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Suárez JA, Cerrud B, Pachar M, Patiño LH, Reidy J, Chace A, Chen-Camaño R, Alvarado-Barría D, Nakadar MZ, Ramirez JD, Paniz-Mondolfi A. Human Lobomycosis Caused by Paracoccidioides (Lacazia) loboi, Panama, 2022. Emerg Infect Dis 2023; 29:2513-2517. [PMID: 37987584 PMCID: PMC10683804 DOI: 10.3201/eid2912.231092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
We report a patient from Panama who had lobomycosis caused by Paracoccidioides (Lacazia) loboi. We used combined clinical-epidemiologic and phylogenetic data, including a new gene sequence dataset on this fungus in Panama, for analysis. Findings contribute useful insights to limited knowledge of this fungal infection in the Mesoamerican Biologic Corridor.
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Tafuri WL, Tomokane TY, Silva AMG, Kanashiro‐Galo L, Mosser DM, Quaresma JAS, Pagliari C, Sotto MN. Skin fibrosis associated with keloid, scleroderma and Jorge Lobo's disease ( lacaziosis): An immuno-histochemical study. Int J Exp Pathol 2022; 103:234-244. [PMID: 36183172 PMCID: PMC9664412 DOI: 10.1111/iep.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022] Open
Abstract
Fibrosis is a common pathophysiological response of many tissues and organs subjected to chronic injury. Despite the diverse aetiology of keloid, lacaziosis and localized scleroderma, the process of fibrosis is present in the pathogenesis of all of these three entities beyond other individual clinical and histological distinct characteristics. Fibrosis was studied in 20 samples each of these three chronic cutaneous inflammatory diseases. An immunohistochemical study was carried out to explore the presence of α-smooth muscle actin (α-SMA) and vimentin cytoskeleton antigens, CD31, CD34, Ki67, p16; CD105, CD163, CD206 and FOXP3 antigens; and the central fibrotic cytokine TGF-β. Higher expression of vimentin in comparison to α-SMA in all three lesion types was found. CD31- and CD34-positive blood vessel endothelial cells were observed throughout the reticular dermis. Ki67 expression was low and almost absent in scleroderma. p16-positive levels were higher than ki67 and observed in reticular dermis of keloidal collagen in keloids, in collagen bundles in scleroderma and in the external layers of the granulomas in lacaziosis. The presence of α-actin positive cells and rarely CD34 positive cells, observed primarily in keloids, may be related to higher p16 antigen expression, a measure of cell senescence. Low FOXP3 expression was observed in all lesion types. CD105-positive cells were mainly found in perivascular tissue in close contact with the adventitia in keloids and scleroderma, while, in lacaziosis, these cells were chiefly observed in conjunction with collagen deposition in the external granuloma layer. We did not find high involvement of CD163 or CD206-positive cells in the fibrotic process. TGF-β was notable only in keloid and lacaziosis lesions. In conclusion, we have suggested vimentin to be the main myofibroblast general marker of the fibrotic process in all three studied diseases, while endothelial-to-mesenchymal transition (EndoMT) and mesenchymal stem cells (MSCs) and M2 macrophages may not play an important role.
