MSD Manual

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Paschalis Vergidis

, MD, MSc, Mayo Clinic College of Medicine & Science

Reviewed/Revised Nov 2023
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 medication 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. It occurs only in parts of South and Central America.

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 medications 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. The most common symptom of... 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 (ulcers) may develop in the mouth and on the skin, most often the face, especially around the nose and mouth, including the tongue, throat, and gums.

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 people under age 30 years or in people with HIV infection or AIDS, it 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 medication)

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

Trimethoprim/sulfamethoxazole (sulfamethoxazole/trimethoprim, SMX-TMP, cotrimoxazole) 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.

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