Contribuição ao estudo anátomo-clínico da Paracoccidioiodomicose em Minas Gerais. meio século de experiência - avaliação das necrópsias realizadas no período compreendido entre 1944 até 1999, no departamento de anatomia patológica e medicina legal, da Faculdade de Medicina da Universidade Federal de Minas Gerais.

Abstract

Paracoccidioidomycosis (PCM), caused by a dimorphic fungus Paracoccidioides brasiliensis, is the most prevalent mycosis in Latin America. Brazil is located in the endemic center, and Minas Gerais (MG) state has a great relevance. It entails social and economical costs not only caused by the disease itself, being responsible for high morbidity and mortality. In this study, it was attempted to conduce a comprehensive and systematic study of the lethal paracoccidioidomycosis cases observed in almost half a century experience (1944 to 1999) of the Anatomical Pathology and Forensic Department of the Medical School of the UFMG. From the 41 autopsied patients with PCM in this period, all came from MG state and 71% were male, with a ratio of 2.4 men to each woman. The average age was 27.8 years, with a predominance of patients aged between 18 and 40 (46%). The brown color skin was found in 44% of patients. The MG state mesoregions, presented by order of decreasing frequency, showed: Central/Centroeste (36.6%), da Mata (19.5%), Vale do Rio Doce (17.1%), Vale do Mucuri/Jequitinhonha (14.6%), Sul/Sudoeste (4.9%), Norte/Noroeste (2.4%) and Alto Paranaíba/Triangulo Mineiro (2.4%). Agriculture was the main working activity counting 39% of the cases. The most frequent signal and symptoms were lymphadenomegaly (79%), weight loss (72%), asthenia/hipodinamia (65%), mucocutaneous pallor (62%) and fever (52%). The predominant clinical form found was the disseminated type, corresponding to 34% of patients. Lymphonodal, mucocutaneous and pulmonary involvement were observed, isolated or associated with other forms, in 59%, 56% and 49% of cases, respectively. Unifocal clinical forms showed the following distribution: lymph node (24%), mucocutaneous (22%), visceral (15%), pulmonary (7%), neurological (5%) and bone (5%). The predominant anatomoclinical presentation was the acute/subacute form, represented by 54% of the cases. Lymph nodes involvement was present in 100% (p <0.028), 91% spleen (p <0.001), 68% liver (p <0.024) and 50% of the gastrointestinal tract (p <0.003). The chronic form/multifocal represented 46% of cases, showing involvement of 79%, 73%, 42%, and 42% of lymph nodes (p <0.028), lungs, spleen (p <0.001) and skin and mucosae, respectively. The average time of progression to death was 7.8 months. There was discordance between the clinical diagnosis hypothesis and anatomopathological findings in 28 of 41 cases (68%). Intestinal parasites, schistosomiasis, and tuberculosis were major associated infections found. Associated neoplasia was not detected. These data show the great importance of the necropsy study in understanding several issues related to the PCM in order to better comprehend the natural behavior and be able to design strategies to epidemic control, diagnostic methods, clinical evolution and therapeutic.