Squamous-cell carcinoma and lobomycosis (Jorge Lobo's disease)

Among the Cayabi Indians in Central Brazil, we found a high and unexpected prevalence of lobomycosis, which represents 21% of all the cases reported in the world medical literature until now. Most of the Cayabi patients have been observed for many years, and recently two developed cauliflower-like tumours in old lobomycosis scar lesions. The diagnosis of squamous cell carcinoma was confirmed histologically. In both cases, the tumor was surgically removed, but several months later tumors recurred in both patients. The appearance of squamous cell carcinoma in chronic scar lesions and ulcers of various etiologies has been reported by many authors, and should include lobomycosis.

Deep mycoses in Amazon region

Patients with deep mycoses diagnosed in dermatologic clinics of Manaus (state of Amazonas, Brazil) were studied from November 1973 to December 1983. They came from the Brazilian states of Amazonas, Pará, Acre, and Rondônia and the Federal Territory of Roraima. All of these regions, with the exception of Pará, are situated in the western part of the Amazon Basin. The climatic conditions in this region are almost the same: tropical forest, high rainfall, and mean annual temperature of 26C. The deep mycoses diagnosed, in order of frequency, were Jorge Lobo's disease, paracoccidioidomycosis, chromomycosis, sporotrichosis, mycetoma, cryptococcosis, zygomycosis, and histoplasmosis.

Paracoccidioidomycosis in Trinidad

Paracoccidioidomycosis is a systemic disease endemic to South America, but rarely recognised in other parts of the world. The patient we describe represents the first case of paracoccidioidomycosis observed in Trinidad.

Prevalence of paracoccidioidomycosis in hospitalized adults in Rio de Janeiro (RJ) Brazil

Double immunodiffusion were used as screening test for the diagnosis of paracoccidioidomycosis. Five hundred hospitalized adults from general (150 patients--group I) and from a specialized chest disease hospital (350 patients--group II), were tested. All of them were without definitive etiological diagnosis and clinical specimens were obtained from the patients with positive serology. Testing sera obtained from 150 patients of the group I, fifty six cases of paracoccidioidomycosis were diagnosed. Specimens for mycological examination were subsequently obtained from 50 of these patients; P. brasiliensis could be recovered in 49 (98%). Fundamental importance was the finding of 17 (4.8%) cases of paracoccidioidomycosis among the 350 patients referred from a chest disease hospital (group II). Serological evidence of paracoccidioidomycosis found in 73 (14.6%) of the 500 screened patients, indicates a relatively high prevalence of this mycosis in adults patients admitted to several hospitals in RJ. These data probably do not reflect the real prevalence of paracoccidioidomycosis in RJ and should be considered as a gross underestimation. Thus, attention should also be paid to juvenile forms and DID could be of a great value in screening these cases too.

Imported paracoccidioidomycosis: a public health problem in non-endemic areas

Diagnosis of paracoccidioidomycosis in an immigrant who had returned to Italy following a long sojourn in Venezuela prompted a review of imported cases of this Latin American disease in nonendemic countries. Forty-two such instances of well-documented paracoccidioidomycosis were complied. Among these, eleven individuals had arrived in nonendemic countries with active symptomatic infections, fifteen others were first suspected of having tuberculosis, and four each were considered to have blastomycosis caused by Blastomyces dermatitidis and carcinomas. Three individuals were considered to have Wegener's granulomatosis or blastomycosis. Two other patients were treated for syphilis before being diagnosed as having paracoccidioidomycosis. A striking feature of most of these cases was the long asymptomatic period following initial infection. The dormant periods ranged form four months to 60 years with an average duration of 14 years. The need to question patients about travel to or residency in foreign countries is emphasized, along with the necessity to include the mycoses in differential diagnoses. Three reported cases, all from Africa with no history of travel to the endemic areas of the New World, were considered to be doubtful. In one of these, Russell bodies apparently had been mistaken for the tissue-form cells of Paracoccidioides brasiliensis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Between Yucatan, Florida and French Guiana does lobomycosis exist in the Antilles?]

Lobomycosis, or Blastomicose queloidiforme de Jorge Lobo, has been described in men around the North of South America, Central America, and the case reported in Yucatan, Mexico, is the northest. The same disease has been seen in Dolphins in Florida, where the humans cases are unknown. Epidemiology, pathogenic curiosities, and diagnosis are presented for all practicians in the geographic area.

[Survey on paracoccidioidin in a population of Bahia (Brazil)]

No Município de Una, localizado ao Sul do Estado da Bahia, em área com registro freqüente de casos de leishmaniose tegumentar, foram estudados 177 indivíduos, na faixa etária entre três meses e 73 anos, através de provas intradérmicas com paracoccidioidina (antígeno péptido-polissacarídico do Paracoccidioides brasiliensis). Positividade foi obtida em dez indivíduos (5,6%). Somente foi considerada positiva a reação que apresentava enduração igual ou maior que 5 mm. Em nenhum dos casos positivos à paracoccidioidina havia evidência clínica de lesões blastomicóticas. Com os soros dos indivíduos positivos à paracoccidioidina, foram realizadas provas de imunodifusão dupla e contraimunoeletroforese, com resultados negativos para anticorpos circulantes anti-P. brasiliensis. Este dado indica que, em nenhum dos reatores à paracoccidioidina, havia processo infeccioso em atividade. O percentual de positividade obtido com a paracoccidioidina, em que pesem eventuais reações cruzadas com histoplasmose, sugere a ocorrência da paracoccidioidomicose na área estudada.