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Affiliation(s)
- Wagner Luiz Tafuri
- Departamento de Patologia GeralInstituto de Ciências BiológicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil
- Faculdade de Medicina, Departamento de PatologiaUniversidade de São PauloSao PauloBrazil
| | - Thaise Yumie Tomokane
- Laboratório de Patologia das Moléstias Infecciosas – LIM50, Departamento de PatologiaFaculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | | | - Luciane Kanashiro‐Galo
- Faculdade de Medicina, Departamento de PatologiaUniversidade de São PauloSao PauloBrazil
| | | | | | - Carla Pagliari
- Faculdade de Medicina, Departamento de PatologiaUniversidade de São PauloSao PauloBrazil
- Instituto de Assistência Médica ao Servidor Público Estadual e Programa de pós‐graduação em Ciências da SaúdeSão PauloBrazil
| | - Mirian N. Sotto
- Faculdade de Medicina, Departamento de PatologiaUniversidade de São PauloSao PauloBrazil
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Hornberger MM, Farnsworth GS, Vilela R, Mendoza L, Bandino JP. Extensive, multifocal lobomycosis. J Cutan Pathol 2021; 49:957-959. [PMID: 34382237 DOI: 10.1111/cup.14114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Maria M Hornberger
- Transitional Year Program, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - G Strider Farnsworth
- Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Raquel Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan, USA
| | - Leonel Mendoza
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan, USA.,Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, USA
| | - Justin P Bandino
- Department of Dermatology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
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Abstract
Lobomycosis is a disease that is endemic to the Amazon rainforest and is caused by the still uncultured fungus Lacazia loboi. This disease occurs in loggers, farmers, miners, fishermen, and persons living near coastal rivers of this region. We report 6 soldiers in Colombia in whom lobomycosis developed after military service in the Amazon area. The patients had nodular and keloid-like lesions on the face, neck, trunk, and limbs. The duration of illness ranged from 2 years to 15 years. The initial diagnosis was leishmaniasis on the basis of clinical manifestations and direct smear results, but biopsies confirmed the final diagnosis of lobomycosis. Treatment with surgical excision, itraconazole and clofazimine was satisfactory. However, the follow-up time was short. Healthcare professionals responsible for the diagnosis and treatment of skin diseases need to be able to recognize the clinical signs of lobomycosis and differentiate them from those of cutaneous leishmaniasis.
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Vilela R, Bossart GD, St Leger JA, Dalton LM, Reif JS, Schaefer AM, McCarthy PJ, Fair PA, Mendoza L. Cutaneous Granulomas in Dolphins Caused by Novel Uncultivated Paracoccidioides brasiliensis. Emerg Infect Dis 2018; 22:2063-2069. [PMID: 27869614 PMCID: PMC5189160 DOI: 10.3201/eid2212.160860] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Our findings could stimulate study of public health implications of diseases caused by this fungus. Cutaneous granulomas in dolphins were believed to be caused by Lacazia loboi, which also causes a similar disease in humans. This hypothesis was recently challenged by reports that fungal DNA sequences from dolphins grouped this pathogen with Paracoccidioides brasiliensis. We conducted phylogenetic analysis of fungi from 6 bottlenose dolphins (Tursiops truncatus) with cutaneous granulomas and chains of yeast cells in infected tissues. Kex gene sequences of P. brasiliensis from dolphins showed 100% homology with sequences from cultivated P. brasiliensis, 73% with those of L. loboi, and 93% with those of P. lutzii. Parsimony analysis placed DNA sequences from dolphins within a cluster with human P. brasiliensis strains. This cluster was the sister taxon to P. lutzii and L. loboi. Our molecular data support previous findings and suggest that a novel uncultivated strain of P. brasiliensis restricted to cutaneous lesions in dolphins is probably the cause of lacaziosis/lobomycosis, herein referred to as paracoccidioidomycosis ceti.
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Abstract
Lobomycosis is a subcutaneous mycosis of chronic evolution caused by the Lacazia loboi fungus. Its distribution is almost exclusive in the Americas, and it has a particularly high prevalence in the Amazon basin. Cases of lobomycosis have been reported only in dolphins and humans. Its prevalence is higher among men who are active in the forest, such as rubber tappers, bushmen, miners, and Indian men. It is recognized that the traumatic implantation of the fungus on the skin is the route by which humans acquire this infection. The lesions affect mainly exposed areas such as the auricles and upper and lower limbs and are typically presented as keloid-like lesions. Currently, surgical removal is the therapeutic procedure of choice in initial cases. Despite the existing data and studies to date, the active immune mechanisms in this infection and its involvement in the control or development of lacaziosis have not been fully clarified. In recent years, little progress has been made in the appraisal of the epidemiologic aspects of the disease. So far, we have neither a population-based study nor any evaluation directed to the forest workers.
