Occasional cases have been observed in the United States in patients traveling from countries where this mycosis is endemic. Male rural workers from 30 to 60 years of age constitute the population at risk. Paracoccidioides is most frequently acquired by inhalation of the organism. The primary lung infection may be asymptomatic and then disseminate to involve mucous membranes, lymph nodes, and other organs. The mucosal lesions are ulcerative with a serpiginous active border and a crusted surface.
Microscopic examination is important for the diagnosis of paracoccidioidomycosis.
Nonbudding cells may resemble Blastomyces dermatitidis, Histoplasma and Coccidioides. Carcinomas have been associated with scarring after infection. Progressive chronic forms are treated with itraconazole for long periods. References Belfort Jr R, Fishman O, Camargo ZP, Almada A. Paracoccidioidomycosis with palpebral and conjunctival involvement. Pathology of Tropical and Extraordinary Diseases.