Lobomycosis: a therapeutic challenge

Arajo, Marcelo Grossi; Cirilo, Nathalie Silva; Santos, Soraya Neves Marques Barbosa dos; Aguilar, Claudemir Roberto; Guedes, Antônio Carlos Martins

doi:10.1590/abd1806-4841.20187044

Cited by 17 publications

(38 citation statements)

References 10 publications

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“…Molecular taxonomy was used to identify an imported case of lobomycosis in a traveler from Europe who visited the Amazon region of Venezuela ( 41 ). However, in disease-endemic countries, the diagnosis should include clinical and microscopic results because molecular diagnosis might not be available ( 42 , 43 )…”

Section: Discussionmentioning

confidence: 99%

Lobomycosis in Soldiers, Colombia

Arenas¹,

Rodríguez-Toro²,

Ortiz-Florez³

et al. 2019

Emerg. Infect. Dis.

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Lobomycosis is a disease that is endemic to the Amazon rainforest and is caused by the still uncultured fungus Lacazia loboi. This disease occurs in loggers, farmers, miners, fishermen, and persons living near coastal rivers of this region. We report 6 soldiers in Colombia in whom lobomycosis developed after military service in the Amazon area. The patients had nodular and keloid-like lesions on the face, neck, trunk, and limbs. The duration of illness ranged from 2 years to 15 years. The initial diagnosis was leishmaniasis on the basis of clinical manifestations and direct smear results, but biopsies confirmed the final diagnosis of lobomycosis. Treatment with surgical excision, itraconazole and clofazimine was satisfactory. However, the follow-up time was short. Healthcare professionals responsible for the diagnosis and treatment of skin diseases need to be able to recognize the clinical signs of lobomycosis and differentiate them from those of cutaneous leishmaniasis.

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Section: Discussionmentioning

confidence: 99%

Lobomycosis in Soldiers, Colombia

Arenas¹,

Rodríguez-Toro²,

Ortiz-Florez³

et al. 2019

Emerg. Infect. Dis.

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“…Case reports have shown successful outcomes following surgical excision and antifungal and/or antitubercular drug use (e.g., itraconazole, posaconazole, and clofazimine). [9][10][11] However, the Acre Dermatology Service noted a high disease recurrence risk with this approach, especially in disseminated disease. 12,13 Furthermore, completion of therapy may be hampered by the high cost of antifungals.…”

Section: Introductionmentioning

confidence: 99%

Multidrug Therapy for Leprosy Can Cure Patients with Lobomycosis in Acre State, Brazil: A Proof of Therapy Study

Gonçalves

Rosa

Belone

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Lobomycosis, also referred to as lacaziosis, is an endemic cutaneous and subcutaneous fungal disease that mainly affects Amazonian forest dwellers in Brazil. There is no disease control program in place in Brazil, and antifungal therapy failures are common, and the therapy is inaccessible to most patients. We performed a randomized, unblinded clinical trial testing the cure rate of multiple drug therapy (MDT) for leprosy with surgical excision, with or without itraconazole. A control arm consisted of patients who did not adhere to either therapeutic regimens but continued to be followed up. Multiple drug therapy consisted of monthly supervised doses of 600 mg rifampicin, 300 mg clofazimine, and 100 mg dapsone, in addition to daily doses of 50 mg clofazimine and 100 mg dapsone. The patients in the MDT plus itraconazole arm also received itraconazole 100 mg twice daily. We followed up 54 patients from the MDT group and 26 patients from the MDT plus itraconazole group for an average of 4 years and 9 months. The 23 controls were followed up for 6 months on average. The following endpoints were observed: 1) unchanged (no apparent improvement), 2) improved (reduction in lesion size and/or pruritus), and 3) cured (complete remission of the lesions, no viable fungi, and no relapse for 2 years after the end of the drug treatment). The results indicated a significantly greater likelihood of cure associated with the use of multidrug therapy for leprosy with or without itraconazole when compared with the control group. The addition of itraconazole to MDT was not associated with improved outcomes, suggesting that MDT alone is effective.

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“…Afecta principalmente a hombres trabajadores de bosques, dedicados a la recolección de caucho y mineros. El ingreso del hongo al organismo es casi siempre a través de una lesión traumática; cuando la infección ya está presente, las lesiones priman en zonas expuestas, como en extremidades superiores e inferiores, y se exhiben lesiones queloides ulceradas o verrugosas (2,3,4) . Debe considerarse como diagnóstico diferencial la cromomicosis (1) , lepra lepromatosa, queloides, leishmaniasis tegumentaria y paracoccidiomicosis (15) .…”

Section: Introductionunclassified

“…Debe considerarse como diagnóstico diferencial la cromomicosis (1) , lepra lepromatosa, queloides, leishmaniasis tegumentaria y paracoccidiomicosis (15) . En la dermis, el hongo comienza su fase proliferativa dentro de los macrófagos (5) . Además, favorece en el aumento de la concentración del factor de crecimiento transformante β1, la cual, es una citocina producida por macrófagos y linfocitos Th3 y se considera una potente sustancia inmunosupresora.…”

Section: Introductionunclassified

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Posible caso de lobomicosis en un paciente alcohólico crónico de Chiclayo, Perú

et al. 2020

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La lobomicosis es una enfermedad fúngica causada producida por la levadura Lacazzia loboi, que afecta a piel y tejido conectivo subyacente de humanos y animales como los delfines. La enfermedad es de evolución crónica y se caracteriza por lesiones de aspecto nódulo-queloideas y verrugosas. Se presenta un posible caso en un paciente de 49 años, alcohólico desde hace 12 años en estado de delirium tremens, el cual tras un accidente hace cinco años comienza a desarrollar lesiones compatibles con lobomicosis en la pierna y tobillo izquierdos. El paciente, además, presentó sepsis de foco dérmico y abdominal, razón por el que se le inició tratamiento antibacteriano de amplio espectro y tratamiento antifúngico; sin embargo la evolución fue lenta y el paciente falleció.

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Lobomycosis: a therapeutic challenge

Cited by 17 publications

References 10 publications

Lobomycosis in Soldiers, Colombia

Lobomycosis in Soldiers, Colombia

Multidrug Therapy for Leprosy Can Cure Patients with Lobomycosis in Acre State, Brazil: A Proof of Therapy Study

Posible caso de lobomicosis en un paciente alcohólico crónico de Chiclayo, Perú

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