Paracoccidioidomycosis
Introduction
Introduction to Paraspora The paraspora fungus is called Brazilian or South American blast fungus, a progressive fungal disease of the skin and mucous membranes, lymph nodes and internal organs caused by Paraspora paratubis. The disease is only prevalent in Central and South America, and is common among men aged 20-50 years, especially coffee workers in Colombia, Venezuela and Brazil. Although parasporosporosis is not a very common opportunistic infection, sometimes it occurs in immunocompromised patients, including AIDS patients. Parastaminium is not known in a specific place in nature, presumably in the form of fungi. In the soil, the human body is infected by inhalation of spores, and the spores are transformed into invasive yeasts at 37 ° C in the lungs, which can be spread to other parts by blood flow and lymph. basic knowledge The proportion of sickness: 0.8% Susceptible people: no special people Mode of infection: contagious Complications: emphysema
Cause
Cause of paraspora fungus
(1) Causes of the disease
Paraspora, also known as Brazil's paraspora, or Brazilian bud, cultured as a biphasic type, cultured as a yeast-like colony at 37 ° C, and spheroidal colonies in the greenhouse, recently considered to be more germinated spores It is very similar to endospores after the rupture of coccidioides, so it is generally called paraspora.
(two) pathogenesis
The pathogen of the disease is invaded by the mouth, skin and mucous membrane damage. When the body's resistance is weakened and pathogens invade, not only local lesions occur, but also lymphatic and blood circulation can be quickly invaded, causing internal organs. The lesion.
Prevention
Parasporosis prevention
Conazole is ideal, other drugs are less effective, early detection, early diagnosis and early treatment are essential, otherwise the prognosis is poor.
The pathogenic bacteria of the disease enter the human body through the oral cavity or nasal mucosa, and the low immune function is the predisposing factor of the disease. Therefore, strengthening physical exercise and improving immunity are essential for the prevention and treatment of the disease, and avoiding entering the epidemic area can prevent the occurrence of the disease.
Complication
Parasitic complication Complications emphysema
Pulmonary fibrosis and emphysema can occur in combination, and in severe cases, perforation can occur in the mouth, nose, throat and nearby tissues.
Symptom
Paraspora sclerotium symptoms Common symptoms Difficulty breathing High fever fatigue Papular lymphadenopathy Ascites nausea
The disease occurs mostly in middle-aged people, more men than women, skin and mucous membrane damage is the predisposing factor of this disease, when the body's resistance is weakened and pathogens invade, not only local lesions, but also can quickly invade lymph and blood. Circulation, causing lesions of internal organs, oral mucosa is the most common site of infection, followed by the lungs, proximal lymph nodes can be enlarged, according to different clinical symptoms, it is divided into skin mucosa and visceral type.
1. Mucosal parasporosis
Pathogenic bacteria often enter the human body through the oral mucosa or skin. The lesions start in the gums, mouth, upper jaw, throat, nasal cavity, lips and tongue. Skin damage is caused by mucosal damage, or from visceral blood. Or the skin is broken by superficial lymph nodes, forming ulcers, which occur mostly in the face, and are common in the mouth and nose.
The damage of the primary mucosa is papules or blisters, which in turn form ulcers. The surface is covered with white exudate. There is a bleeding point on the base. When the lesion invades the deep part, it can destroy the epiglottis, sag, soft palate and cause perforation, causing pain, oropharynx. Partial involvement can cause difficulty in swallowing, and the affected lips can cause local hard edema. The gums can damage the tissue and cause tooth loss. The lymph nodes in the early stage of the lesion are swollen, especially the cervical lymph nodes, which can be hard but not painful. Necrosis, suppuration, and skin piercing can occur to form a fistula.
2. Visceral parasporosis
Most of the lung infections are primary, and there are burnout, fatigue, high fever, chest pain, dyspnea, cough and bloodshot sputum. If it is secondary to other lesions and blood, it can be clinically symptomatic. Very light, intestinal infections are mostly transmitted by the digestive tract, lesions are mostly in the ileocecal area, the intestines can have extensive ulcers, accompanied by abdominal pain, nausea, vomiting, hepatosplenomegaly, ascites, intra-abdominal lymph nodes can be swollen, thereby It is easy to be mistaken for tuberculosis or tumor. When the lesion spreads, it can affect the stomach, pancreas, anus, etc. If the lymph nodes are swollen, it is often misdiagnosed as Hodgkin's disease. When the disease develops, the lesion can spread to the central nervous system, urinary. Reproductive system and muscle, cartilage, etc., when the adrenal cortex is involved in time, a series of clinical symptoms of Edison disease, X-ray examination damage is often located in the lower lungs, mostly bilateral, lesions can be nodular, invasive Or striped, nodules can be dispersed, can also be fused, infiltration can be limited, but also diffuse, general lung lesions have no calcification, the pleura is also rarely affected.
Examine
Examination of paracoccidial disease
1. Direct microscopic examination of the ulcer exudate, pus, puncture and other specimens for potassium hydroxide smear, visible round, thick-walled, 10 ~ 60m diameter bud spores, spores can be single or more life, typical It is suspicion, and the small spores are 1 to 2 m in diameter, and the larger ones are 10 m or larger.
2. The fungus was cultured on glucose peptone agar at 25 ° C, showing mycelial growth, slow growth, small colonies, microscopic examination of 1-2 m wide divided mycelium, round or oval on both sides of the hyphae Lateral small conidia of 3 ~ 6m size, similar to dermatitis buds, in blood agar or brain heart glucose agar, 37 ° C, yeast growth, microscopic examination and direct smear.
3. Serological tests detect antibodies and antigens.
4. X-ray examination damage is often located in the lower limbs of the lungs, mostly bilateral, lesions can be nodular, invasive or streaked, nodules can be dispersed, but also fusion, infiltration can be limited, but also diffuse, general lung There was no calcification in the lesion.
Diagnosis
Diagnosis and identification of paraspora fungus disease
diagnosis:
1. The disease is endemic fungal disease, and patients often have a history of residence in endemic areas.
2. Patients with pulmonary infection, accompanied by prolonged skin ulcers and swollen lymph nodes, or multiple system involvement should consider the possibility of this disease.
3. The diagnosis of cutaneous sporozoites is relatively easy, mainly to find pathogens.
Although large (often >15 m) yeasts that form characteristic multi- buds are found in the specimens, which provide a strong basis for diagnosis, can be confirmed by fungal culture.
It should be differentiated from cutaneous leishmaniasis, yaws, skin tuberculosis and tumors. In addition, it should be differentiated from other deep mycosis such as histoplasmosis, coccidioidomycosis, actinomycosis, blastomycosis, cryptococcosis and sporotrichosis, for visceral paraspora mycosis. It should be differentiated from kala-azar, tuberculous lymphadenitis, tuberculous peritonitis.
