P. brasiliensis has the peculiarity among the fungi of responding to treatment with sulfa drugs. However regimens with these agents require maintenance treatment for up to 5 years. Amphotericin B is not curative by itself and should be given with sulfas or azoles. The azole antifungals have provided a significant advance in the treatment of paracoccidioidomycosis. Histopathology Areas of granulomatous inflammation containing focal area of central caseation mixed with pyogenic abscesses are usually present.
Many giant cells are present in the granulomatawhich contain the organisms.
The fungus occurs as a budding yeast with cells 12-14 um in diameter. The central cell is surrounded by numerous blastoconidia of various sizes that are attached by narrow necks. Some cells may reach 60 um in diameter. Isolation Inoculate the clinical material onto Sabouraud dextrose agar and a medium containing cycloheximide. The colony may require 10 or more days to reach 1 cm in diameter.