علاج داء الباراكوكسيديويدس عند وجود ثلاثة معايير أو أكثر للشدة

References

DOI: 10.1590/S0036-46652015000700007

• In severe or moderate acute cases, the patient has three or more of the following criteria: total body weight loss ≥ 10%; counter immunoelectrophoresis (CIE) titers ≥ 1/64; presence of tumor-like lesions or suppurative lymph nodes; multiple organ involvement (central nervous system, adrenal, bones); and lack of intradermal reaction to paracoccidioidin.
• AmB has been recommended since 1958 for the treatment of the most severe PCM cases.
• The starting dose varies from 5-10 mg but in severe cases, the total dose should be rapidly increased to 1 mg/kg/day.
• Severe cases received SMX-TMT intravenously, including those with CNS involvement.
• Once the acute phase is under control, the treatment can be changed to oral drugs (once or twice daily), favoring the adherence to longer treatment regimens.
• For maintenance therapy, slowly excreted sulfa (sulfamethoxypyridazin) could be used twice a day or even SMX-TMT 2-3 times a day.
• Involution of active lesions and resolution of signs and symptoms should occur within 1-8 weeks of starting therapy.
• Acute phase tests: decreased erythrocyte sedimentation rates and normalization of acute phase proteins should occur in the first 4-12 weeks (C-reactive protein and alpha1 acid glycoproteins).