Paracoccidioidomycosis
[Lancet 2021;21:e364-74, Rev Soc Bras Med Trop 2017;50:715-40]
Usual Pathogen
Paracoccidioides brasiliensis
- Soil fungus in subtropical humid areas of central/south America.
- Can cause acute, subacute and chronic infections involving lungs, skin (ulcers), mucous membranes, lymph nodes, bone and internal organs.
- Infectious Diseases consult recommended.
Mild-moderate
| Empiric Therapy | Duration | |
|---|---|---|
| Itraconazole | 200mg PO daily |
6-9 months for mild 12-18 months for moderate Lifelong for HIV positive patients |
| Alternative | ||
| TMP-SMX | 1 DS PO bid or tid, then |
30 days Indefinitely (up to 3-5 years; lifelong for HIV positive patients) |
Severe infection or immunocompromised
| Empiric Therapy | Duration | |
|---|---|---|
|
Induction therapy: |
|
|
| Amphotericin B | 0.7-1mg/kg IV daily | To cumulative total of 30mg/kg |
| followed by | ||
| Itraconazole | 200mg PO daily |
For at least 12 months Lifelong for HIV positive patients |
| Alternative |
|
|
| Amphotericin B, liposomal | 3-5mg/kg IV daily |
|
| followed by |
|
|
| Itraconazole | 200mg PO daily |
For at least 12 months Lifelong for HIV positive patients |
| or |
|
|
| Voriconazole |
6mg/kg PO bid x 2 doses, then 4mg/kg PO bid |
For at least 12 months Lifelong for HIV positive patients |