XI International Meeting on Paracoccidioidomycosis

XI International Meeting on Paracoccidioidomycosis

Resume:161-1

Investigação

161-1

The lung in treated Paracoccidioidomycosis patients: new insights into an old problem.

Authors:

Andre Nathan Costa (HC-FMUSP - Pulmonary Division, Heart Institute (InCor), USP) ; Andre Luis Pereira Albuquerque (HC-FMUSP - Pulmonary Division, Heart Institute (InCor), USP) ; Adriana Satie Kono Magri (HC-FMUSP - Infectious Diseases Division, Hospital das Clínicas, USP) ; Gil Benard (HC-FMUSP - Laboratory of Dermatology and Immunodeficiencies) ; Ronaldo Adib Kairalla (HC-FMUSP - Pulmonary Division, Heart Institute (InCor), USP) ; Maria Shicanai Yasuda (HC-FMUSP - Infectious Diseases Division, Hospital das Clínicas, USP) ; Carlos Roberto Ribeiro Carvalho (HC-FMUSP - Pulmonary Division, Heart Institute (InCor), USP)

Abstract

RATIONALE: Paracoccidioidomycosis (PCM) is the most frequent systemic਀洀礀挀漀猀椀猀椀渀匀漀甀琀栀䄀洀攀爀椀挀愀Ⰰ 愀渀搀㠀　─ 漀昀眀漀爀氀搀挀愀猀攀猀漀挀挀甀爀椀渀䈀爀愀稀椀氀⸀ 倀甀氀洀漀渀愀爀礀 involvement is the main feature in chronic form of disease, with some patients਀搀攀瘀攀氀漀瀀椀渀最爀攀猀椀搀甀愀氀爀攀猀瀀椀爀愀琀漀爀礀愀戀渀漀爀洀愀氀椀琀椀攀猀愀昀琀攀爀琀爀攀愀琀洀攀渀琀⸀ 䤀渀琀栀椀猀猀琀甀搀礀眀攀 evaluated lung tomographic and functional abnormalities in PCM patients.਀䴀䔀吀䠀伀䐀匀㨀倀爀漀猀瀀攀挀琀椀瘀攀攀瘀愀氀甀愀琀椀漀渀漀昀㐀㤀瀀漀猀琀ⴀ琀爀攀愀琀洀攀渀琀氀甀渀最倀䌀䴀瀀愀琀椀攀渀琀猀眀椀琀栀 chest high-resolution computed tomography (HRCT), spirometry,਀瀀氀攀琀栀礀猀洀漀最爀愀瀀栀椀挀Ⰰ 挀愀爀搀椀漀瀀甀氀洀漀渀愀爀礀攀砀攀爀挀椀猀攀琀攀猀琀Ⰰ 猀椀砀洀椀渀甀琀攀眀愀氀欀琀攀猀琀 ⠀㘀䴀圀吀⤀ and respiratory quality of life questionnaire. RESULTS: Mean age was 57±7਀礀攀愀爀猀⸀ 䘀漀爀琀礀ⴀ渀椀渀攀瀀愀琀椀攀渀琀猀眀攀爀攀挀甀爀爀攀渀琀漀爀昀漀爀洀攀爀猀洀漀欀攀爀猀Ⰰ 洀攀愀渀氀攀渀最琀栀漀昀 38.5±1.4 pack-years. Mean time elapsed between treatment institution and਀攀渀爀漀氀氀洀攀渀琀眀愀猀㘀넀㌀⸀㤀礀攀愀爀猀Ⰰ 愀渀搀洀攀愀渀琀爀攀愀琀洀攀渀琀氀攀渀最栀眀愀猀昀漀甀爀礀攀愀爀猀⸀ 䴀攀愀渀 initial serology was 106±42 and mean final serology was 5±1. Main HRCT਀昀椀渀搀椀渀最猀眀攀爀攀愀爀挀栀椀琀攀挀琀甀爀攀搀椀猀琀漀爀琀椀漀渀 ⠀㤀㈀─⤀Ⰰ 猀攀瀀琀愀氀琀栀椀挀欀攀渀椀渀最愀渀搀爀攀琀椀挀甀氀愀爀 opacities (90%), bronchial wall thickening (84%), peribronchovascular interstitial thickening and nodules (64%) and ground glass opacities (48%). Air trapping was found in 78% of patients. The radiologic findings were diffusely present in all lung zones in 84% of patients. Pulmonary function tests showed: forced vital capacity 3.8±0.9L (93±18% predicted), forced expiratory volume in 1 second 2.5±0.7 L (79.6±20%), total lung capacity 6.2±1.3 L (101±16%), residual volume 2.5±0.9 L (125 ± 40%), and DLCO 72%. Cardiopulmonary exercise test showed: maximum oxygen uptake 21.0±1,2 mL/kg/min (66±17%), maximal਀眀漀爀欀爀愀琀攀㜀㌀Ⰰ　넀㤀Ⰰ㈀─Ⰰ 洀愀砀椀洀愀氀栀攀愀爀琀爀愀琀攀㜀㌀Ⰰ㔀넀㤀Ⰰ㄀─Ⰰ 漀砀礀最攀渀瀀甀氀猀攀㄀　⸀㤀넀㈀Ⰰ㠀 mL/beat, minute ventilation 191.7±22.2 L/min (53.7±8,5%) and minute਀瘀攀渀琀椀氀愀琀椀漀渀⼀洀愀砀椀洀愀氀瘀漀氀甀渀琀愀爀礀瘀攀渀琀椀氀愀琀椀漀渀　⸀㘀㄀ 넀 　⸀　㤀Ⰰ 眀椀琀栀愀洀攀愀渀瘀攀渀琀椀氀愀琀漀爀礀 reserve of 39%. Mean walked distance (6MWT) was 574±21 meters (85% of਀瀀爀攀搀椀挀琀攀搀⤀⸀ 匀愀椀渀琀䜀攀漀爀最攀刀攀猀瀀椀爀愀琀漀爀礀儀甀攀猀琀椀漀渀渀愀椀爀攀洀攀愀渀瘀愀氀甀攀猀眀攀爀攀㘀　㜀넀㜀㠀 points, showing low impact of the pulmonary symptoms in quality of life.਀䌀伀一䌀䰀唀匀䤀伀一匀㨀䠀攀爀攀椀渀眀攀椀渀搀椀挀愀琀攀Ⰰ 椀渀搀椀猀愀最爀攀攀洀攀渀琀眀椀琀栀挀甀爀爀攀渀琀氀椀琀攀爀愀琀甀爀攀Ⰰ that adequately treated PCM patients present very frequent radiological਀愀戀渀漀爀洀愀氀椀琀椀攀猀渀漀琀猀漀氀攀氀礀愀琀琀爀椀戀甀琀攀搀琀漀琀漀戀愀挀挀漀攀砀瀀漀猀甀爀攀⸀ 䠀漀眀攀瘀攀爀Ⰰ 琀栀攀猀攀 findings, associated to mild static and dynamic functional abnormalities and with slight abnormal exercise capacity, are not linked to a severe life impact.

Keyword: LUNG, respiratory sequelae, treated paracocicdioidomycosis

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