[Paracoccidioidomycosis: apropos of 3 new Uruguayan cases]

Three new Uruguayan paracoccidioidomycosis human cases are presented. Two of them correspond to the disseminated form with metastatic lesions at the oral mucosa; the remaining one, with important pulmonary bilateral lesions corresponds to the pure chronic pulmonary form of the disease which is recognized by the first time in the country. No doubt, these clinical forms will be found much more frequently in the endemic areas of Latin America if serological surveys are developed in the near future.

[Dermatology in French Guiana]

In French Guayana, climatic and geographic conditions enhance development of numerous fungal, parasitic and microbial skin diseases. The most particular infectious diseases of this French department are lobomycosis, chromomycosis (Phialophora pedrosoi), creeping disease, cutaneous leishmaniasis, tungiasis, mycobacterial ulcus (Mycobacterium ulcerans) and papular dermatitis caused by nettling hairs of lepidoptera (Hylesia urticans). The occurence of these skin diseases is demonstrative of pathological ecology of the Amazonian country.

South American blastomycosis of epididymis

Reported herein is the first Brazilian case of epididymal involvement by South American blastomycosis, and apparently the second case to be reported in the world literature.

[South American blastomycosis (paracoccidioidomycosis) in Switzerland. Clinical course and morphological findings in a case following long-term therapy]

The clinical course and morphological findings are reported of visceral paracoccidioidomycosis or South American blastomycosis with lung involvement in a 47-year-old male after specific antimycotic treatment for 11 years. The patient had been infected during a stay in São Paulo, Brazil, from 1950 to 1954. The diagnosis was established in 1959 after his return to St. Gall, Switzerland, in tissue from buccal mucosa and cervical lymph node biopsy and in fungus cultures. The patient was treated with Fungizone (amphotericin B) and with the sulfonamide Fanasil. He died in 1970 from acute right heart failure. Autopsy revealed multiple encapsulated mycotic foci in both lungs, together with healed foci and pulmonary fibrosis. Histological examination showed a large amount of Paracoccidioides brasiliensis in the mycotic foci, but cultural proof was no longer possible. In the buccal mucosa and lymph nodes, only fungus-free scars were observed. There are only a few effective antimycotic agents. With a thorough knowledge of their side effects and dosage modalities, it is possible to achieve highly satisfactory results.

Paracoccidioidin and histoplasmin sensitivity in Coari (state of Amazonas), Brazil

A skin test survey with paracoccidioidin and histoplasmin was conducted on 495 residents of Coari in the Brazilian state of Amazonas. Positive dermal reactions to paracoccidioidin and histoplasmin were seen, respectively, in 13.9% and 50.1% of the study subjects. Specific reaction to paracoccidioidin was observed in 1.6% of the individuals, and to histoplasmin in 37.8%. Cross-reactivity between the two antigens in persons who reacted positively to both skin tests was not totally reciprocal. There were no significant differences in dermal reactivity to either of the two antigens in either sex, or among different occupational groups. No precipitating antibody to paracoccidioidin or histoplasmin was detected in the sera of the skin test-positive individuals by the immunodiffusion test. Skin test positivity in the general population of Coari reaffirmed the concept of benign, self-limited infection in paracoccidioidomycosis and histoplasmosis. It also identified the equatorial forests of the Upper Amazon Basin as endemic zones of these two mycoses.

[Paracoccidioidomycosis: an epidemic in the Republic of Paraguay, the center of South America]

The investigation done on the frequency or incidence of Paracoccidioidomycosis in the Republic of Paraguay, with the cases appeared and registered in the Institute of Pathology of Asuncion, presents an incidence rate of 0.46 per 100,000 in the total population; 0.52 per 100,000 in the population at risk. Considering the exposed masculine population the rate is 1.03 per 100,000 and for the feminine 0.02 per 100,000. The age group most affected is within the 50-54 year range with 3.54 per 100,000, the highest rate of all the groups studied. These are the incidence in a strongly exposed population which is controlled and well known. The period of 10 years (1960/69) which has been chosen for this investigation, shows a frequency of the mixed type (lymphatic-visceral or lymphoma-type) which reaches 25% of the total, and a low frequency for the pulmonary form which reaches a mere 12.5%. The mucocutaneous lesion with the involvement of the regional lymph nodes is the dominating form. Considering three consecutive 5 year periods between 1960 to 1974, no cases with proved pulmonary involvement were found until 1964; from 1965 to 1969 the percentage of pulmonary lesions in all the cases considered was 23.0% and from 1970 to 1974 reached to 38.4%. However, mucocutaneous and the lymphatic-visceral or mixed forms do not show significant variations. The rats are small and represent the incidence of this mycosis. It is suggested that a failure of the immunologic system would be found in those affected by the disease and there would be a strong resistence in the majority of the population exposed or within the endemic area of the infection.