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Hepatic Involvement in Pediatric Patients with Paracoccidioidomycosis: A Clinical and Laboratory Study

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Abstract

The liver is one of the organs most affected by paracoccidioidomycosis, a systemic mycosis endemic in some Latin American countries. The majority of articles focused on adult populations and failed to describe any detailed experience of liver abnormalities in pediatric patients. Therefore, the aim of this study was to describe the frequency and characteristics of liver involvement in children with paracoccidioidomycosis. This study comprised 102 patients less than 16 years of age (median 104.3 months) diagnosed with paracoccidioidomycosis from 1980 to 2010. Diagnosis was established by the identification of fungus. Forty-one patients had liver involvement. The main clinical features were generalized lymph node enlargement (39/41), weight loss (34/41) and fever 32/41). Approximately, one-third of the patients had jaundice. Patients with hepatic involvement were younger. A predominant elevation of canalicular enzymes occurred. There was a statistically significant difference in albumin (p < 0.001) and hemoglobin (p = 0.002) values between patients with and without liver involvement, and the lowest values were found in the former group. Cutoff levels of albumin (<3.05 g/dL) and hemoglobin (<9.2 g/dL) can be used to infer hepatic involvement. Hypoalbuminemia (median 2.4 g/dl) is more severe in patients with hepatic involvement and may indicate a worse liver function or complication of the disease (intestinal lymphangiectasia). Deaths (6) occurred only among patients with liver involvement. Particular clinical and laboratory characteristics are present in pediatric patients with hepatic involvement. Younger patients and those with severe hypoalbuminemia are more likely to present liver involvement by Paracoccidioides brasiliensis.

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References

  1. Coutinho ZF, Silva D, Lazera M, Petri V, Oliveira RM, Sabroza PC, Wanke B. Paracoccidioidomycosis mortality in Brazil (1980–1995). Cad Saúde Pública. 2002;18:1441–54.

    Article  PubMed  Google Scholar 

  2. Moreira APV. Paracoccidioidomicose: histórico, etiologia, epidemiologia, patogênese, formas clínicas, diagnóstico laboratorial e antígenos. Bol Epidemiol Paul. 2008;51:11–24.

    Google Scholar 

  3. Brummer E, Castaneda E, Restrepo A. Paracoccidioidomycosis: an update. Clin Microbiol Rev. 1993;6:89–117.

    PubMed  CAS  Google Scholar 

  4. Del-Negro G, Lacaz CS, Fiorillo AM, editors. Paracoccidioidomicose (Blastomicose sul-americana). Sarvier-Edusp: São Paulo; 1982.

    Google Scholar 

  5. Matute DR, McEween JG, Montes BA, San-Blas G, Bagagli E, Rauscher JT, Restrepo A, Morais F, Niño-Vega G, Taylor JW. Cryptic speciation and recombination in the fungus Paracoccidioides brasiliensis as revealed by gene genealogies. Mol Biol Evol. 2006;23:65–73.

    Article  PubMed  CAS  Google Scholar 

  6. Carrero LL, Niño-Vega G, Teixeira MM, Carvalho MJ, Soares CM, Pereira M, Jesuino RS, McEwen JG, Mendoza L, Taylor JW, Felipe MS, San-Blas G. New Paracoccidioides brasiliensis isolate reveals unexpected genomic variability in this human pathogen. Fungal Genet Biol. 2008;45:605–12.

    Article  PubMed  CAS  Google Scholar 

  7. Teixeira MM, Theodoro RC, Carvalho MJ, Fernandes L, Paes HC, Hahn RC, Mendoza L, Bagagli E, San-Blas G, Felipe MS. Phylogenetic analysis reveals a high level of speciation in the Paracoccidioides genus. Mol Phylogenet Evol. 2009;52:273–83.

    Article  PubMed  Google Scholar 

  8. Theodoro RC, Teixeira Mde M, Felipe MS, Paduan Kdos S, Ribolla PM, San-Blas G, Bagagli E. Genus paracoccidioides: species recognition and biogeographic aspects. PLoS One. 2012;. doi:10.1371/journal.pone.0037694.

