Lobomycosis is a fungal infection 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 animal coverings, such as the arthropod exoskeleton, have different de ...

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

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 else ...

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 sout ...

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 bite Insect bites and stings occur when an insect is agitated and seeks to defend itself through its natural defense mechanisms, or when an insect seeks to feed off the bitten person. Some insects inject formic acid, which can cause an immediate skin ...

s, but many patients cannot recall any

skin trauma Skin trauma is serious and altering physical injury experienced by the skin or multiple layers of epithelial tissue Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue ...

. Human-to-human transmission does not occur, and the disease is only acquired from the environment. The disease manifests as chronic keloidal 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 Skin biopsy is a biopsy technique in which a skin lesion is removed to be sent to a pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 days. ...

) 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 invisi ...

. ''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 constit ...

-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'' or '' Paracoccidiodes brasiliensis'' due to its similar morphology.

Treatment

Surgical excision or

cryosurgery Cryosurgery is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. The term comes from the Greek words cryo (κρύο) ("icy cold") and surgery (''cheirourgiki'' – χ� ...

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 cryp ...

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 sup ...

and dapsone 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 Itraconazole, sometimes abbreviated ITZ, is an antifungal medication used to treat a number of fungal infections. This includes aspergillosis, blastomycosis, coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis. It may be given by mo ...

, has been used to prevent recurrence after surgery.

Other animals

Lesions in dolphins occur on the dorsal fin, head, flukes, and peduncle. In January 2006, a potential epidemic of lobomycosis was reported in dolphins of the Indian River Lagoon in

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