Monthly serologic monitoring recommended for 2 years after stopping
Sequelae prevention and management
Pulmonary fibrosis: early treatment initiation may reduce extent
Baseline and annual pulmonary function testing
Smoking cessation counseling
Microstomy (reduced oral aperture) from orofacial fibrosis
ENT and oral surgery referral for reconstructive planning
Addison's syndrome: lifelong steroid replacement if adrenal destruction occurs
Neurological sequelae: rehabilitation referral for persistent deficits
Patient Discharge Instructions
copy discharge instructions
Diagnosis and disease explanation
Paracoccidioidomycosis (PCM) is a fungal infection caused by Paracoccidioides
Endemic to South and Central America; acquired by inhaling soil fungi
Not contagious from person to person
This infection requires months to years of antifungal treatment
Do not stop your medication early, even if you feel better
Medication instructions
Itraconazole: take every day with a full meal or cola drink
Avoid antacids (Tums, Maalox), omeprazole, or ranitidine — these reduce absorption
Do not drink alcohol during treatment (liver damage risk)
Take itraconazole at the same time each day
TMP-SMX: take twice daily with plenty of water
Report rash, severe stomach pain, or unusual bruising immediately
Steroid replacement (if prescribed): never skip a dose
Carry a medical alert card or bracelet indicating adrenal insufficiency
Double dose during any illness, fever, or surgical stress (sick-day rules)
Follow-up instructions
Return to clinic in 2–4 weeks for blood tests and symptom check
Liver blood tests and fungal antibody levels will be monitored
Treatment will last at least 9–18 months; follow-up is essential throughout
Do not miss appointments — stopping treatment too early causes relapse
Return to emergency department immediately for
Worsening shortness of breath or coughing up blood
Severe mouth pain or inability to swallow
New or worsening headache, seizure, confusion, or weakness
Fainting, severe dizziness, or very low blood pressure
Yellowing of skin or eyes (jaundice) suggesting liver problems
New skin sores or rapidly enlarging lymph nodes
Fever above 38.5°C not responding to acetaminophen
Nausea and vomiting preventing medication intake
References
Guidelines and key sources
Thompson GR, Le T, Chindamporn A, et al.
Global Guideline for the Diagnosis and Management of the Endemic Mycoses
The Lancet Infectious Diseases 2021
https://pubmed.ncbi.nlm.nih.gov/34364529
Hahn RC, Hagen F, Mendes RP, et al.
Paracoccidioidomycosis: Current Status and Future Trends
Clinical Microbiology Reviews 2022
https://pubmed.ncbi.nlm.nih.gov/36074014
Queiroz-Telles F, Fahal AH, Falci DR, et al.
Neglected Endemic Mycoses
The Lancet Infectious Diseases 2017
https://pubmed.ncbi.nlm.nih.gov/28774696
de Siqueira NPL, da Silva Pinto G, Ueda CY, et al.
Paracoccidioidomycosis in Childhood and Adolescence: Clinical-Epidemiological Review of South American Cases (1970–2023)
Mycopathologia 2025
https://pubmed.ncbi.nlm.nih.gov/41298938
Comparative treatment trials
Cavalcante Rde S, Sylvestre TF, Levorato AD, et al.
Comparison Between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidioidomycosis
PLoS Neglected Tropical Diseases 2014
https://pubmed.ncbi.nlm.nih.gov/24743230
Borges SR, Silva GM, Chambela Mda C, et al.
Itraconazole vs. Trimethoprim-Sulfamethoxazole: A Comparative Cohort Study of 200 Patients With Paracoccidioidomycosis
Medical Mycology 2014
https://pubmed.ncbi.nlm.nih.gov/24577007
Kruschewsky WLL, de Freitas VLT, Taborda M, et al.
Therapeutic Drug Monitoring of Itraconazole in Endemic Paracoccidioidomycosis: Real-World Data
Mycopathologia 2025
https://pubmed.ncbi.nlm.nih.gov/41400786
Venturini J, Fernandez NB, de Macedo PM, et al.
Paracoccidioidomycosis in the 21st Century: Challenges and Milestones
PLoS Neglected Tropical Diseases 2026
https://pubmed.ncbi.nlm.nih.gov/41494000
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.