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Bai J, Qiao J. Multiple Umbilicated Papules on the Face. JAMA Dermatol 2024; 160:103-104. [PMID: 37966830 DOI: 10.1001/jamadermatol.2023.4162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
A man in his 20s presented to the dermatology department with a monthlong history of gradually progressing papules and nodules on the face, accompanied by fever, fatigue, and weight loss. What is your diagnosis?
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Affiliation(s)
- Juan Bai
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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2
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Chavan SS, Chandrashekhar TN. Lobomycosis in a Post-Covid 19 Patient: A Case Report and Review of Literature. Turk Patoloji Derg 2023; 39:206-211. [PMID: 37218667 PMCID: PMC10521202 DOI: 10.5146/tjpath.2023.01604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/13/2023] [Indexed: 05/24/2023] Open
Abstract
AIM To document a case of lobomycosis and to discuss its epidemiology & diagnosis. CASE REPORT A 53-year-old male presented with a history of nasal congestion, nasal discharge, and epistaxis following Covid 19 infection. On physical examination, there was necrotic slough in the nasal vestibule near the inferior turbinate. Scrapings and punch biopsy were taken from the lesion. Hematoxylin-eosin-stained sections showed necrotic and mucoid areas with mixed inflammatory cell infiltration and numerous budding yeasts 3- 7μm diameter in singles, and small clusters with single narrow based budding as well as multiple budding including sequential budding forming "chains of yeasts". A diagnosis of Lobomycosis was made. Yeasts of lobomycosis are often confused with other yeasts such as P. brasiliensis, Candida spp., B. dermatitidis, and Cryptococci, but characteristic 'sequential budding' with a 'chain of yeasts" aid in the final diagnosis. Demonstration of yeasts with characteristic chains either in tissue sections or in potassium hydroxide (KOH) preparation of scraped material, exudate, or exfoliative cytology is the mainstay in the diagnosis as the organisms are uncultivable in vitro in culture medium.
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Affiliation(s)
- Sateesh S Chavan
- Departments of Pathology, Karnataka Institute of Medical Sciences, Karnataka, India
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3
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Gonçalves FG, Rosa PS, Belone ADFF, Carneiro LB, de Barros VLQ, Bispo RF, Sbardelott YADS, Neves SAVM, Vittor AY, Woods WJ, Laporta GZ. Lobomycosis Epidemiology and Management: The Quest for a Cure for the Most Neglected of Neglected Tropical Diseases. J Fungi (Basel) 2022; 8:jof8050494. [PMID: 35628750 PMCID: PMC9144079 DOI: 10.3390/jof8050494] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 01/27/2023] Open
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.
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Affiliation(s)
- Franciely G. Gonçalves
- Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André 09060-870, SP, Brazil;
- Research Lab at Centro Universitario UNINORTE, Rio Branco 69915-901, AC, Brazil
- State Dermatology Program of Acre, Secretariat of Health in the State of Acre (SESACRE), Rio Branco 69917-650, AC, Brazil; (L.B.C.); (V.L.Q.d.B.); (R.F.B.); (Y.A.d.S.S.); (W.J.W.)
| | - Patrícia S. Rosa
- Division of Research, Lauro de Souza Lima Institute, Bauru 17034-971, AP, Brazil; (P.S.R.); (A.d.F.F.B.)
| | - Andrea de F. F. Belone
- Division of Research, Lauro de Souza Lima Institute, Bauru 17034-971, AP, Brazil; (P.S.R.); (A.d.F.F.B.)
| | - Léia B. Carneiro
- State Dermatology Program of Acre, Secretariat of Health in the State of Acre (SESACRE), Rio Branco 69917-650, AC, Brazil; (L.B.C.); (V.L.Q.d.B.); (R.F.B.); (Y.A.d.S.S.); (W.J.W.)
| | - Vania L. Q. de Barros
- State Dermatology Program of Acre, Secretariat of Health in the State of Acre (SESACRE), Rio Branco 69917-650, AC, Brazil; (L.B.C.); (V.L.Q.d.B.); (R.F.B.); (Y.A.d.S.S.); (W.J.W.)