    PubMed  Google Scholar 

  9. Franco M, Montenegro MR, Mendes RP, Marques SA, Dillon ML, Mota NGS. Paracoccidioidomycosis: a recently proposed classification of its clinical forms. Rev Soc Bras Med Trop. 1987;20:129–32.

    Article  PubMed  CAS  Google Scholar 

  10. Shikanai-Yasuda MA, Telles Filho FQ, Mendes RP, Colombo AL, Moretti ML. Guidelines in paracoccidioidomycosis. Rev Soc Bras Med Trop. 2006;39:297–310.

    Article  PubMed  Google Scholar 

  11. Pinto HB. La paracoccidiodosis brasiliensis como enfermedad sistemica. Comentarios a la casuistica venezolana. Mycopathologia. 1961;15:90–114.

    Google Scholar 

  12. Peña CE. Deep mycotic infections in Colombia. A clinicopathologic study of 162 cases. Am J Clin Path. 1967;47:505–20.

    PubMed  Google Scholar 

  13. Raphael A, Campana AO, Waimann J. Coma hepático na blastomicose sul-americana. Rev Ass Méd Bras. 1964;10:151–4.

    PubMed  CAS  Google Scholar 

  14. Teixeira F, Gayotto LC, Brito T. Morphological patterns of the liver in South American blastomycosis. Histopathology. 1978;2:231–7.

    Article  PubMed  CAS  Google Scholar 

  15. Boccalandro I, Albuquerque FJM. Icterícia e comprometimento hepático na blastomicose sul-americana. A propósito de 10 casos. Rev Paul Med. 1960;56:350–66.

    PubMed  CAS  Google Scholar 

  16. Daher RR, Vasconcelos WMP, Cardoso VM. Fígado e a blastomicose sul-americana. J Bras Med. 1973;25:83–90.

    Google Scholar 

  17. Marques SA. Paracoccidioimycosis: epidemiological, clinical and treatment up-date. An Bras Dermatol. 2003;78:135–50.

    Article  Google Scholar 

  18. Campos MV, Penna GO, Castro CN, Moraes MA, Ferreira MS, Santos JB. Paracoccidioidomycosis at Brasilias university hospital. Rev Soc Bras Med Trop. 2008;41:169–72.

    Article  PubMed  Google Scholar 

  19. Paniago AM, Aguiar JI, Aguiar ES, da Cunha RV, Pereira GR, Londero AT, Wanke B. Paracoccidioidomycosis: a clinical and epidemiological study of 422 cases observed in Mato Grosso do Sul. Rev Soc Bras Med Trop. 2003;36:455–9.

    Article  PubMed  Google Scholar 

  20. Gomez F. Desnutrición. Bol Med Hosp Infant Mex. 1946;3:543–51.

    PubMed  CAS  Google Scholar 

  21. Bellissimo-Rodrigues F, Machado AA, Martinez R. Paracoccidioidomycosis epidemiological features of a 1,000-cases series from a hyperendemic area on the southeast of Brazil. Am J Trop Med Hyg. 2011;85:546–50.

    Article  PubMed  Google Scholar 

  22. Barbosa GL. Paracoccidioidomicose na criança. Rev Pat Trop. 1992;21:269–383.

    Google Scholar 

  23. Castro RM, Del Negro G. Particularidades clínicas da paracoccidioidomicose na criança. Rev Hosp Clin Fac Med Sao Paulo. 1976;31:194–8.

    PubMed  CAS  Google Scholar 

  24. Fonseca ERS, Pardal PPO, Severo LC. Paracoccidioidomicose em crianças em Belém do Pará. Rev Soc Bras Med Trop. 1999;32:31–3.

    Article  PubMed  CAS  Google Scholar 

  25. Pereira RM, Bucaretchi F, Barison Ede M, Hessel G, Tresoldi AT. Paracoccidioidomycosis in children: clinical presentation, follow-up and outcome. Rev Inst Med Trop Sao Paulo. 2004;46:127–31.

    PubMed  Google Scholar 

  26. Londero AT, Gonçalves AJR, Cruz MLS, Rozembaum R, Cunha RQ, Machado ES, Viera ARM, Carvalho FG, Braga MP, Azevedo ECL, Wanke B, Cruz MFF, Menezes JA. Paracoccidioidomicose disseminada “infanto-juvenil” em adolescentes. Relato de quatro casos e revisão da literatura. Arq Bras Med. 1987;61:5–12.

