PURPOSE: The association between paracoccidioidomycosis and tuberculosis is reported to be between 5.5% and 19%. Due to their clinical and radiological similitude, misdiagnosis of both diseases can occur if a definite microbiological diagnosis is not pursued. The objective of this study was to evaluate the frequency of the association and misdiagnosis in a teaching hospital scenario.
METHODS: 227 clinical sheets of patients previously treated for the adult chronic form of pulmonary paracoccidioidomycosis in our Division of Lung Diseases (period of time: 1980 to 2005), were retrospectively evaluated regarding the accuracy of diagnosis of both diseases based on the microbiological criteria, that is, AFB positivity or culture positivity for M tuberculosis, or the presence of, or positive culture for, the Paracoccidioides brasiliensis in sputum specimens.
RESULTS: All 227 patients had positive Paracoccidioides brasiliensis in sputum (positivity in direct examination or culture). Third six (36) cases (15.85%) had already been treated for tuberculosis, although only 18 (7,9%) had showed positive AFB or positive culture for M tuberculosis in the sputum. Analysis of the clinical sheets showed that the remaining 18 cases (AFB or culture negative) did not have any improvement during empirical treatment for tuberculosis.
CONCLUSION: In this group of patients with definite diagnosis of pulmonary paracoccidioidomycosis, the frequency of the association with tuberculosis was 7.9%, with a similar frequency of tuberculosis misdiagnosis.
CLINICAL IMPLICATIONS: Due to the clinical and radiological similitude between paracoccidioidomycosis and tuberculosis, AFB or culture positivity must be ascertained before the institution of prolonged tuberculosis treatment.
DISCLOSURE: Reynaldo Quagliato Jr, None.