Emergence of juvenile paracoccidioidomycosis in Northeast Argentina

CATTANA ME; SOSA MA; FERNANDEZ MS; ROJAS FD; AGUIRRE C; VRATNICA C; CORALLO T; GIUSIANO GE

Córdoba

Congreso; Infocus 2015; 2015

Circulo médico de Córdoba.

Paracoccidioidomycosis (PCM) is an endemic neglected disease in Northeast Argentina without mandatory reporting.Even though in this area the PMC typically affects predominantly male adults with a chronic evolution, in the last five years, several cases (never described before) of sub-acute clinical forms with progressive evolution in children aged 10 to 16 years (median 12) were described.We present 6 cases (Table 1) in which were observed cutaneous, mucocutaneous and exacerbated subcutaneous manifestations, also bone and multisystem involvement. No gender difference was observed. In some patients PCM presentations were severe, in a few weeks with multiorganic affectation and lymph node chains involvement. Interestingly, four cases were urban without any exposure to rural environment and one case had negative serology.All patients received itraconazole as treatment and amphotericine B in severe cases. Only one patient died, in other cases good outcomes were observed. Since there were no previous reports of juvenile PCM clinical form in children in Northeast Argentina, the diagnosis was challenging, difficult and delayed. This should be considered and require a higher level of suspicion throughout the endemic area, but also in the main referral centers.The recognition of this emergence requires urgent research to explore the circulating Paracoccidioides species implicated in PCM in order to improve the diagnostic and therapeutic tools.