    Google Scholar 

  27. Londero AT, Gonçalves AJR, Terra GMF, Nogueira SA. Paracoccidiodomycosis in Brazilian children. A critical review (1911-1994). Arq Bras Med. 1996;70:197–203.

    Google Scholar 

  28. Nogueira MGS, Andrade GMQ, Tonelli E. Clinical evolution of paracoccidioidomycosis in 38 children and teenagers. Mycopathologia. 2006;161:73–81.

    Article  PubMed  Google Scholar 

  29. Terra GMF, Rios-Gonçalves AJ, Londero AT, Braga MP, Ouricuri AL, Mesquita CC, Marino JCA, Ervilha LM, Vieira ARM, Deker-Macher S, Duarte DMA. Paracoccidioidomicose em crianças. Apresentação de casos. Arq Bras Med. 1991;65:8–15.

    Google Scholar 

  30. Ferreira MS. Contribuição para o estudo clínico-laboratorial e terapêutico da formação juvenil da paracoccidioidomicose. Rev Pat Trop. 1993;22:267–406.

    Google Scholar 

  31. Blotta MH, Mamoni RL, Oliveira SJ, Nouér SA, Papaiordanou PM, Goveia A, Camargo ZP. Endemic regions of paracoccidioidomycosis in Brazil: a clinical and epidemiologic study of 584 cases in the southeast region. Am J Trop Med Hyg. 1999;61:390–4.

    PubMed  CAS  Google Scholar 

  32. Valle ACP. Tratamento da paracoccidioidomicose: estudo retrospectivo de 500 casos Análise clínica, laboratorial e epidemiológica. An Bras Derm. 1992;67:251–4.

    Google Scholar 

  33. Brito T, Castro RM, Shiroma M. Biópsia hepática na blastomicose sul-americana. Rev Inst Med Trop Sao Paulo. 1968;10:188–91.

    PubMed  Google Scholar 

  34. Santo AH. Tendência da mortalidade relacionada à paracoccidioidomicose, Estado de São Paulo, Brasil, 1985 a 2005: estudo usando causas múltiplas de morte. Rev Panam Salud Publica. 2008;23:313–23.

    Article  PubMed  Google Scholar 

  35. Hildebrand TM, Rosario Filho NA, Telles Filho FQ, Costa O, Miasaki N, Miyaki M. Paracoccidioidomicose na criança: aspectos clínicos-laboratoriais em 25 casos. J Ped. 1987;63:92–6.

    Google Scholar 

  36. Nogueira MGS, Andrade GMQ, Tonelli E, Diniz SN, Góes AM, Cisalpino PS. Aspectos laboratoriais evolutivos de crianças em tratamento da paracoccidioidomicose. Rev Soc Bras Med Trop. 2006;39:478–83.

    Article  PubMed  Google Scholar 

  37. Gonzalez-Casas R, Jones EA, Moreno-Otero R. Spectrum of anemia associated with chronic liver disease. World J Gastroenterol. 2009;15:4653–8.

    Article  PubMed  CAS  Google Scholar 

  38. Troncon LE, Martinez R, Meneghelli UG, De Oliveira RB, Iazigi N. Protein-losing enteropathy in paracoccidioidomycosis. Rev Hosp Clin Fac Med Sao Paulo. 1981;36:172–8.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Center for Investigation in Pediatrics, UNICAMP School of Medicine, Campinas, São Paulo, Brazil

    Giselle de Melo Braga

  2. Department of Pediatrics, UNICAMP School of Medicine, São Paulo, Brazil

    Gabriel Hessel & Ricardo Mendes Pereira

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  1. Giselle de Melo Braga
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  2. Gabriel Hessel
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  3. Ricardo Mendes Pereira
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Correspondence to Giselle de Melo Braga.

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de Melo Braga, G., Hessel, G. & Pereira, R.M. Hepatic Involvement in Pediatric Patients with Paracoccidioidomycosis: A Clinical and Laboratory Study. Mycopathologia 176, 279–286 (2013). https://doi.org/10.1007/s11046-013-9682-8

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  • DOI: https://doi.org/10.1007/s11046-013-9682-8

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