| | - Rosineide F. Bispo
- State Dermatology Program of Acre, Secretariat of Health in the State of Acre (SESACRE), Rio Branco 69917-650, AC, Brazil; (L.B.C.); (V.L.Q.d.B.); (R.F.B.); (Y.A.d.S.S.); (W.J.W.)
| | - Yally A. da S. Sbardelott
- State Dermatology Program of Acre, Secretariat of Health in the State of Acre (SESACRE), Rio Branco 69917-650, AC, Brazil; (L.B.C.); (V.L.Q.d.B.); (R.F.B.); (Y.A.d.S.S.); (W.J.W.)
| | | | - Amy Y. Vittor
- Division of Infectious Diseases and Global Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - William J. Woods
- State Dermatology Program of Acre, Secretariat of Health in the State of Acre (SESACRE), Rio Branco 69917-650, AC, Brazil; (L.B.C.); (V.L.Q.d.B.); (R.F.B.); (Y.A.d.S.S.); (W.J.W.)
| | - Gabriel Z. Laporta
- Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André 09060-870, SP, Brazil;
- Correspondence:
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Vilela R, Huebner M, Vilela C, Vilela G, Pettersen B, Oliveira C, Mendoza L. The taxonomy of two uncultivated fungal mammalian pathogens is revealed through phylogeny and population genetic analyses. Sci Rep 2021; 11:18119. [PMID: 34518564 PMCID: PMC8438014 DOI: 10.1038/s41598-021-97429-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/18/2021] [Indexed: 01/21/2023] Open
Abstract
Ever since the uncultivated South American fungal pathogen Lacazia loboi was first described 90 years ago, its etiology and evolutionary traits have been at the center of endless controversies. This pathogen infects the skin of humans and as long believed, dolphin skin. However, recent DNA analyses of infected dolphins placed its DNA sequences within Paracoccidioides species. This came as a surprise and suggested the human and dolphin pathogens may be different species. In this study, population genetic analyses of DNA from four infected dolphins grouped this pathogen in a monophyletic cluster sister to P. americana and to the other Paracoccidioides species. Based on the results we have emended the taxonomy of the dolphin pathogen as Paracoccidioides cetii and P. loboi the one infecting human. Our data warn that phylogenetic analysis of available taxa without the inclusion of unusual members may provide incomplete information for the accurate classification of anomalous species.
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Affiliation(s)
- Raquel Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, 31270, Brazil
| | - Marianne Huebner
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, 48824, USA
| | - Camila Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
| | - Gabriella Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
| | - Bruno Pettersen
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
| | - Claudia Oliveira
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA
| | - Leonel Mendoza
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI, 48824, USA.
- Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, 48824, USA.
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Florian MC, Rodrigues DA, de Mendonça SBM, Colombo AL, Tomimori J. Epidemiologic and Clinical Progression of Lobomycosis among Kaiabi Indians, Brazil, 1965-2019. Emerg Infect Dis 2020; 26:930-936. [PMID: 32310067 PMCID: PMC7181903 DOI: 10.3201/eid2605.190958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Lobomycosis is a rare granulomatous skin disease with a high prevalence in the Amazon region. The Kaiabi Indians are an especially affected group. We studied the current epidemiologic and clinical progression of lobomycosis among the Kaiabi in Brazil, from initial case reports in 1965 through 2019. A total of 60 lobomycosis cases had been reported among the Kaiabi, and we identified 3 new cases in our review. Of 550 cases of lobomycosis ever reported worldwide, 11.5% were among the Kaiabi. We note a high incidence among female Kaiabi and a precocious onset of disease in this indigenous population. Male Kaiabi frequently are infected with the multicentric form and women more frequently exhibit the localized form. Ulcerated lesions are observed more often in the multicentric form. The prevalence among this indigenous group could be explained by genetic susceptibility and lifestyle, which exposes them to a particular agent in the habitats in which they live.
