, Volume 92, Issue 3, pp 179–188 | Cite as

Pathology of the human pulmonary paracoccidioidomycosis

  • R. M. Tuder
  • R. El Ibrahim
  • C. E. Godoy
  • T. De Brito


Lungs of twelve patients with chronic paracoccidioidomycosis (Pb) were studied in an attempt to understand the pathogenesis of the pulmonary disease. Ribbons of the lung parenchyma including the hilar region and directed towards apical, basal and lateral regions were subdivided into sections from the hilar, intermediate and peripheral segments. The following histopathological reactions directly or indirectly related to P. brasiliensis were described and analysed in relation to the number of slides studied and the pulmonary region involved: (1) pneumonic reaction; (2) early granulomatous formation; (3) mature and healed granulomata; (4) mixed pattern (early and mature granuloma in the same pulmonary area visualized in the slide); (5) pulmonary fibrosis.

It was concluded that chronic pulmonary Pb is a recurrent disease affecting equally both lungs. Fibrosis was connected mainly with the progressive evolution of the granulomata towards cicatrization and to a lesser degree probably to a direct induction by the fungi. Based chiefly on the tendency of the fibrosis to run around bronchi and to make up septa interconnecting bronchi and vessels it was hipothesized that these findings were the result of a previous chronic specific lymphangitis by the fungi. Hilar fibrosis would be the result of this lymphangitis and/or of the progression of the specific granulomatous reaction seen in the hilar lymph nodes.

Non specific forms of arteritis and areas of destructive emphysema related to granulomatous inflammation and fibrosis were described. Three cases developed pulmonary hypertension.


Pulmonary Hypertension Pulmonary Fibrosis Lung Parenchyma Hilar Region Granulomatous Formation 
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  1. 1.
    Agia, G. A., D. J. Hupst, W. A. Rogers, 1980. Paracoccidioidomycosis presenting as a cavitating pulmonary mass. Chest. 75: 650–652.Google Scholar
  2. 2.
    Angulo-Ortega, A. & L. Pollack, 1971. Paracoccidioidomycosis: The pathological anatomy of the mycosis. In: R. D. Baker (ed.) Human infections with fungi, actinomycetes and Algae. Springer Verlag, Berlin: 507–560.Google Scholar
  3. 3.
    Brass, K., 1969. Observaciones sobre la anatomia patologica, patogénesis y evolución de la paracoccidioidomicosis. Mycopathol. Mycol. Appl. 37: 119–138.Google Scholar
  4. 4.
    Crystal, R. G., P. B. Bitterman, S. I. Rennard, A. J. Hance & B. A. Keogh, 1984. Interstitial lung diseases of unknown cause: disorders characterized by chronic inflammation of the lower respiratory tract (first of two parts). N. Engl. J. Med. 310: 154–166.Google Scholar
  5. 5.
    Cunha Motta, L., 1942. Granulomatose paracoccidioidica (‘Blastomycose brasileira’). Anais da Faculdade de Medicina da Universidade de S. Paulo 18: 145–159.Google Scholar
  6. 6.
    De Brito, T., J. S. Furtado, R. Martins Castro & M. Manini, 1973. Intraepithelial parasitism as an infection mechanism in human paracoccidioidomycosis (South American Blastomycosis). Virchows Arch. Abt. A Path. Anat. 361: 129–138.Google Scholar
  7. 7.
    Defaveri, J., M. T. Rezkallah-Iwasso & M. F. Franco, 1982. Experimental pulmonary paracoccidioidomycosis in mice: morphology and correlation of lesions with humoral and cellular immune response. Mycopathologia 77: 3–11.Google Scholar
  8. 8.
    Fialho, A., 1960. Die pathologische Anatomie der sudamerikanischen Blastomykose (Lutzsche Krankheit). Ergeb. Allg. Pathol. 40: 99–138, 1960.Google Scholar
  9. 9.
    Giraldo, R., A. Restrepo, F. Gutiérrez, M. Robledo, F. Londoño, H. Hernández, F. Sierra & G. Calle, 1976. Pathogenesis of paracoccidioidomycosis: a model based on the study of 46 patients. Mycopathologia 58: 63–70.Google Scholar
  10. 10.
    Heitzman, R., A. Markarian, B. N. Raasch, E. W. Carsky, E. J. Lane & M. E. Berlow, 1982. Pathways of tumor spread through the lung: radiologic correlations with anatomy and pathology. Radiology 144: 3–14.Google Scholar
  11. 11.
    Londero, A. T. & L. C. Severo, 1981. The gamut of progressive pulmonary paracoccidioidomycosis. Mycopathologia 75: 65–74.Google Scholar
  12. 12.
    Mackinnon, J. E., 1959. Pathogenesis of South American blastomycosis. Trans. R. Soc. Trop. Med. Hyg. 53: 487–494.Google Scholar
  13. 13.
    Restrepo, A., D. L. Greer & M. Vasconcellos, 1973. Paracoccidioidomycosis: a review. Rev. Med. Vet. Mycol. 8: 98–123.Google Scholar
  14. 14.
    Restrepo, A., M. Robledo, F. Gutiérrez, M. Sanclemente, E. Castaňeda & G. Calle, 1970. Paracoccidioidomycosis (South American Blastomycosis): a study of 39 cases observed in Medellin, Colombia. Am. J. Trop. Med. Hyg. 19: 68–76.Google Scholar
  15. 15.
    Salfelder, K., G. Doehnert, H. R. Doehnert, 1969. Paracoccidioidomycosis: anatomic study with complete autopsies. Virchows Arch. Abt. A. Path. Anat. 348: 51–76.Google Scholar

Copyright information

© Martinus Nijhoff/Dr W. Junk Publishers 1985

Authors and Affiliations

  • R. M. Tuder
    • 1
  • R. El Ibrahim
    • 1
  • C. E. Godoy
    • 1
  • T. De Brito
    • 1
  1. 1.Department of Pathology, São Paulo Medical SchoolUniversity of São PauloSão PauloBrazil

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