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

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.

Lobomycosis. Literature Review and Future Perspectives / Revisión de la literatura y perspectivas futuras

Lobomycosis is a cutaneous infection of tropical and subtropical regions caused by the fungus Lacazia loboi, which still has a controversial taxonomical position. The first description of the disease and fungus was made in 1930 by Jorge Lobo.1t is a chronic disease with predominance of lesions similar to keloids, in exposed areas, limited to skin and semimucosa. There is no systemic involvement and patients maintain a good general health. Diagnosis is confirmed by direct or histopathologic exam and, until present, the fungus has not been cultivated. Surgery is the treatment of choice for isolated lesions, but there are frequent recurrences. Good therapeutic responses have been reported with clofazimine, with or without itraconazole, and with 5-fluorocytosine. This disease should be recognized by dermatologists worldwide because, although restricted to the Amazon region, it has been observed in other locations. Research development and achievement of new knowledge in molecular biology and genetic engineering of lobomycosis are of utmost importance because they may, in the future, lead to the culture of the fungus in the laboratory and to a better understanding of its pathogenesis, transmission mechanism, and new methods of diagnosis, prevention and treatment (AU)

La lobomicosis es una infección cutánea de las regiones tropicales y subtropicales que está causada por el hongo Lacazia loboi, y cuya posición taxonómica continúa siendo controvertida. Jorge Lobo realizó la primera descripción de la enfermedad y del hongo en 1930. Se trata de una enfermedad crónica con predominio de lesiones que se asemejan a queloides, en áreas fotoexpuestas, limitadas a la piel y a la semimucosa. No existe afectación sistémica y los pacientes presentan buen estado general. El diagnóstico se confirma por el examen directo o el estudio histológico y, hasta el momento, el hongo no se ha podido cultivar. La escisión quirúrgica es el tratamiento de elección para lesiones aisladas, pero las recurrencias son frecuentes. Se han descrito respuestas favorables con clofazimina, con o sin itraconazol, y con 5-fluorocitosina. Aunque es una enfermedad propia de la región del Amazonas, los dermatólogos de todo el mundo deben reconocerla, ya que también se ha observado en otras regiones. El desarrollo de la investigación y la consecución de nuevos conocimientos en biología molecular e ingeniería genética sobre la lobomicosis son de gran importancia ya que, en un futuro, permitirán el cultivo del hongo en el laboratorio, 10 que facilitará una mejor comprensión de su patogenia, mecanismo de transmisión y nuevos métodos de diagnóstico, prevención y tratamiento (AU)

Accidental Jorge Lobo's disease in a worker dealing with Lacazia loboi infected mice: a case report

INTRODUCTION: Jorge Lobo's disease (Lacaziosis) is a subcutaneous infection of humans living in the Amazon region of Latin America, and in dolphins inhabiting the east coastal areas of the United States. The disease mainly affects people from rural areas living or working in close contact with vegetation and aquatic environments. Most patients refer having developed lesions after accidental trauma with plant thorns or insect bites. Inter-human transmission has never been confirmed suggesting that Lacazia loboi is acquired from environmental propagules. CASE PRESENTATION We report the case of a 41-year-old woman from São Paulo, Brazil, a non-endemic area of Jorge Lobo's disease, with L. loboi skin infection most likely accidentally acquired while manipulating experimentally infected mice in the laboratory. CONCLUSION: Because many patients with Jorge Lobo's disease do not recall accidental skin trauma before their infections, the possibility of accidentally acquired Jorge Lobo's disease through unnoticed broken skin should be considered during the clinical investigation of nodular skin diseases in people who have contact with the fungus or who live in endemic areas. This is the second report of animal to human transmission of this disease.