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What is your diagnosis? Keloidal cord-like lesion on the leg. An Bras Dermatol 2020; 95:386-389. [PMID: 32312547 PMCID: PMC7253847 DOI: 10.1016/j.abd.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/04/2019] [Indexed: 11/23/2022] Open
Abstract
We report a 74-year-old male presented to an outpatient dermatology clinic in Manaus, Amazonas, with a one-year history of pruritic, keloidal lesions on his left lower extremity. Histopathology showed round structures in reticular dermis. Grocott methenamine silver stain revealed numerous round yeasts with thick double walls, occurring singly or in chains connected by tubular projections. The diagnosis was lobomycosis. Although the keloidal lesions presented by this patient are typical of lobomycosis, their linear distribution along the left lower limb is unusual.
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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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Beltrame A, Danesi P, Farina C, Orza P, Perandin F, Zanardello C, Rodari P, Staffolani S, Bisoffi Z. Case Report: Molecular Confirmation of Lobomycosis in an Italian Traveler Acquired in the Amazon Region of Venezuela. Am J Trop Med Hyg 2017; 97:1757-1760. [PMID: 29016315 DOI: 10.4269/ajtmh.17-0446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Lobomycosis is a chronic skin mycosis endemic in Amazon regions characterized by chronic nodular or keloidal lesions caused by Lacazia loboi, an uncultivable fungus. Imported cases in nonendemic countries are rare and diagnosed after years. We describe a case of lobomycosis in a healthy 55-year-old Italian traveler who had acquired the infection during 5-day-honeymoon in the Amazon region of Venezuela in 1999. Several weeks after return, he recalled pruritus and papular skin lesions on the left lower limb, subsequently evolving to a plaque-like lesion. Blastomycosis and cryptococcosis were hypothesized based on microscopic morphology of yeast-like bodies found in three consecutive biopsies, although fungal cultures were always negative. In 2016, exfoliative cytology and a biopsy specimen examination showed round yeast-like organisms (6-12 μm), isolated or in a chain, connected by short tubular projections fulfilling the morphologic diagnostic criteria of Lacazia spp. The microscopic diagnosis was confirmed by molecular identification.
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Affiliation(s)
- Anna Beltrame
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Patrizia Danesi
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Claudio Farina
- Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, UOC Microbiologia e Virologia, Bergamo, Italy
| | - Pierantonio Orza
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Francesca Perandin
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Paola Rodari
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Silvia Staffolani
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
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Beaufrère A, Cherif K, Chrétien F, Lamarche F, Grossin M. [An exceptional cause of skin tumor]. Ann Pathol 2014; 34:400-2. [PMID: 25439996 DOI: 10.1016/j.annpat.2014.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 04/19/2014] [Accepted: 08/27/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Aurélie Beaufrère
- Service d'anatomie et cytologie pathologiques de l'hôpital Louis-Mourier, 92701 Colombes, France.
| | - Khedija Cherif
- Service d'anatomie et cytologie pathologiques de l'hôpital Louis-Mourier, 92701 Colombes, France
| | - Fabrice Chrétien
- Service d'histopathologie humaine de l'Institut Pasteur, 75015 Paris, France
| | - François Lamarche
- Cabinet de pathologie, 13, rue Sainte-Catherine, 80100 Abbeville, France
| | - Maggy Grossin
- Service d'anatomie et cytologie pathologiques de l'hôpital Louis-Mourier, 92701 Colombes, France
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Arju R, Kothadia JP, Kaminski M, Abraham S, Giashuddin S. Jorge Lobo's disease: a case of keloidal blastomycosis (lobomycosis) in a nonendemic area. Ther Adv Infect Dis 2014; 2:91-6. [PMID: 25469235 DOI: 10.1177/2049936114559919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lobomycosis or lacaziosis is a chronic subcutaneous fungal infection, caused by the fungus Lacazia loboi, which is phylogenetically related to Coccidioides, Blastomyces, Histoplasma, and Paracoccidioides. The disease was first recognized in 1931 by Jorge Lobo, who found the disease to be a keloidal blastomycosis and named it Jorge Lobo's disease. This case was perplexing initially as this fungal infection is very uncommon in the USA. However, with the ever-increasing frequency of international travel, many more cases of lobomycosis have been diagnosed in areas of nonendemicity, such as the USA, Europe, and South Africa. The clinical histories of such imported fungal infections often illustrate their long latency periods. In lobomycosis, the onset of the disease is usually insidious and often difficult to document. We describe a case of a New York resident who presented with multiple skin nodules over both his arms and forearms, and was subsequently diagnosed with Jorge Lobo's disease. The case, diagnosis, histopathologic findings, complication, and management of this rare clinical disease are discussed.
