressing the importance of adequate treatment associated with tobacco exposure cessation.

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Published

2013-04-01

Issue

Section

Clinical Sciences

How to Cite

Costa, A. N., Benard, G., Albuquerque, A. L. P., Fujita, C. L., Magri, A. S. K., Salge, J. M., Shikanai-Yasuda, M. A., & Carvalho, C. R. R. (2013). The lung in paracoccidioidomycosis: new insights into old problems. Clinics, 68(4), 441-448. https://doi.org/10.1590/clin.v68i4.76785