Oral Manifestations Associated to Paracoccidioidomicosis and Histoplasmosis

Rommie Lucía Merino-Alado, Sofia Mata-Essayag, Jacinto Pineda, Gustavo Moronta, Elsi Natali Briceño, Valentina Mujica, Maria Eugenia Landaeta, Liseloth Garrido, Vanesa Pineda, Maria Teresa Colella

Abstract


Objective: To determine the frequency and clinical forms of oral manifestations associated to Paracoccidioidomycosis (PCM) and Histoplasmosis. Material and Methods: 481 medical records of outpatients referred to the Medical Mycology Department were reviewed since 2009 to 2016. Data were analyzed using descriptive statistical methods. Results: 47 (9.77%) cases had oral manifestations, 29 (61.70%) were associated to PCM and 18 (38.29%) to histoplasmosis. For PCM, male-female ratio was 8:1 and 1:1 for histoplasmosis. The average age for PCM was 48 years old and 53 for histoplasmosis. All the PCM patients had more than 1 oral structure affected: 44.82% were gingival lesions and 27.58% palate. In patients with histoplasmosis, 6 (33.33%) were lesions affecting palate and 6 (33.33%) involving tongue. For both entities, painful ulcers and granulomatous-like lesions were the most prevalent clinical forms; however, we observed a wide range of other oral manifestations. Regarding PCM patient’s comorbidities, 3 (10.34%) cases had HIV/AIDS, 8 (27.58%) histoplasmosis and 2 (6.89%) carcinomas. Whereas the comorbidities of patients with histoplasmosis, 2 (11.11%) had HIV/AIDS and 1 (5.55%) had carcinoma. Conclusion: In endemic countries for both mycoses, dentists must be aware of patients with mouth lesions, take advantage of epidemiologic clues that suggest risk factors and be acquainted with all the current diagnostic tests in order to make a quick diagnosis and treatment in highly suspicious cases.

Keywords


Paracoccidioidomycosis; Histoplasmosis; Oral Manifestations

Full Text:

PDF

References


Mata-Essayag S, Colella MT, Roselló A, de Capriles CH, Landaeta ME, de Salazar CP, et al. Histoplasmosis: A study of 158 cases in Venezuela 2000-2005. Medicine 2008; 87(4):193-202. doi: 10.1097/MD.0b013e31817fa2a8.

Bellissimo-Rodrigues F, Artioli-Machado A, 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(3):546-50. doi: 10.4269/ajtmh.2011.11-0084.

Teixeira M, Theodoro RC, Nino-Vega G, Bagagli E, Felipe M. Paracoccidioides species complex: Ecology, phylogeny, sexual reproduction, and virulence. PLoS Pathog 2014; 10(10):e1004397. doi: 10.1371/journal.ppat.1004397.

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(4):455-9. doi: 10.1590/S0037-86822003000400004.

Abreu e Silva MA, Salum FG, Figueiredo MA, Cherubini K. Important aspects of oral paracoccidioidomycosis – A literatura review. Mycoses 2013; 56(3):189-99. doi: 10.1111/myc.12017.

Godoy H, Reichaart A. Oral manifestations of paracoccidioidomycosis. Report of 21 cases from Argentina. Mycoses 2003; 46(9-10):412-7. doi: 10.1046/j.0933-7407.2003.00917.x.

Webber LP, Martins MD, de Oliveira MG, Munhoz EA, Carrard VC. Disseminated paracoccidioidomycosis diagnosis based on oral lesions. Contemp Clin Dent 2014; 5(2):213-6. doi: 10.4103/0976-237X.132340.

Goldani LZ, Aquino VR, Lunardi LW, Cunha VS, Santos RP. Two specific strains of Histoplasma capsulatum causing mucocutaneous manifestations of histoplasmosis: preliminary analysis of frequent manifestations of histoplasmosis in southern Brazil. Mycopathologia 2009; 167(4):181-6. doi: 10.1007/s11046-008-9171-7.

Shankar J, Restrepo A, Clemons K, Stevens D. Hormones and the resistence of women to paracoccidioidomycosis. Clin Microbiol Rev 2011; 24(2):296-313. doi: 10.1128/CMR.00062-10.

Kauffman C. Histoplasmosis: A clinical and laboratory update Clin Microbiol Rev 2007; 20(1):115-32. doi: 10.1128/CMR.00027-06.

Hernández SL, López De Blanc SA, Sambuelli RH, Roland H, Cornelli C, Lattanzi V, Carnelli MA. Oral histoplasmosis associated with HIV infection: A comparative study. J Oral Pathol Med 2004; 33(8):445-50. doi: 10.1111/j.1600-0714.2004.00200.x-i1.

Lopez-Martinez R, Hernandez-Hernanadez F, Mendez-Tovar L, Manzano-Gayosso P, Bonifaz A, Arenas R, et al. Paracoccidioidomycosis in Mexico: Clinical and epidemiological data from 93 new cases (1972-2012). Mycoses 2014; 57(9):525-30. doi: 10.1111/myc.12190.

