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Page number:812 
Description type:Pathology 
Description:Pathogenicity. BSL-3. Agent of paracoccidioidomycosis (p. 25). The species causes a systemic, chronic disease, occasionally occurring in otherwise healthy patients (Benard et al., 1994). The portal of entry is not known with certainty. Possibly the fungus is acquired by inhalation, but it may also be introduced by local trauma. Infection may lead to painful, erosive stomatitis with loss of teeth (Godoy & Reichart, 2003), frequently associated with swollen lymph nodes. The fungus has a predilection for mucosa and may be found in the male genital tract (Severo et al., 2000), rarely in the intestines (Hahn et al., 2003). It is abundantly present with yeast cells in pus and in tissue, allowing direct diagnosis by fine-needle aspiration (Drut, 1995). Bone invasion is often observed (Amstalden et al., 1996; Fulciniti et al., 1996). Eventually the lymphatic system, intestines, spleen, lungs and liver may become involved. Neurological cases are uncommon, but frequently have fatal outcome (Plá et al., 1994). Infections are rarely superficial, with no signs of systemic disease (Tomimori-Yamashita et al., 1997), or perianally (Ollague et al., 2000). Male, alcoholic patients are particularly affected (Meneses-Garcia et al., 2002). In contrast to most systemic Onygenales, it is relatively infrequently found in AIDS patients (Goldani & Sugar, 1995), although such cases do occur (Tobon et al., 1998). Reactivation may take place long after the patient has left endemic areas (Manns et al., 1996). Rural dogs frequently have raised antibodies but are mostly not infected (Ono et al., 2001), though Ricci et al. (2004) reported an invasive case. Armadillos could be a natural reservoir (Vidal et al., 1995; Corredor et al., 1999; Silva-Vergara et al., 2000; Tanaka et al., 2001; Corredor et al., 2005). The fungus is found in soil (Franco et al., 2000; Silva-Vergara et al., 1998).
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