Lobomycosis: epidemiology, clinical presentation, and management options

Abstract

Lobomycosis is a subcutaneous mycosis of chronic evolution caused by the Lacazia loboi fungus. Its distribution is almost exclusive in the Americas, and it has a particularly high prevalence in the Amazon basin. Cases of lobomycosis have been reported only in dolphins and humans. Its prevalence is higher among men who are active in the forest, such as rubber tappers, bushmen, miners, and Indian men. It is recognized that the traumatic implantation of the fungus on the skin is the route by which humans acquire this infection. The lesions affect mainly exposed areas such as the auricles and upper and lower limbs and are typically presented as keloid-like lesions. Currently, surgical removal is the therapeutic procedure of choice in initial cases. Despite the existing data and studies to date, the active immune mechanisms in this infection and its involvement in the control or development of lacaziosis have not been fully clarified. In recent years, little progress has been made in the appraisal of the epidemiologic aspects of the disease. So far, we have neither a population-based study nor any evaluation directed to the forest workers.

Epidemiology of lobomycosis-like disease in bottlenose dolphins Tursiops spp. from South America and southern Africa

“…On both occasions, it presented an unusual behaviour, namely continuously leaping out of the water and landing on its right side, during the entire observation period (40 min). Conceivably pruritus may be a symptom of LLD, commonly seen in cutaneous mycoses (Francesconi et al 2014), and could trigger such behaviour. In the other 3 new cases, the disease was characterized by single, small to large, light grey, verrucous lesions.…”

Keloids on the ears

“…Cryosurgery combined with adjuvant itraconazole has been reported to prevent recurrence . Clofazamine is required for prolonged periods of time, up to 2 years, making patient compliance difficult and therefore having disappointing results . Posaconazole, a newer azole, has been reported to achieve remission after 5‐year follow‐up and is thus a promising treatment .…”

Lobomicose

“…Estas particularidades justificam o aspecto queloidiforme. 12 As alterações discrômicas são comumente descritas, variando entre hiperpigmentação, hipopigmentação ou acromia. 13 As lesões surgem, no geral, em áreas expostas como membros superiores, membros inferiores e pavilhão auricular de adultos, com predominância no sexo masculino, tendo em vista que desenvolvem atividades ou a sua vida na floresta (seringueiros, mineiros e Índios).…”

“…Em casos extensos as lesões podem apresentar prurido e disestesia. 12 Golfinhos também foram diagnosticados com quadros idênticos aos dos humanos, descritos pela primeira vez, em 1971, na costa da Flórida, por Migaki et al 13 As lesões mais profundas estão provavelmente relacionadas com inoculações recentes e são descritas como infiltrativas. O crescimento contínuo pode conferir uma aparência exofítica em alguns casos.…”