Different classifications of paracoccidioidomycosis emerged since its discovery in 1908, culminating in the proposition of a simplified and consensual one in 1987. However, by revisiting these classifications, case reports, or case series from which the authors based their own, we found many patients who did not fit in either the 1987 classification or in the correspondent natural history/pathogenesis view. In this report, the concepts of paracoccidioidomycosis infection, primary pulmonary paracoccidioidomycosis (PP-PCM), and other subclinical forms of PCM are reassessed. A classification is proposed to encompass all these subtle but distinct outcomes. I suggest a continuum between the PP-PCM and the overt chronic form of disease, and not the current view of quiescent foci, frozen in time and suddenly reactivated for unknown reasons. Failure to fully resolve the infection in its initial stages is a conceivable hypothesis for the chronic form. The proposed clinical classification might offer new insights to better characterize and manage PCM patients.

中文翻译：

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副球菌病的发病机制和分类：旧的好东西的新见解

自从1908年发现球囊球菌病以来，出现了不同的分类，最终在1987年提出了一种简化且经双方同意的分类法。然而，通过回顾这些分类，病例报告或作者基于其的病例系列，我们发现了许多患者既不符合1987年的分类标准，也不符合相应的自然历史/发病机理的观点。在本报告中，重新评估了球菌旁球菌病，原发性肺部球菌旁球菌病（PP-PCM）和其他亚临床形式的PCM的概念。提出了一个分类，以涵盖所有这些微妙但截然不同的结果。我建议在PP-PCM与明显的慢性疾病之间形成一个连续体，而不是当前的静态病灶观点，该病灶及时冻结并由于未知原因而突然重新激活。在初始阶段未能完全解决感染是慢性形式的一种可能假说。拟议的临床分类可能会提供新的见解，以更好地表征和管理PCM患者。