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Affiliation(s)
- Rezina Arju
- Department of Family Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | | | - Monica Kaminski
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sherly Abraham
- Department of Family Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Shah Giashuddin
- Director, Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
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Francesconi VA, Klein AP, Santos APBG, Ramasawmy R, Francesconi F. Lobomycosis: epidemiology, clinical presentation, and management options. Ther Clin Risk Manag 2014; 10:851-60. [PMID: 25328400 PMCID: PMC4199563 DOI: 10.2147/tcrm.s46251] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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Reif JS, Schaefer AM, Bossart GD. Lobomycosis: risk of zoonotic transmission from dolphins to humans. Vector Borne Zoonotic Dis 2013; 13:689-93. [PMID: 23919604 DOI: 10.1089/vbz.2012.1280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lobomycosis, a fungal disease of the skin and subcutaneous tissues caused by Lacazia loboi, is sometimes referred to as a zoonotic disease because it affects only specific delphinidae and humans; however, the evidence that it can be transferred directly to humans from dolphins is weak. Dolphins have also been postulated to be responsible for an apparent geographic expansion of the disease in humans. Morphological and molecular differences between the human and dolphin organisms, differences in geographic distribution of the diseases between dolphins and humans, the existence of only a single documented case of presumed zoonotic transmission, and anecdotal evidence of lack of transmission to humans following accidental inoculation of tissue from infected dolphins do not support the hypothesis that dolphins infected with L. loboi represent a zoonotic hazard for humans. In addition, the lack of human cases in communities adjacent to coastal estuaries with a high prevalence of lobomycosis in dolphins, such as the Indian River Lagoon in Florida (IRL), suggests that direct or indirect transmission of L. loboi from dolphins to humans occurs rarely, if at all. Nonetheless, attention to personal hygiene and general principals of infection control are always appropriate when handling tissues from an animal with a presumptive diagnosis of a mycotic or fungal disease.
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Affiliation(s)
- John S Reif
- 1 College of Veterinary Medicine and Biomedical Sciences, Colorado State University , Fort Collins, Colorado
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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] [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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Abstract
Lobomycosis is a rare chronic fungal infection of the subcutaneous tissue found in South America, mainly in Brazil. It is caused by Lacazia loboi. Its clinical manifestations are dermal nodules, either lenticular or in plaques, and keloidlike lesions that can resemble nodular leprosy or leishmaniasis, other subcutaneous mycoses (sporotrychosis, chromomycosis, paracoccidioidomycosis), keloids, and malignant tumors. Diagnosis is made by the histopathological findings of the fungus. For treatment, surgical removal of the lesions, followed by itraconazole and clofazimine for disseminated lesions, has been used with variable results.
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Affiliation(s)
- Sinésio Talhari
- Faculty of Medicine, Nilton Liins University, Av. Professor Nilton Lins 3259, Parque das Laranjeiras, Manaus, Amazonas, Brazil.
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Paniz-Mondolfi A, Talhari C, Sander Hoffmann L, Connor DL, Talhari S, Bermudez-Villapol L, Hernandez-Perez M, Van Bressem MF. Lobomycosis: an emerging disease in humans and delphinidae. Mycoses 2012; 55:298-309. [DOI: 10.1111/j.1439-0507.2012.02184.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Esperón F, García-Párraga D, Bellière EN, Sánchez-Vizcaíno JM. Molecular diagnosis of lobomycosis-like disease in a bottlenose dolphin in captivity. Med Mycol 2011; 50:106-9. [PMID: 21838615 DOI: 10.3109/13693786.2011.594100] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the diagnosis and molecular characterization of lobomycosis-like lesions in a captive bottlenose dolphin. The clinical picture and the absence of growth in conventional media resembled the features associated with Lacazia loboi. However sequencing of ribosomal DNA and further phylogenetic analyses showed a novel sequence more related to Paracoccidioides brasilensis than to L. loboi. Moreover, the morphology of the yeast cells differed from those L. loboi causing infections humans. These facts suggest that the dolphin lobomycosis-like lesions might have been be caused by different a different fungus clustered inside the order Onygenales. A successful treatment protocol based on topic and systemic terbinafine is also detailed.
