Evaluation of the hepatobiliary system in patients with paracoccidioidomycosis treated with cotrimoxazole or itraconazole

A prospective study was performed in 200 paracoccidioidomycosis (PCM) patients, 51 presenting the acute/subacute form (AF) and 149 the chronic form (CF), submitted to the evaluation of the hepatobiliary system at admission and during the follow-up treatment with cotrimoxazole (CMX) or itraconazole (...

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Published in:Medical mycology (Oxford) 2018-07, Vol.56 (5), p.531-540
Main Authors: Levorato, Adriele Dandara, Moris, Daniela Vanessa, Cavalcante, Ricardo de Souza, Sylvestre, Tatiane Fernanda, de Azevedo, Priscila Zacarias, de Carvalho, Lídia Raquel, Mendes, Rinaldo Poncio
Format: Article
Language:English
Subjects:
Adult
Alanine Transaminase - blood
Antifungal Agents - adverse effects
Antifungal Agents - therapeutic use
Aspartate Aminotransferases - blood
Bilirubin - blood
Brazil
Female
Follow-Up Studies
gamma-Glutamyltransferase - blood
Humans
Itraconazole - adverse effects
Itraconazole - therapeutic use
Liver - metabolism
Liver Function Tests
Male
Paracoccidioidomycosis - drug therapy
Prospective Studies
Treatment Outcome
Trimethoprim, Sulfamethoxazole Drug Combination - adverse effects
Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
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Summary:A prospective study was performed in 200 paracoccidioidomycosis (PCM) patients, 51 presenting the acute/subacute form (AF) and 149 the chronic form (CF), submitted to the evaluation of the hepatobiliary system at admission and during the follow-up treatment with cotrimoxazole (CMX) or itraconazole (ITC). This study aimed to better evaluate the involvement of the hepatobiliary system in PCM and the effect of these antifungal compounds on this system. Serum levels of direct bilirubin (DB), total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) were evaluated. At admission, all the variables showed changes with elevated values ranging from 6.2% for TB to 32.6% for GGT. After treatment, the incidence of elevated serum levels ranged from 3.6% for DB to 27.5% for ALT. The course of the alterations during the treatment showed regression to normal values in CMX-treated patients and persistence in ITC-treated patients but without the need to discontinue the therapy. Our findings contribute to the knowledge of the hepatobiliary involvement by Paracoccidioides sp. and to a safe follow-up of PCM patients under treatment.
ISSN:1369-3786
1460-2709
DOI:10.1093/mmy/myx080