title: Hepatic involvement in pediatric patients with paracoccidioidomycosis: a clinical and laboratory study.
abstract: The liver is one of the organs most affected by paracoccidioidomycosis, a systemic mycosis endemic in some Latin American countries. The majority of articles focused on adult populations and failed to describe any detailed experience of liver abnormalities in pediatric patients. Therefore, the aim of this study was to describe the frequency and characteristics of liver involvement in children with paracoccidioidomycosis. This study comprised 102 patients less than 16 years of age (median 104.3 months) diagnosed with paracoccidioidomycosis from 1980 to 2010. Diagnosis was established by the identification of fungus. Forty-one patients had liver involvement. The main clinical features were generalized lymph node enlargement (39/41), weight loss (34/41) and fever 32/41). Approximately, one-third of the patients had jaundice. Patients with hepatic involvement were younger. A predominant elevation of canalicular enzymes occurred. There was a statistically significant difference in albumin (p < 0.001) and hemoglobin (p = 0.002) values between patients with and without liver involvement, and the lowest values were found in the former group. Cutoff levels of albumin (<3.05 g/dL) and hemoglobin (<9.2 g/dL) can be used to infer hepatic involvement. Hypoalbuminemia (median 2.4 g/dl) is more severe in patients with hepatic involvement and may indicate a worse liver function or complication of the disease (intestinal lymphangiectasia). Deaths (6) occurred only among patients with liver involvement. Particular clinical and laboratory characteristics are present in pediatric patients with hepatic involvement. Younger patients and those with severe hypoalbuminemia are more likely to present liver involvement by Paracoccidioides brasiliensis.
authors.affiliation: Center for Investigation in Pediatrics, UNICAMP School of Medicine, Campinas, São Paulo, Brazil, gimed38@gmail.com.
authors.forename: Giselle de Melo
authors.initials: Gde M
authors.lastname: Braga
authors.forename: Gabriel
authors.initials: G
authors.lastname: Hessel
authors.forename: Ricardo Mendes
authors.initials: RM
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D001774:Blood Chemical Analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000453:epidemiology* / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D010228:Paracoccidioides / Q000302:isolation & purification*; D010229:Paracoccidioidomycosis / Q000150:complications*
references.citation: World J Gastroenterol. 2009 Oct 7;15(37):4653-8
references.pmid: 19787828
references.citation: Rev Soc Bras Med Trop. 1987 Apr-Jun;20(2):129-32
references.pmid: 3507739
references.citation: Rev Panam Salud Publica. 2008 May;23(5):313-24
references.pmid: 18510791
references.citation: Rev Paul Med. 1960 May;56:350-66
references.pmid: 13801826
references.citation: Rev Hosp Clin Fac Med Sao Paulo. 1981 Aug;36(4):172-8
references.pmid: 7330559
references.citation: Mol Biol Evol. 2006 Jan;23(1):65-73
references.pmid: 16151188
references.citation: Am J Trop Med Hyg. 1999 Sep;61(3):390-4
references.pmid: 10497977
references.citation: Mycopathologia. 2006 Feb;161(2):73-81
references.pmid: 16463090
references.citation: Rev Inst Med Trop Sao Paulo. 1968 May-Jun;10(3):188-91
references.pmid: 5737874
references.citation: Fungal Genet Biol. 2008 May;45(5):605-12
references.pmid: 18364259
references.citation: Rev Soc Bras Med Trop. 1999 Jan-Feb;32(1):31-3
references.pmid: 9927822
references.citation: Rev Soc Bras Med Trop. 2006 May-Jun;39(3):297-310
references.pmid: 16906260
references.citation: Rev Soc Bras Med Trop. 2006 Sep-Oct;39(5):478-83
references.pmid: 17160327
references.citation: Rev Inst Med Trop Sao Paulo. 2004 May-Jun;46(3):127-31
references.pmid: 15286812
references.citation: Rev Assoc Med Bras. 1964 Jul;10:151-4
references.pmid: 14187788
references.citation: Rev Soc Bras Med Trop. 2008 Mar-Apr;41(2):169-72
references.pmid: 18545838
references.citation: Histopathology. 1978 Jul;2(4):231-7
references.pmid: 700600
references.citation: Am J Clin Pathol. 1967 Apr;47(4):505-20
references.pmid: 6021555
references.citation: Mol Phylogenet Evol. 2009 Aug;52(2):273-83
references.pmid: 19376249
references.citation: Cad Saude Publica. 2002 Sep-Oct;18(5):1441-54
references.pmid: 12244377
references.citation: Rev Soc Bras Med Trop. 2003 Jul-Aug;36(4):455-9
references.pmid: 12937721
references.citation: Rev Hosp Clin Fac Med Sao Paulo. 1976 May-Jun;31(3):194-8
references.pmid: 935722
references.citation: Am J Trop Med Hyg. 2011 Sep;85(3):546-50
references.pmid: 21896820
references.citation: Bol Med Hosp Infant Mex. 1946 Sep-Oct;3(4):543-51
references.pmid: 20297387
references.citation: Clin Microbiol Rev. 1993 Apr;6(2):89-117
references.pmid: 8472249
references.citation: PLoS One. 2012;7(5):e37694
references.pmid: 22666382