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Affiliation(s)
| | | | | | - Rajendranath Ramasawmy
- Department of Immunogenetics, Tropical Medicine Foundation Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Fábio Francesconi
- Department of Dermatology, Tropical Medicine Foundation Heitor Vieira Dourado, Manaus, Amazonas, Brazil
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Pagliari C, Kanashiro-Galo L, Silva AADL, Barboza TC, Criado PR, Duarte MIS, Brito ACD, Xavier MB, Unger D, Maria Moraes Oliveira C, Quaresma JAS, Sotto MN. Plasmacytoid dendritic cells in cutaneous lesions of patients with chromoblastomycosis, lacaziosis, and paracoccidioidomycosis: a comparative analysis. Med Mycol 2014; 52:397-402. [PMID: 24782102 DOI: 10.1093/mmy/myt026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Plasmacytoid dendritic cells (pDCs) are characterized by expression of CD123 and BDCA-2 (Blood Dendritic Cell Antigen 2) (CD303) molecules, which are important in innate and adaptive immunity. Chromoblastomycosis (CBM), lacaziosis or Jorge Lobo's disease (JLD), and paracoccidioidomycosis (PCM), are noteworthy in Latin America due to the large number of reported cases. The severity of lesions is mainly determined by the host's immune status and in situ responses. The dendritic cells studied in these fungal diseases are of myeloid origin, such as Langerhans cells and dermal dendrocytes; to our knowledge, there are no data for pDCs. Forty-three biopsies from patients with CBM, 42 from those with JLD and 46 diagnosed with PCM, were evaluated by immunohistochemistry. Plasmacytoid cells immunostained with anti-CD123 and anti-CD303 were detected in 16 cases of CBM; in those stained with anti-CD123, 24 specimens were obtained from PCM. We did not detect the presence of pDCs in any specimen using either antibody in JLD. We believe that, albeit a secondary immune response in PCM and CBM, pDCs could act as a secondary source of important cytokines. The BDCA-2 (CD303) is a c-type lectin receptor involved in cell adhesion, capture, and processing of antigens. Through the expression of the c-lectin receptor, there could be an interaction with fungi, similar to other receptors of this type, namely, CD207 in PCM and CD205 and CD209 in other fungal infections. In JLD, the absence of expression of CD123 and CD303 seems to indicate that pDCs are not involved in the immune response.
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Affiliation(s)
- Carla Pagliari
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia
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Papadavid E, Dalamaga M, Kapniari I, Pantelidaki E, Papageorgiou S, Pappa V, Tsirigotis P, Dervenoulas I, Stavrianeas N, Rigopoulos D. Lobomycosis: A case from Southeastern Europe and review of the literature. J Dermatol Case Rep 2012; 6:65-9. [PMID: 23091581 DOI: 10.3315/jdcr.2012.1104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 07/19/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Lobomycosis, also known as Jorge Lobo's disease, represents a rare chronic subcutaneous mycosis caused by the fungus Lacazia loboi, an organism that is found within lesions but has not been cultured to date. The natural reservoir of L. loboi is unknown but it is believed to be aquatic, or associated with soil and vegetation. More than 550 human cases have been reported, especially in patients with a history of travel or residence in endemic areas (Central and South America, particularly Brazil) or in communities along rivers. MAIN OBSERVATIONS We describe a 64-year-old Greek female farmer living in a coastal region, who presented with an erythematous plaque on her left inner thigh resembling a keloid. The diagnosis was based on the triad: 1) absence of fungal growth in cultures, 2) positive direct microscopic examination of the lesion and 3) histopathology, all consistent with lobomycosis. Particularly, skin biopsy showed deep cutaneous fungal infection with granulomatous reaction. Fungal cells were found inside giant cells. The fungi were thick-walled with some budding, isolated or in short chains. Dermal fibrosis was present. Our patient had a medical history of common variable immunodeficiency but no history of travel to South or Central America. She probably acquired this rare infection by injury during her agricultural works. CONCLUSION Our case represents probably the first documented case of human lobomycosis in Southeastern Europe. This case is unusual due to the rarity of lobomycosis in Mediterranean countries, particularly in Southeastern Europe.
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Affiliation(s)
- Evangelia Papadavid
- 2nd Department of Dermatology, Athens University School of Medicine, Attikon General University Hospital, Chaidari, Athens, Greece
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