Lesões orais e correlação com aspectos clínicos, epidemiológicos e laboratoriais da paracoccidioidomicose
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Data
2017-10-17
Autores
Durlacher, Rui Rafael [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: a paracoccidioidomicose (PCM) é uma micose sistêmica endêmica cuja incidência vem aumentando de forma significativa na região norte do Brasil. Duas espécies, Paracoccidioides brasiliensis e Paracoccidioides lutzii podem causar a doença. A última aparenta ter maior importância em Rondônia, estado com as maiores taxas de incidência e mortalidade por PCM do Brasil. Objetivo: descrever as características clínicas, epidemiológicas e laboratoriais de pacientes portadores de PCM e estabelecer correlação com lesões orais. Material e Métodos: estudo retrospectivo de pacientes atendidos no Centro de Referência em Medicina Tropical de Rondônia durante o período de janeiro de 2013 a dezembro de 2016. Resultados: foram diagnosticados 107 pacientes com média de idade de 53,8 anos, sendo 100 homens e 07 mulheres. Observou-se que 77% mantinham contato ou relataram experiência anterior com lavoura. A maioria (98,1%) apresentou a forma crônica da doença. O diagnóstico foi confirmado em 74,7%, e baseado em achados clínicos e/ou epidemiológicos no restante. O diagnóstico sorológico não esteve disponível no período. O tempo médio entre o início dos sintomas e a realização do diagnóstico foi de 7,3 meses. Os principais locais acometidos foram os pulmões (95,3%), seguidos da cavidade oral (55,1%) e dos gânglios (28%). Na cavidade oral, a faringe/laringe predominou (33%), seguida da mucosa jugal (17,8%) e palato mole (13,1%). Houve 58,3% de associação com tabagismo. O medicamento mais utilizado para o tratamento foi o Itraconazol, fornecido pelo governo. Conclusão: não houve diferença entre os grupos com ou sem comprometimento da cavidade oral. A presença de lesões orais em mais da metade dos casos, com diagnóstico mais acessível, sugere que se pode diminuir o tempo entre o início dos sintomas e o início do tratamento, e contribuir para uma menor proporção de sequelas. Sugere-se ainda que o P. lutzii pode manifestar doença com características clínicas, epidemiológicas e laboratoriais semelhantes ao P. brasiliensis, exceto pela menor proporção de formas agudas de PCM. Mas novos estudos são necessários.
Background: Paracoccidioidomycosis (PCM) is an endemic systemic mycosis whose incidence has been increasing significantly in the northern region of Brazil. Two species, Paracoccidioides brasiliensis and Paracoccidioides lutzii can cause the disease. The latter appears to be more important in Rondônia, the state with the highest incidence and mortality rates by PCM in Brazil. O bjective : T o describe the clinical, epidemiological and laboratory characteristics of PCM patients and to establish correlation with oral lesions . Material and Methods: a retrospective study of patients attended at the Reference Center in Tropical Medicine of Rondônia during the period from January 2013 to December 2016. Results: A total of 107 patients were diagnosed, with mean age of 53.8 years, 100 men and 7 women. It was observed that 77% maintained contact or reported previous experience with rural areas . The majority (98.1%) presented the chronic form of the disease. The diagnosis was confirmed by the finding of the fungus in clinical specimen s in 74.7%, and based on clinical and/or epidemiological findings in the rest. The serological diagnosis was not available in the period. The mean time between onset of symptoms and the diagnosis was 7.3 months. The main sites were the lungs (95.3%), follo wed by the oral cavity (55.1%) and the ganglia (28%). In the oral cavity, the pharynx/larynx predominated (33%), followed by jugal mucosa (17.8%) and soft palate (13.1%). There was an 58,3 % association with smoking . The most commonly used drug was Itr acona zole in 93.5% of patients. Conclu sion: There was no difference between groups with or without oral cavity involvement. The presence of oral lesions in more than half of the cases, with a more accessible diagnosis, suggests that the time between onset of sy mptoms and the beginning of treatment can be shortened and contribute to a lower proportion of sequelae. It is also suggested that P. lutzii can manifest disease with clinical, epidemiological and laboratory characteristics similar to P. brasiliensis , exce pt for the smaller proportion of acute forms of PCM. But new studies are needed.
Background: Paracoccidioidomycosis (PCM) is an endemic systemic mycosis whose incidence has been increasing significantly in the northern region of Brazil. Two species, Paracoccidioides brasiliensis and Paracoccidioides lutzii can cause the disease. The latter appears to be more important in Rondônia, the state with the highest incidence and mortality rates by PCM in Brazil. O bjective : T o describe the clinical, epidemiological and laboratory characteristics of PCM patients and to establish correlation with oral lesions . Material and Methods: a retrospective study of patients attended at the Reference Center in Tropical Medicine of Rondônia during the period from January 2013 to December 2016. Results: A total of 107 patients were diagnosed, with mean age of 53.8 years, 100 men and 7 women. It was observed that 77% maintained contact or reported previous experience with rural areas . The majority (98.1%) presented the chronic form of the disease. The diagnosis was confirmed by the finding of the fungus in clinical specimen s in 74.7%, and based on clinical and/or epidemiological findings in the rest. The serological diagnosis was not available in the period. The mean time between onset of symptoms and the diagnosis was 7.3 months. The main sites were the lungs (95.3%), follo wed by the oral cavity (55.1%) and the ganglia (28%). In the oral cavity, the pharynx/larynx predominated (33%), followed by jugal mucosa (17.8%) and soft palate (13.1%). There was an 58,3 % association with smoking . The most commonly used drug was Itr acona zole in 93.5% of patients. Conclu sion: There was no difference between groups with or without oral cavity involvement. The presence of oral lesions in more than half of the cases, with a more accessible diagnosis, suggests that the time between onset of sy mptoms and the beginning of treatment can be shortened and contribute to a lower proportion of sequelae. It is also suggested that P. lutzii can manifest disease with clinical, epidemiological and laboratory characteristics similar to P. brasiliensis , exce pt for the smaller proportion of acute forms of PCM. But new studies are needed.
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Palavras-chave
Paracoccidioidomicose, Paracoccidioides brasiliensis, Paracoccidioides lutzii, Características clínicas, Epidemiologia, Paracoccidioidomycosis