P308 Jorge lobo's disease in brazil: a new recognized reservoir?
Authors: de Azevedo Conceição de Maria Pedrozo e Silva , Júnior Francisco Marcio Casarim , Neto Eudes Alves Simões , Branco Pedro Afonso Brito Castelo , Santos Julliana Ribeiro Alves dos , Medeiros Guilherme de Alencar , Marques Sirlei Garcia , Wagner Daniel 
Published: September 2022

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM
Lobomycosis (lacaziosis) is a chronic subcutaneous disease caused by the uncultivated fungus Lacazia loboi. The disease was first described in 1931 by Jorge Lobo in Brazil and has been reported in South and Central America. Lobomycosis is a rare disease that affects certain geographic regions, mainly in countries of low socioeconomic status, but its prevalence among indigenous people in Brazil is exceptionally high. The state of Maranhão is located in the northeast region of the country and there are rare clinical reports of imported cases of the disease in our region. This is the first published series of autochthonous cases of lacaziosis in Maranhão.

Objective
To describe seven cases of Lacazia loboi infections in immunocompetent patients in an endemic area for other subcutaneous mycoses.

Methods
We retrospectively reviewed the medical records of all patients who developed Jorge Lobo's diseases in a new area recognized as a potential environment reservoir. An incident case was defined as a patient who developed proven lacaziosis based on the presence of topical fungal elements in the tissue on histopathology or mycologic direct exam. Epidemiological and clinical data of all cases of lacaziosis were collected using a standard clinical form.

Results
In the period from 2000 to 2021, seven patients were identified. All cases were diagnosed by histopathology and direct mycological examination of the lesions. A total of 6 out of 7 (85.7%) patients were men and the mean age was 57 years (52-70 years). The median time between onset of infection symptoms and diagnosis was ˃2 years in 6 patients, with 15 years of symptoms duration in patient 7. All patients reported having worked with agricultural activities before. A total of 50% of patients were diagnosed with localized lesions and the other half with disseminated lesions. Subcutaneous lesions involved the upper limbs (4/6; 66.6%), ears (2/6; 33.3%), lower limbs (1/6; 16.6%), and trunk (1/6; 16.6%). All patients exhibited nodules as a dominant pattern of skin lesion, sometimes coalescing with the tumor's appearance. Regarding treatment, a combination of itraconazole and clofazimine therapy was added to all patients. Surgical excision was possible only in 2 episodes due to the limited availability of this procedure at the site. Cure was documented in 2 cases, with no recurrence to date.

Conclusion
The present series represents the first and largest collection of case studies of lacaziosis in Maranhão state, with all cases classified as autochthonous. Lacaziosis involves mainly adult males with different occupational risks such as agricultural labor, and other workers exposed to contaminated soil and plant materials. Few data are available to support suggested therapy with itraconazole and clofazime. Excision surgery is important for treatment due to the absence of clinical trials in the medical literature. Epidemiological surveillance studies of new cases of lacasiozis in Maranhão are important for mapping this new reservoir and developing public policies for diagnosis and treatment.