MSD Manual

Please confirm that you are not located inside the Russian Federation

honeypot link


(South American Blastomycosis)


Sanjay G. Revankar

, MD, Wayne State University School of Medicine

Reviewed/Revised Apr 2021 | Modified Sep 2022
Topic Resources

Paracoccidioidomycosis is an infection caused by the fungus Paracoccidioides brasiliensis.

  • Spores of the fungus, which grow in soil, may be inhaled.

  • Most people have no symptoms, but symptoms, if they occur, usually occur years after people inhale the fungus.

  • Paracoccidioidomycosis usually causes a cough, fever, shortness of breath, and difficulty breathing, but it can cause sores, swollen lymph nodes, and sometimes abdominal pain.

  • Doctors diagnose the infection by identifying the fungus in tissue samples.

  • Doctors usually treat paracoccidioidomycosis with the antifungal drug itraconazole.

Paracoccidioidomycosis is caused by inhaling spores of the fungus, which grow in soil.

Paracoccidioidomycosis usually involves the lungs, skin, mouth, throat, and lymph nodes, although it sometimes appears in the liver or spleen.

It occurs more often in men aged 20 to 50, particularly agricultural workers such as coffee growers in Colombia, Venezuela, and Brazil. About 5 to 10% of cases occur in younger people (both sexes). It occurs only in parts of South and Central America (particularly Brazil), where an estimated 10 million people are infected.

Paracoccidioidomycosis typically infects people with a healthy immune system. However, it sometimes occurs in people who have a weakened immune system (because of another disorder or use of drugs that suppress the immune system).

Symptoms of Paracoccidioidomycosis

Most people who inhale the spores develop an infection that causes no symptoms. Symptoms, if they occur, usually develop months to years after the initial exposure.

Paracoccidioidomycosis, if it develops, usually resembles pneumonia Overview of Pneumonia Pneumonia is an infection of the small air sacs of the lungs (alveoli) and the tissues around them. Pneumonia is one of the most common causes of death worldwide. Often, pneumonia is the final... read more Overview of Pneumonia , causing a cough, fever, shortness of breath, and difficulty breathing, and may resolve on its own.

The infection may spread from the lungs to other parts of the body. Painful sores may develop in the mouth and on the skin. Infected lymph nodes become swollen, and pus may drain from them, breaking through the skin but causing little pain. The lymph nodes most commonly infected are those in the neck and under the arms. The liver and spleen may enlarge, sometimes causing abdominal pain. Sometimes symptoms last a long time, but the infection is rarely fatal.

Some people with paracoccidioidomycosis develop a chronic lung disorder, which causes scarring (fibrosis) and widespread damage in the lungs (emphysema).

When paracoccidioidomycosis occurs in younger people or in people with HIV infection or AIDS, the infection is more aggressive. It spreads widely, including to the bone marrow and other organs. People have a fever and lose weight. The lymph nodes, liver, and spleen enlarge, and anemia develops.

Diagnosis of Paracoccidioidomycosis

  • Examination and culture of samples of infected tissue

Doctors suspect paracoccidioidomycosis based on symptoms and results of the physical examination.

To diagnose paracoccidioidomycosis, a doctor takes tissue samples for examination under a microscope and for culture.

Treatment of Paracoccidioidomycosis

  • Itraconazole (an antifungal drug)

The antifungal drug itraconazole, given by mouth, is the treatment of choice for paracoccidioidomycosis.

Trimethoprim/sulfamethoxazole is an alternative, but people must take it much longer (for example, for up to 5 years) than itraconazole (for example, for 6 to 12 months).

Amphotericin B is also effective, but because of its side effects, it is reserved for very severe cases.

quiz link

Test your knowledge

Take a Quiz!