Lobomycosis Epidemiology and Management: The Quest for a Cure for the Most Neglected of Neglected Tropical Diseases

Abstract

Lobomycosis is a chronic disease caused by Lacazia loboi, which is endemic to the Amazon rainforest, where it affects forest dwellers in Brazil. There is no disease control program and no official therapeutic protocol. This situation contributes to an unknown disease prevalence and unmet needs of people disabled by this disease who seek access to treatment. This review provides an update on the subject with an emphasis on therapeutic advances in humans. All relevant studies that addressed epidemiology, diagnosis, or therapeutics of lobomycosis were considered. Seventy-one articles published between 1931 and 2021 were included for a narrative literature review on the epidemiology and quest for a cure. An effective therapy for lobomycosis has been found following decades of research led by the State Dermatology Program of Acre in the Amazon rainforest, where the largest number of cases occur. This discovery opened new avenues for future studies. The main recommendations here, addressed to the Brazilian Ministry of Health, are for lobomycosis to become a reportable disease to ensure that disease prevalence is measured, and that it be prioritized such that affected individuals may access treatment free-of-charge.

Development of a Multiplex qPCR Assay for Fast Detection and Differentiation of Paracoccidioidomycosis Agents

“…A major pitfall of our study is the absence of clinical samples from patients with PCM loboi or cetaceans with PCM ceti [ 12 , 26 , 71 ], which is partially justified due to the unculturable nature of the etiological agents and the rarity of these infections compared with classic PCM [ 1 , 8 ]. A BLAST search using the Primer-BLAST tool and the sequences of Paracoco-F and Paracoco-R primers or probes did not retrieve any amplicon related to P. loboi , which could be associated with the scarcity of P. loboi rDNA sequences from public databases [ 7 ].…”

“…Paracoccidioides lutzii has an elevated disease burden in the Brazilian Midwest, as well as scattered cases in the Amazon and Peru [ 4 , 9 , 10 , 11 ]. Paracoccidioides cetii from cetaceans is detected through the nearshore zones of the Americas, while P. loboi predominates in riverside populations in the Amazon basin and South America [ 1 , 7 , 12 ].…”

Lobomycosis (Lacaziosis) - case series in Colombia and literature review

“…En Colombia, el primer reporte fue hecho en 1958, con posterior reporte de más casos que han predominado en las regiones de la Amazonía, Orinoquía y Pacífico Colombiano, con afectación de agricultores, mineros y pescadores, mestizos, mulatos, así como indígenas y población afrodescendiente residentes en estas áreas geográficas indicadas; también han sido reportados casos en soldados colombianos, en quienes la lobomicosis se desarrolló después del servicio militar prestado en la zona amazónica del país (3)(4)(5)(6) . En una revisión publicada recientemente se mencionan los casos reportados en diferentes países del mundo hasta el año 2006, donde se contabiliza un total de 490 casos de lobomicosis, de los cuales, el 65% eran de Brasil, con 318 casos, y, en segundo lugar, el 10% eran de Colombia, lo que equivalían a 50 casos hasta ese momento (7) . En esta publicación reportamos cuatro casos, dos hombres y dos mujeres, diagnosticados en brigadas de salud realizadas con la Patrulla Aérea Civil Colombiana en los departamentos del Vichada y Chocó, entre los años 2017 y 2020.…”

Molecular Diagnosis of Endemic Mycoses

“…The true incidence of emergomycosis is unknown, but after the introduction of molecular techniques, many cases initially classified as histoplasmosis on the basis of histopathology have been demonstrated to be emergomycosis, indicating that its prevalence may be more frequent than previously thought [ 17 ]. Lobomycosis prevalence is unknown but an increase in new cases has been observed in recent years [ 18 ].…”