Paracoccidioidomycosis
ICD-10 B41 · ICD-11 1F2E
Treatment of Mild Paracoccidioidomycosis with Limited Pulmonary and Skin Involvement
This protocol addresses paracoccidioidomycosis presenting in its mild form — defined by minimal weight loss, low-titer counter immunoelectrophoresis serology, and disease confined to specific organ systems without widespread dissemination.
Clinical Scenario
- Body weight loss less than 5%
- Counter immunoelectrophoresis (CIE) titers less than 1/16
- Involvement exclusive to the lungs, upper digestive tract, respiratory tract, and/or skin
- Positive intradermic paracoccidioidin reaction
Treatment Approach
Oral antifungal therapy is the cornerstone of management for this mild presentation — the specific agent selection and course are defined in the structured protocol.
Treatment Goals
- Involution of active lesions and resolution of signs and symptoms within 1–8 weeks
- Decreased erythrocyte sedimentation rate and normalisation of C-reactive protein and alpha₁ acid glycoproteins within 4–12 weeks
- Decrease in antibody titers 4–6 months after starting treatment
References
DOI: 10.1590/S0036-46652015000700007- Mild forms present less than 5% of weight loss; counter immunoelectrophoresis titers less than 1/16; and exclusive involvement of the lungs, upper digestive, respiratory tract and skin, associated with a positive intradermic paracoccidioidin.
- In our out-patient clinic, sulfadiazine and SMX-TMT have been the choice for non-life threatening PCM, with favorable outcomes.
- Doses from 100-400 mg a day were effective when administered for 6-24 months, and associated with 91% of clinical improvement.
- A disadvantage of sulfadiazine is posology (two or three 500 mg tablets every six hours, or 100 mg/kg/d, maximum 6 g).
- The recommended posology is 480-960 mg every 8-12 hours, and the combination is available for oral or parenteral administration.
- 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).
- With respect to the serological parameters, antibody titers should decrease 4-6 months after the beginning of treatment, reaching stabilization after 10 months (1/4 of initial titers detected by CIE or negative results in undiluted serum tested by DID).