Paracoccidioidomycosis: a recently proposed classification of its clinical forms.

Many attempts have been made to define the cli­ nical forms of human paracoccidioidomycosis15. Several classifications are based on different para­ meters of the disease such as entry route (tegumentary or pulmorary15); presence or absence of signs and/or symptoms (infection vs. disease2 14); organs involved (lymphatic form; pulmonary form15); presen­ ce or absence of activity (active; latent12); type of evolution (progressive; regressive1 2 20); duration of the disease (acute; subacute; chronic4); clinical course (localised; systemic4 26); type of infection (primary; endogenous or exogenous reinfection19); presence or absence of sequelae (cor pulmonale; Addison’s disea­ se12); pathological anatomy (isolated organic form; pseudotumoral forms22) and immunohistological res­ ponse (polar forms21). This variety of criteria is an indication of the partial acceptance of most of them. This is comprehen­ sible since we still do not know where the fungus comes from and how it invades the human host, making difficult the evaluation of the early phases of the disease. In the “ Segundo Encontro sobre Paracoccidioidomicose” held in Botucatu, Brazil, in 1983, a commi­ ttee of experts* was nominated with the objective of proposing a classification of clinical forms of the disease. A questionnaire was circulated among the members and the committee reconvened at the Inter­