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Affiliation(s)
- Fernando Esperón
- Centro de Investigación en Sanidad Animal (CISA-INIA), Valdeolmos, Madrid, Spain.
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Queiroz-Telles F, Nucci M, Colombo AL, Tobón A, Restrepo A. Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment. Med Mycol 2011; 49:225-36. [DOI: 10.3109/13693786.2010.539631] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Lobomycosis is a cutaneous infection of tropical and subtropical regions caused by the fungus Lacazia loboi, which still has a controversial taxonomical position. The first description of the disease and fungus was made in 1930 by Jorge Lobo. It is a chronic disease with predominance of lesions similar to keloids, in exposed areas, limited to skin and semimucosa. There is no systemic involvement and patients maintain a good general health. Diagnosis is confirmed by direct or histopathologic exam and, until present, the fungus has not been cultivated. Surgery is the treatment of choice for isolated lesions, but there are frequent recurrences. Good therapeutic responses have been reported with clofazimine, with or without itraconazole, and with 5-fluorocytosine. This disease should be recognized by dermatologists worldwide because, although restricted to the Amazon region, it has been observed in other locations. Research development and achievement of new knowledge in molecular biology and genetic engineering of lobomycosis are of utmost importance because they may, in the future, lead to the culture of the fungus in the laboratory and to a better understanding of its pathogenesis, transmission mechanism, and new methods of diagnosis, prevention and treatment.
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Carneiro FP, Maia LB, Moraes MAP, de Magalhães AV, Vianna LMDS, Zancanaro PCQ, Reis CM. Lobomycosis: diagnosis and management of relapsed and multifocal lesions. Diagn Microbiol Infect Dis 2009; 65:62-4. [PMID: 19679237 DOI: 10.1016/j.diagmicrobio.2009.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 04/08/2009] [Accepted: 04/18/2009] [Indexed: 10/20/2022]
Abstract
We report a case of lobomycosis in the left leg of a patient that had traveled to the endemic Brazilian Amazon region. After surgical resection of the lesion, there was relapse with local dissemination of the disease and the treatment was successfully performed by oral itraconazole and cryosurgery.
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Affiliation(s)
- Fabiana Pirani Carneiro
- Department of Pathology, University Hospital of Brasília, Brasília, DF CEP: 70840-050, Brazil.
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Rosa PS, Soares CT, Belone ADFF, Vilela R, Ura S, Filho MC, Mendoza L. Accidental Jorge Lobo's disease in a worker dealing with Lacazia loboi infected mice: a case report. J Med Case Rep 2009; 3:67. [PMID: 19220901 PMCID: PMC2647936 DOI: 10.1186/1752-1947-3-67] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 02/16/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Jorge Lobo's disease (Lacaziosis) is a subcutaneous infection of humans living in the Amazon region of Latin America, and in dolphins inhabiting the east coastal areas of the United States. The disease mainly affects people from rural areas living or working in close contact with vegetation and aquatic environments. Most patients refer having developed lesions after accidental trauma with plant thorns or insect bites. Inter-human transmission has never been confirmed suggesting that Lacazia loboi is acquired from environmental propagules. CASE PRESENTATION We report the case of a 41-year-old woman from São Paulo, Brazil, a non-endemic area of Jorge Lobo's disease, with L. loboi skin infection most likely accidentally acquired while manipulating experimentally infected mice in the laboratory. CONCLUSION Because many patients with Jorge Lobo's disease do not recall accidental skin trauma before their infections, the possibility of accidentally acquired Jorge Lobo's disease through unnoticed broken skin should be considered during the clinical investigation of nodular skin diseases in people who have contact with the fungus or who live in endemic areas. This is the second report of animal to human transmission of this disease.
