Lobomycosis is a

fungal infection Fungal infection, also known as mycosis, is disease caused by fungi. Different types are traditionally divided according to the part of the body affected; superficial, subcutaneous, and systemic. Superficial fungal infections include common ti ...

of the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...

. It usually presents with bumps in the skin, firm swellings, deep skin lesions, or malignant tumors. It is caused by ''

Lacazia ''Lacazia'' is a genus of fungi containing the single species ''Lacazia loboi'', which is responsible for Lobo's disease. It is a member of the order Onygenales. Description and natural habitats ''Lacazia loboi'' is a yeast-like fungus that ca ...

loboi'' (formerly named ''Loboa loboi''). Transmission is generally by direct contact with contaminated water, soil, vegetation, or by direct contact with an infected dolphin. Diagnosis is by identifying ''Lacazia laboi'' in a lesion. This disease is usually found in humans and

bottlenose dolphin Bottlenose dolphins are aquatic mammals in the genus ''Tursiops.'' They are common, cosmopolitan members of the family Delphinidae, the family of oceanic dolphins. Molecular studies show the genus definitively contains two species: the common ...

s, with the possible risk of transmission from one species to the other. It was discovered by

Brazil Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...

ian dermatologist Jorge Lobo. Other names which were given to the disease are: keloidal blastomycosis, Amazonian blastomycosis, blastomycoid granuloma, miraip and piraip. These last two names were given by natives of the

Amazon Amazon most often refers to: * Amazons, a tribe of female warriors in Greek mythology * Amazon rainforest, a rainforest covering most of the Amazon basin * Amazon River, in South America * Amazon (company), an American multinational technology c ...

and mean ''that which burns''.

Signs and symptoms

The disease is

endemic Endemism is the state of a species being found in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also found elsew ...

in rural regions in

South America South America is a continent entirely in the Western Hemisphere and mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere at the northern tip of the continent. It can also be described as the southe ...

and

Central America Central America ( es, América Central or ) is a subregion of the Americas. Its boundaries are defined as bordering the United States to the north, Colombia to the south, the Caribbean Sea to the east, and the Pacific Ocean to the west. ...

.Infection most commonly develops after minor scratches or insect bites, but many patients cannot recall any skin trauma. Human-to-human transmission does not occur, and the disease is only acquired from the environment. The disease manifests as chronic

keloid Keloid, also known as keloid disorder and keloidal scar, is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation t ...

al nodular lesions on the ears, legs, or arms. Lobomycosis-fungus-lesions

Diagnosis of Lobo's disease is made by taking a sample of the infected skin (a skin biopsy) and examining it under the

microscope A microscope () is a laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using a microscope. Microscopic means being invisibl ...

. ''Lacazia loboi'' is characterized by long chains of spherical cells interconnected by tubules. The cells appear to be

yeast Yeasts are eukaryotic, single-celled microorganisms classified as members of the fungus kingdom. The first yeast originated hundreds of millions of years ago, and at least 1,500 species are currently recognized. They are estimated to constitut ...

-like with a diameter of 5 to 12 μm. Attempts to culture ''L. loboi'' have so far been unsuccessful.

Diagnosis

Differential diagnosis

The disease is often misdiagnosed as ''

Blastomyces dermatitidis ''Blastomyces dermatitidis'' is a dimorphic fungus that causes blastomycosis, an invasive and often serious fungal infection found occasionally in humans and other animals. It lives in soil and wet, decaying wood, often in an area close to a wate ...

'' or ''

Paracoccidiodes brasiliensis ''Paracoccidioides brasiliensis'' is a dimorphic fungus and one of the two species that cause paracoccidioidomycosis (the other being '' Paracoccidioides lutzii).'' The fungus has been affiliated with the family Ajellomycetaceae (division Ascom ...

'' due to its similar morphology.

Treatment

Surgical excision or cryosurgery is the treatment of choice. Treatment with

antifungals An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as crypto ...

has been considered ineffective, but the use of

clofazimine Clofazimine, sold under the brand name Lamprene, is a medication used together with rifampicin and dapsone to treat leprosy. It is specifically used for multibacillary (MB) leprosy and erythema nodosum leprosum. Evidence is insufficient to suppor ...

and

dapsone Dapsone, also known as 4,4'-sulfonyldianiline (SDA) or diaminodiphenyl sulfone (DDS), is an antibiotic commonly used in combination with rifampicin and clofazimine for the treatment of leprosy. It is a second-line medication for the treatment a ...

in patients with

leprosy Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...

and lobomycosis has been found to improve the latter. This treatment regimen, with concomitant itraconazole, has been used to prevent recurrence after surgery.

Other animals

Lesions in dolphins occur on the dorsal fin, head, flukes, and

peduncle Peduncle may refer to: *Peduncle (botany), a stalk supporting an inflorescence, which is the part of the shoot of seed plants where flowers are formed *Peduncle (anatomy), a stem, through which a mass of tissue is attached to a body **Peduncle (art ...

. In January 2006, a potential epidemic of lobomycosis was reported in dolphins of the

Indian River Lagoon The Indian River Lagoon is a grouping of three lagoons: the Mosquito Lagoon, the Banana River, and the Indian River, on the Atlantic Coast of Florida; one of the most biodiverse estuaries in the Northern Hemisphere and is home to more than 4,300 ...

Florida Florida is a state located in the Southeastern region of the United States. Florida is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Bahamas and Atlantic Ocean, and to ...

References

External links

{{Mycoses Tropical diseases Animal fungal diseases Mycosis-related cutaneous conditions