ACOMETIMENTO ESOFÁGICO ASSOCIADO À PARACOCCIDIOIDOMICOSE

A Paracoccidioidomicose (PCM), também chamada de Blastomicose Sul Americana por ser endêmica na América do Sul, consiste em uma infecção sistêmica, descrita pela primeira vez em 1908, cujo agente etiológico é o fungo do gênero Paracoccidioidis sp. Sua incidência varia ainda de 4 a 40 casos / 100.00 habitantes em áreas endêmicas. Após a aquisição do fungo, a pessoa pode permanecer assintomática, entretanto a doença pode progredir manifestando em formas aguda/subaguda, que geralmente afeta de crianças a adultos jovens, tendo a linfadenopatia como manifestação clínica predominante, e a forma crônica, que surge com a reativação da infecção latente manifestando-se principalmente pelo acometimento do pulmão, mucosas e pele. No entanto a doença pode afetar diversos órgãos e sistemas como as glândulas adrenais, sistema nervoso central, fígado, baço, estruturas da laringe, ossos e sistema digestivo em ambas as formas clínicas. Desse modo este trabalho busca identificar na literatura os relatos de acometimento esofágico pela PCM, uma vez que sintomas digestivos como sialorréia, disfagia, halitose, pirose, anormalidades de hábitos intestinais, náuseas, regurgitações, soluços, presença de massa, dor e distensão abdominais são frequentemente relatados. Através desta revisão constatou-se que o acometimento de esôfago associado à PCM é raro e as lesões fúngicas encontradas são principalmente úlceras ou fístulas. Ainda, o diagnóstico diferencial com as linfadenopatias próximas ao esôfago é necessário uma vez que podem acarretar sinais e sintomas semelhantes ao das lesões esofágicas propriamente ditas. Palavras-chave: Paracoccidioidomicose; Trato digestivo; Paracoccidioides brasiliensis; Doenças Endêmicas; Infecções fúngicas. ABSTRACT Paracoccidioidomycosis (PCM), also called South American Blastomycosis, because it is endemic in South America, consists of a systemic infection, first described in 1908, whose etiologic agent is the fungus of the gender Paracoccidioidis sp. Its incidence varies from 4 to 40 cases / 100.00 inhabitants in endemic areas. After the acquisition of the fungus, the person may remain asymptomatic; however, the disease may progress in acute / subacute forms, which usually affects children to young adults, with lymphadenopathy as the predominant clinical manifestation, and the chronic form that arises with a reactivation of the latent infection, manifested mainly by the involvement of the lung, mucous membranes and skin. However the disease can affect several organs and systems such as the adrenal glands, central nervous system, liver, spleen, structures of the larynx, bones and digestive system in both clinical forms. Thus, this work seeks to identify in the literature the reports of esophageal involvement by PCM, since digestive symptoms such as sialorrhea, dysphagia, halitosis, heartburn, intestinal habits abnormalities, nausea, regurgitation, hiccups, presence of mass, pain and abdominal distension are often reported. Through this review it was observed that the involvement of esophagus associated with PCM is rare and the fungal lesions found are mainly ulcers or fistulas. Moreover, the differential diagnosis with lymphadenopathy close to the esophagus is necessary since it can lead to signs and symptoms similar to that of the esophageal lesions themselves. Keywords: Paracoccidioidomycosis; Digestive Tract; Paracoccidioides brasiliensis; Endemic diseases; Fungal infections.

A retrospective study of oral manifestations in patients with paracoccidioidomycosis

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.