Paracoccidioidomycosis with Total Body Weight Loss Between 5 and 10%

This protocol addresses Paracoccidioidomycosis presenting in the moderate clinical form — characterised by a specific pattern of weight loss and serological findings — and outlines the structured treatment approach applicable to this sub-population.

Clinical Scenario

In the moderate form of Paracoccidioidomycosis, total body weight loss ranges between 5 and 10%, and counter immunoelectrophoresis (CIE) titers are between 1/16 and 1/32. This distinguishes it from the severe form, which meets three or more additional severity criteria.

Treatment Approach

Management involves a two-phase oral therapy strategy — an induction phase aimed at controlling clinical symptoms, followed by a more prolonged maintenance phase. The specific agents, sequencing, and duration criteria are detailed in the full protocol.

Treatment Goals

Involution of active lesions and resolution of signs and symptoms within 1–8 weeks of starting therapy
Normalisation of acute-phase markers (C-reactive protein, alpha1 acid glycoproteins) within 4–12 weeks
Decrease in antibody titers within 4–6 months of treatment initiation

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1590/S0036-46652015000700007

In severe infections, patients present ≥ 3 of the criteria above mentioned; in the moderate form, total body weight loss ranges between 5 and 10% and the counter immunoelectrophoresis titers are between 1/16–1/32.

Recommended treatment for moderate or severe cases of PCM consists in two steps: a) an induction phase to control clinical symptoms until acute phase laboratory parameters return to normal; b) a maintenance phase up to the interruption of treatment based on immunological and other laboratory inflammation markers such as acute phase proteins.

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 long term treatments, 6–12 months are required for induction and 12–24 months for maintenance.

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