Mota de Almeida F, Kivijärvi K, Roos G, Nylander K. A case of disseminated histoplasmosis diagnosed after oral presentation in an old HIV-negative patient in Sweden. Gerodontology 2015; 32(3):234-6. doi: 10.1111/ger.12150.

Jain VV, Evans T, Peterson MW. Reactivation histoplasmosis after treatment with anti-tumor necrosis factor alpha in a patient from a nonendemic area. Respir Med 2006; 100(7):1291-3. doi: 10.1016/j.rmed.2005.09.020.

Vergidis P, Avery RK, Wheat LJ, Dotson JL, Assi MA, Antoun SA, et al. Histoplasmosis complicating tumor necrosis factor-α blocker therapy: A retrospective analysis of 98 cases. Clin Infect Dis 2015; 61(3):409-17. doi: 10.1093/cid/civ299.

Myint T, Anderson AM, Sanchez A, Farabi A, Hage C, Baddley JW, et al. Histoplasmosis in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS): Multicenter study of outcomes and factors associated with relapse. Medicine 2014; 93(1):11-8. doi: 10.1097/MD.0000000000000016.

Jaimes A, Muvdi S, Alvarado Z, Rodriguez G. Perforation of the nasal septum as the first sign of histoplasmosis associated with AIDS and review of published literature. Mycopathologia 2013; 176(1-2):145-50. doi: 10.1007/s11046-013-9662-z.

Patil K, Mahima V, Prathibha R. Oral histoplasmosis. J Indian Soc Periodontol 2009; 13(3):157-9. doi: 10.4103/0972-124X.60230.

Vargas PA, Mauad T, Böhm G, Saldiva PHN, Almeida O. Parotid gland involvement in advanced AIDS. Oral Dis 2003; 9(2):55-61. doi: 10.1034/j.1601-0825.2003.02868.x.

Torres-Esteche V, Arteta Z, Torres G, Vaucher A, Gezuele E, Balleste R. Un caso excepcional de paracoccidioidomicosis e histoplasmosis pulmonares de presentación concomitante. J Bras Pneumol 2012; 38(2):264-8. doi: 10.1590/S1806-37132012000200017.

Shikanai-Yasuda MA, Conceição YM, Kono A, Rivitti E, Campos AF, Campos SV. Neoplasia and paracoccidioidomycosis. Mycopathologia 2008; 165(4-5):303-12. doi: 10.1007/s11046-007-9047-2.

Benard G. An overview of the immunopathology of human paracoccidioidomycosis. Mycopathologia 2008; 165(4-5):209-21. doi: 10.1007/s11046-007-9065-0.

Rodrigues G da S, Severo CB, Oliveira F de M, Moreira J da S, Prolla JC, Severo LC. Association between paracoccidioidomycosis and cancer. J Bras Pneumol 2010; 36(3):356-62. doi: 10.1590/S1806-37132010000300014.

Souza-Azevedo R, Ferreira A, Ajudarte-Lopes M, Brum-Correa M, Jorges J. Synchronous oral paracoccidioidomycosis and oral squamous cell carcinomas with submandibular enlargement. Med Mycol 2011; 49(1):84-9. doi: 10.3109/13693786.2010.496118.

Padula DH. Paracoccidioidomycosis: Estudio sobre 284 pacientes en la Provincia de Misiones. Rev Asoc Odontol Argent 1999; 87(3):251-3.

Oliveira-Gondak R, Mariano FV, Dos Santos-Silva AR, Vargas PA, Ajudarte-Lopes M. Single oral paracoccidioidomycosis mimicking other lesions: Report of eight cases. Mycopathologia 2012; 173(1):47-52. doi: 10.1007/s11046-011-9461-3.

Rodrigues Azenha M, Caliento R, Brentegani LG, De Lacerda SA. A retrospective study of oral manifestations in patients with paracoccidioidomycosis. Braz Dent J 2012; 23(6):753-7. doi: 10.1590/S0103-64402012000600021.

Do Valle AC, Moreira LC, Almeida-Paes R, Moreira J, Pizzini C, Muniz M, Zancopé-Oliveira R. Chronic disseminated histoplasmosis with lesions restricted to the mouth: Case report. Rev Inst Med Trop Sao Paulo 2006; 48(2):113-6. doi: 10.1590/S0036-46652006000200012.

Iqbal F, Schifter M, Coleman HG. Oral presentation of histoplasmosis in an immunocompetent patient: A diagnostic challenge. Aust Dent J 2014; 59(3):386-8. doi: 10.1111/adj.12187.

Viswanathan S, Chawla N, D’Cruz A, Kane S. Head and neck histoplasmosis - A nightmare for clinicians and pathologists! Experience at a tertiary referral cancer centre. Head and Neck Pathol 2007; (1):169-72. doi: 10.1007/s12105-007-0034-1.




DOI: http://dx.doi.org/10.4034/PBOCI.2018.181.07

PBOCI is a member of CrossRef and all the content of its journals are linked by DOIs through CrossRef.