lobomycosis

Lobomycosis: A Rare Fungal Infection

Lobomycosis, also known as lacaziosis, is a rare and chronic fungal infection that primarily affects the skin and subcutaneous tissues [5][10]. It is caused by the uncultivable dimorphic onygenales fungus Lacazia loboi [9][10].

Symptoms and Manifestations

The disease typically presents with bumps in the skin, firm swellings, deep skin lesions, or malignant tumors [1][2]. Lesions commonly occur in exposed areas such as the lower and upper limbs, outer ears, face, and thorax [12]. Patients often report having suffered a previous traumatic event at the site of the lesion, such as animal or insect bites, splinter, or ray sting [12].

Transmission

The transmission of lobomycosis is generally by direct contact with contaminated water, soil, vegetation, or by direct contact with an infected dolphin [2][10]. Human-to-human transmission does not appear to occur [10].

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Common Signs and Symptoms of Lobomycosis

Lobomycosis, a rare chronic fungal infection caused by Lacazia loboi, can manifest in various ways. The signs and symptoms may develop slowly over months or years, varying in severity and location between infected individuals.

• Skin Lesions: Skin lesions are the most common manifestation of lobomycosis. They can appear as bumps, firm swellings, deep skin lesions, or malignant tumors [1][2].
• Pleomorphic Lesions: The clinical manifestations of lobomycosis are pleomorphic lesions, dermal nodules, either lenticular or in plaques, which can be either hyperpigmented or hypopigmented [12].
• Dermal Nodules: Dermal nodules, either lenticular or in plaques, are a common clinical manifestation of lobomycosis [13][14].
• Keloidlike Lesions: Keloid-like lesions that can resemble nodular leprosy or leishmaniasis are also associated with lobomycosis [13].
• Pruritus and Dysesthesia: Pruritus (itching) and dysesthesia (abnormal sensations) are symptoms more often described in extensive cases, which may lead to deformation and cause localized pruritus that may be mild or severe [4][8][9].

Other Symptoms

• Pain and Strong Odor: Secondary infection can cause pain and a strong odor from the lesions.
• Slow Insidious Onset: The most common manifestation of lobomycosis is a nodular keloid appearance with a slow insidious onset [6][7].
• Previous Traumatic Event: Patients often refer having suffered a previous traumatic event at the site of the lesion, such as animal or insect bites, splinter, ray sting, or trauma from a cutting instrument [10][11].

Important Note

Lobomycosis does not affect the general health of the patient [12]. However, it is essential to seek medical attention if you suspect you have this condition.

References:

[1] Context reference 1 [2] Context reference 2 ... (and so on for all references)

Lobomycosis, also known as Lacazia loboi infection, can be diagnosed through various diagnostic tests.

• Molecular testing has been successfully employed for the diagnosis of lobomycosis [1]. This method involves amplification and direct sequencing of fungal ribosomal RNA genes to confirm the presence of the causative organism.
• Histopathology is considered the gold standard for diagnosing lobomycosis [4, 14]. A skin biopsy can be stained with hematoxylin & eosin (H&E) or Gomori-Grocott to visualize the characteristic yeast-like cells.
• Direct microscopic examination of exudates or skin scrapings can also be used to identify the yeast-like cells of lobomycosis [7, 9].
• Vinyl adhesive tape test, also known as the Scotch test, can be used for diagnosis after observation of ulcerated lesions [8].
• Skin biopsy with silver or periodic acid-Schiff (PAS) stain is recommended to visualize the fungal forms and confirm the diagnosis [14].

These diagnostic tests are essential in confirming the presence of lobomycosis, especially in cases where clinical presentation is suspicious.

Treatment Options for Lobomycosis

Lobomycosis, also known as Pityriasis versicolor-like lobomycosis, is a rare fungal infection that affects the skin and mucous membranes. While there are no reliably effective pharmacological treatments, some treatment regimens have been reported to be effective.

• Itraconazole: Itraconazole has been used in combination with cryosurgery to treat relapse of lobomycosis [5]. However, its effectiveness is not consistently reported across studies.
• Clofazimine: Clofazimine, a drug commonly used to treat leprosy, has been found to be effective in treating lobomycosis when used in combination with other drugs. A prolonged course of clofazimine (300 mg daily initially and then for up to 2 years) has been reported to be effective [6].
• Triple Drug Therapy: Triple drug therapy with clofazimine, rifampin, and dapsone, along with adjunctive surgical excision, has been highlighted as a potentially effective treatment regimen [4].
• Posaconazole: Posaconazole has been used to treat lobomycosis in some cases, with one patient experiencing a favorable clinical response after four months of treatment [1].

Surgical Excision

Wide surgical excision of the lesions is often considered the primary treatment for lobom

The differential diagnosis for lobomycosis includes several conditions that can present similarly to this rare fungal infection. Some of these conditions include:

• Chromoblastomycosis
• Blastomycosis (caused by Blastomyces dermatitidis)
• Paracoccidioidomycosis
• Cutaneous leishmaniasis, particularly the diffuse and borderline disseminated types
• Leprosy
• Sporotrichosis
• Tuberculosis
• Tertiary syphilis

These conditions can all present with similar symptoms to lobomycosis, such as skin lesions and subcutaneous tissue involvement. However, a definitive diagnosis of lobomycosis is typically made through clinical presentation, histopathology, and the presence of distinctive fungal organisms in tissue sections stained with special fungus procedures (periodic acid-Schiff and Gomori-Grocott stainings).

It's worth noting that the differential diagnosis for lobomycosis can be challenging due to its rarity and the similarity of symptoms with other conditions. However, a thorough evaluation by a healthcare professional, including clinical presentation, laboratory tests, and histopathology, is essential to make an accurate diagnosis.

References:

• [1] Lobomycosis is a rare, chronic, fungal infection of the skin and subcutaneous tissue. Also referred to as Jorge Lobo disease, this condition most commonly presents in rural Latin American communities.
• [3] Lobomycosis is a chronic subcutaneous granulomatous disease. Lesions commonly occur in exposed areas: lower and upper limbs, outer ears, face and thorax. ... Differential diagnosis includes other infectious causes including cutaneous leishmaniasis (diffuse and borderline disseminated types), leprosy, sporotrichosis, paracoccidioidomycosis ...
• [4] The diagnosis of lobomycosis is based on clinical presentation, by identification of a keloid-like lesion in a person living in an endemic region. ... Differential Diagnosis. Paracoccidioidomycosis, leishmaniasis, other subcutaneous mycoses (sporotrychosis ...
• [13] Lobomycosis is a rare chronic fungal infection of the subcutaneous tissue found in South America, mainly in Brazil. It is caused by Lacazia loboi. Its clinical manifestations are dermal nodules, either lenticular or in plaques, and keloidlike lesions that can resemble nodular leprosy or leishmaniasis, other subcutaneous mycoses (sporotrychosis ...
• [15] Lobomycosis is a fungal infection caused by Lacazia loboi. This disease affects primarily the subcutaneous tissue manifested by a chronic granulomatous reaction, full of parasites, in the dermis. ... This clinical picture typically affects the lower limbs and imposes differential diagnosis with chromomycosis.