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Salgado CG, Tavares LSA, Plautz HL, Da Silva MB, Yamano SSP, Da Costa PF, Hamoy IG, Marinho ANDR, Santos AKCRD, Salgado UI, Da Silva JP. Enzymatic isolation ofLacazia loboicells from skin lesions of lobomycosis. Med Mycol 2009; 47:119-23. [DOI: 10.1080/13693780802127177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Clinical Usefulness of ELISPOT Assay on Pericardial Fluid in a Case of Suspected Tuberculous Pericarditis. Infection 2008; 36:601-4. [DOI: 10.1007/s15010-008-7402-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 03/03/2008] [Indexed: 11/26/2022]
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Murdoch ME, Reif JS, Mazzoil M, McCulloch SD, Fair PA, Bossart GD. Lobomycosis in bottlenose dolphins (Tursiops truncatus) from the Indian River Lagoon, Florida: estimation of prevalence, temporal trends, and spatial distribution. ECOHEALTH 2008; 5:289-297. [PMID: 18712442 DOI: 10.1007/s10393-008-0187-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 05/23/2008] [Accepted: 06/16/2008] [Indexed: 05/26/2023]
Abstract
Lobomycosis (lacaziosis) is a chronic fungal disease of the skin that affects only dolphins and humans. Previous studies have shown a high prevalence of lobomycosis in bottlenose dolphins (Tursiops truncatus) from the Indian River Lagoon, Florida (IRL). We studied the occurrence and distribution of lobomycosis in the IRL using photo-identification survey data collected between 1996 and 2006. Our objectives were to (1) determine the sensitivity and specificity of photo-identification for diagnosis of lobomycosis in free-ranging dolphins; (2) determine the spatial distribution of lobomycosis in the IRL; and (3) assess temporal patterns of occurrence. Photographs from 704 distinctly marked dolphins were reviewed for skin lesions compatible with lobomycosis. The presumptive diagnosis was validated by comparing the results of photographic analysis with physical examination and histologic examination of lesion biopsies in 102 dolphins captured and released during a health assessment and 3 stranded dolphins. Twelve of 16 confirmed cases were identified previously by photography, a sensitivity of 75%. Among 89 dolphins without disease, all 89 were considered negative, a specificity of 100%. The prevalence of lobomycosis estimated from photographic data was 6.8% (48/704). Spatial distribution was determined by dividing the IRL into six segments based on hydrodynamics and geographic features. The prevalence ranged from <1% in the Mosquito Lagoon to 16.9% in the south Indian River. The incidence of the disease did not increase during the study period, indicating that the disease is endemic, rather than emerging. In summary, photo-identification is a useful tool to monitor the course of individual and population health for this enigmatic disease.
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Affiliation(s)
- M Elizabeth Murdoch
- Center for Marine Ecosystem Health, Marine Mammal Research and Conservation Program, Harbor Branch Oceanographic Institute at Florida Atlantic University, 5600 US 1 North, Fort Pierce, FL 34946, USA.
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Reif JS, Peden-Adams MM, Romano TA, Rice CD, Fair PA, Bossart GD. Immune dysfunction in Atlantic bottlenose dolphins (Tursiops truncatus) with lobomycosis. Med Mycol 2008; 47:125-35. [PMID: 18608890 DOI: 10.1080/13693780802178493] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Lobomycosis (Lacaziosis) occurs only in humans and dolphins under natural conditions. We evaluated the immune status of eight dolphins with lobomycosis and 40 healthy dolphins from the Indian River Lagoon (IRL), Florida. Lobomycosis cases had multiple abnormalities in their immunologic parameters when compared to healthy dolphins. The absolute number of circulating lymphocytes and serum albumin concentration were reduced (P<0.05) while the segmented neutrophils, alpha 1, total beta, total gamma and total globulins were increased (P<0.05). Although innate immunity was relatively intact and phagocytosis and natural killer cell activity were not affected, the plasma lysozyme concentrations were elevated in dolphins with lobomycosis (P<0.05). Adaptive immunity was depressed with statistically significant decreases found in the absolute numbers of CD4(+) helper T cells and CD19(+) and CD21(+) B cells. The ratios of CD2(+) T cells to CD4(+) cells and CD2(+) to CD21(+) cells were increased (P=0.05 and P<0.05, respectively) and the numbers of lymphocytes expressing MHC class II molecules was decreased in dolphins with lobomycosis (P<0.05). Lymphocyte proliferation was reduced in response to stimulation with lipopolysaccharide and concanavalin A (P<0.05). Antibody titers to Erysipelas rhusiopathiae, a common marine micro-organism, were decreased (P<0.05). In summary, dolphins with lobomycosis exhibit significant impairment in adaptive immunity.
