title: The lung in paracoccidioidomycosis: new insights into old problems.
abstract: OBJECTIVE
  Chronic paracoccidioidomycosis can diffusely affect the lungs. Even after antifungal therapy, patients may present with residual respiratory abnormalities due to fungus-induced lung fibrosis.
  
  
  METHODS
  A cross-sectional analysis of 50 consecutive inactive, chronic paracoccidioidomycosis patients was performed using high resolution computed tomography, pulmonary function tests, ergospirometry, the six-minute walk test and health-related quality of life questionnaires.
  
  
  RESULTS
  Radiological abnormalities were present in 98% of cases, the most frequent of which were architectural distortion (90%), reticulate and septal thickening (88%), centrilobular and paraseptal emphysema (84%) and parenchymal bands (74%). Patients typically presented with a mild obstructive disorder and a mild reduction in diffusion capacity with preserved exercise capacity, including VO2max and six-minute walking distance. Patient evaluation with the Saint-George Respiratory Questionnaire showed low impairment in the health-related quality of life, and the Medical Research Council questionnaire indicated a low dyspnea index. There were, however, patients with significant oxygen desaturation upon exercise that was associated with respiratory distress compared with the non-desaturated patients. The initial counterimmunoelectrophoresis of these patients was higher and lung emphysema was more prominent; however, there were no differences in the interstitial fibrotic tomographic abnormalities, tobacco exposure, functional responses, exercise capacity or quality of life.
  
  
  CONCLUSIONS
  Inactive, chronic paracoccidioidomycosis patients show persistent and disseminated radiological abnormalities by high resolution computed tomography, short impairments in pulmonary function and low impacts on aerobic capacity and quality of life. However, there was a subset of individuals whose functional impairment was more severe. These patients present with higher initial serology and more severe emphysema, stressing the importance of adequate treatment associated with tobacco exposure cessation.
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, Heart Institute (InCor), Pulmonary Division, São Paulo/SP, Brazil. nathan.andre@gmail.com
authors.forename: Andre Nathan
authors.initials: AN
authors.lastname: Costa
authors.forename: Gil
authors.initials: G
authors.lastname: Benard
authors.forename: Andre Luis Pereira
authors.initials: AL
authors.lastname: Albuquerque
authors.forename: Carmem Lucia
authors.initials: CL
authors.lastname: Fujita
authors.forename: Adriana Satie Kono
authors.initials: AS
authors.lastname: Magri
authors.forename: João Marcos
authors.initials: JM
authors.lastname: Salge
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Shikanai-Yasuda
authors.forename: Carlos Roberto Ribeiro
authors.initials: CR
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004812:Epidemiologic Methods; D005260:Female; D005355:Fibrosis / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D010229:Paracoccidioidomycosis / Q000473:pathology / Q000503:physiopathology*; D011788:Quality of Life; D012129:Respiratory Function Tests; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed