PULMONARY PARACOCCIDIOIDOMYCOSIS IN THE PNEUMOLOGY UNIT OF GENERAL HOSPITAL IN RECIFE ( BRASIL ) . IJ Paracoccidioidomicosis pulmonar en la . unidad de neumología de un hospital general en Recife ( Brasil ) / '

In order to determine the presence of fungi in clinical sal11ples of the respiratory system, 322 patients with pneul110pathieswere surveyed. Al! ofthem had been hospitalised in the Pneumology Unit of the Otavio de Freitas General Hospital, Recife, PE, Brazil. Paracoccidioidomycosis was diagnosed in 7 male patients (2.1%), and involvedwith work in the rural zone. In 6 cases there was a "diagnostic mistake" between pulmonary tuberculosis and pull110nary paracoccidioidomycosis; in 1 case the associa!ion of these two pneumopathies was verified.

twoofthem (Londero& Severo, 1981;Rippon, 1982;Wanke, .. 1984;Lacazetal.,1991).Almeida.In Brasil it isthemostfrequentsystemicmYCosis, specially in the SouthEast, South and Centre-West, with less incidence in the Northeast and rarely in Amazonia (Wanke, 1984).The objectives ofthis papers were detect, isolate and identity fungi of the respiratory system of patients hospitalised in the Pneumology Unit of the Otavio de Freitas General Hospital, Recife, PE, Brasil; to determine the existence of fungal pneumopathy; to verity the association of this pneumopathy with other pathologies ofthe respiratory system.

MATERIAL AND METHODS
Clinical samples were collected from patients with problems in therespiratory system who had been hospitali-zed in mentioned institution.In 322 patient surveyed, 225 were males and 97 females .From each patient who had not been drainedand wasfasting, sputumsampleswerecollected 3 times at intervals of 3 to 4 days in sterilized Petri dishes; samples of secretions of the lesions from buccal (cheek and gums) mucosa were al so collected from one patient and transferred by physiological drip contained in a test tube.After collection, the c1inical samples were transported to the Department of Mycology where they were duly processed for direct examination and culture.The time between collection and manipulation ofthe samples dit not exceed 2 hours.The direct exarnination both of the sputum and the secretions of lesions from buccal mucosa was undertaken in the native state (without colouring and without c1arifier), and c1arified with aqueous solution with 20% potassium hydroxide.
In duplicate, the c1inical samples were seeded by spreading on their surface agar infusion ofbrain and heart (BHIDifco) andwith Sabouraudagar+O,5%ofyeastextract (YE), to both of which 50 mg ofCaf.!1 were added.A plate of each method was left at room temperature (RT 28°C approx.)and the other at 37°C.Culture pI ates were incubated for 3 weeks.The pure culture obtained were maintained in BHI agar and Sabouraud + 0.5% of YE and at RT.The identification of P. brasiliensis was confirmed through Conant etal., 1971;Rippon, 1982;Lacazetal., 1991.

RESULTS AND DISCUSSION
PP Was diagnosed through thedirect examination of sputumof 7 (2.1%) patients (Table 1).Onlyoneofthesewas a bearer of lesions in the buccal mucosa and the direct examination of the secretion ofthe latter also revealed the presenceof P. brasiliensis.Thedirectexaminationofsputum andsecretion revealed the presence ofyeast-likecellswith double contour, single and multiple budding, resulting in "Mickey mouse" formations, in a chain and in helm shape, characteristic of parasitic phase of P. brasiliensis (Figures 1 to 7).
AH the cases of PP were diagnosed in male patients, with a rninimum age of 17 and a maximum of76 years, the majority of cases being between the ages of 31 and 48.Among the 7 patients, 6 were from the rural zone ofthe State of Pernambuco, and engaged in ruml work; only one patient was a native of the$tate o"f Alagoas and aIthough he had been a resident ofthe city of Recife for 20 years working as a watchman, he had once been a rural worker (Table .1) These results agree with those previously reported in the Iiterature according to which the rural worker over 30 years old. is the representative of the majority of the reports of P ; however there are reports of the afores aid mycosis in 64 individual s who have never undertaken rural work (Conant etal., 1971 ;Rippon, 1982;Wanke , 1984;Lacazetal.,1991).
The 7 patiens with PP had been previously treated has having PT, 1 with positive BAAR (Bacilo-aIcohol-acid resistant), 5 with negativeBAARand 1 without BAAR ha• ving been undertaken (Table 1).In 6 of these cases it was verified that the pneumopathy was PP and only 1 case was the association confirmed between the 2 pneumopathies,Pll and PT.Among the 6 patients uniquely with PP, only 1 was also a carrier of diabetes mellitus (Table 1).
According to Wanke (1984), PP may l?e associated with PT as well as with neoplasias, reflecting irnmunologi• cal compromise which accompanies the disease.
The ocurrence of a case of P in the State of Pero nambuco, Northeast ofBrasil was reported by Guimaraeset al. (1985); since then personal communication by profession• als in the Health field has indicated various cases ofthis mycosis in the same State.On the other hand, Carneiro( 1993), found 20% of positiveness for paracoccidioidine in school children of Greater Recife, these results indicate the contact of these childrens have with P. brasiliensis, and suggest the possible occurrence of this illness in Recife's inhabitants.
So we can concluded tha t no case of PP associated with another mycosis has been found; PP, occurred in an isolated manner in most cases; PP may be associated with PT; there may be "diagnostic mistake" between PP and PT.The direct examination of the sputum was conclusive for diagnosing PP.
is caused by the di morphic fungus Paracoccidioides brasiliensis (Splendore)