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Affiliation(s)
- John S Reif
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA.
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Use of sera from humans and dolphins with lacaziosis and sera from experimentally infected mice for Western Blot analyses of Lacazia loboi antigens. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2007; 15:164-7. [PMID: 17959822 DOI: 10.1128/cvi.00201-07] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Antibodies in the sera of patients with lacaziosis recognized an approximately 193-kDa antigen and other Lacazia loboi antigens. Paracoccidioides brasiliensis gp43 antigen was detected by all evaluated sera, but they failed to detect a protein with the same molecular mass in L. loboi extracts. This study is the first to examine the humoral response to L. loboi antigens by using multiple host sera.
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Abstract
Lacaziose ou doença de Jorge Lobo é micose crônica, granulomatosa, causada por implantação traumática do fungo Lacazia loboi - patógeno não cultivável até o presente - nos tecidos cutâneo e subcutâneo, manifestando-se clinicamente por lesões nodulares queloidianas predominantes, envolvendo sobretudo pavilhões auriculares, face, membros superiores e inferiores, e não comprometendo as mucosas. A maioria dos casos humanos está registrada em países da América do Sul. Entretanto, a enfermidade apresenta aspectos epidemiológicos destacados, como o aparecimento em tribo Caiabi, no Brasil Central e em mamíferos não humanos, golfinhos de duas espécies (Tursiops truncatus e Sotalia guianensis) capturados na costa da Flórida (EUA), na foz do rio Suriname, na costa de Santa Catarina (Brasil), no golfo de Gasconha (baía de Biscaia-Europa), com manifestações cutâneas e achados histopatológicos muito similares às encontradas no homem. O artigo objetiva abordar características do fungo e sua taxonomia, e aspectos históricos, ecoepidemiológicos, clínicos, imuno-histoquímicos, histopatológicos, ultra-estruturais e terapêuticos.
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Abstract
Lobomycosis is a chronic dermal infection that presents a wide spectrum of clinical- dermatological manifestations, mainly characterized by the development of keloid lesions as well as nodular, verrucoid and sometimes ulcerous forms. The etiological agent at an international level, according to the consensus nomenclature, has been called Loboa loboi, even though recently it has been accommodated as Lacazia loboi. The present review extensively covers the clinical-epidemiological aspects as well as the most outstanding historical aspects, including the Venezuelan experience and the presentation of two new cases, which substantiate the Amazon basin as an endemic area for the disease.
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Affiliation(s)
- Alberto E Paniz-Mondolfi
- Laboratorio de Estudio de Antígenos, Instituto de Biomedicina, Universidad Central de Venezuela/Ministerio de Salud y Desarrollo Social, Caracas, Venezuela.
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Paniz-Mondolfi AE, Jaimes OR, Jones LD. Lobomycosis in Venezuela. Int J Dermatol 2006. [DOI: 10.1111/j.1365-4632.2006.02937.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reif JS, Mazzoil MS, McCulloch SD, Varela RA, Goldstein JD, Fair PA, Bossart GD. Lobomycosis in Atlantic bottlenose dolphins from the Indian River Lagoon, Florida. J Am Vet Med Assoc 2006; 228:104-8. [PMID: 16426180 DOI: 10.2460/javma.228.1.104] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the prevalence of lobomycosis, a mycotic infection of dolphins and humans caused by a yeastlike organism (Lacazia loboi), among dolphins in the Indian River Lagoon in Florida. DESIGN Cross-sectional study. ANIMALS 146 Atlantic bottlenose dolphins. PROCEDURE Comprehensive health assessments of bottlenose dolphins in the Indian River Lagoon of Florida (n = 75) and in estuarine waters near Charleston, SC (71), were conducted during 2003 and 2004. Bottlenose dolphins were captured, examined, and released. Skin lesions were photographed and then biopsied. Tissue sections were stained with H&E and Gomori methenamine silver stains for identification of L. loboi. RESULTS 9 of 30 (30%) dolphins captured in the southern portion of the Indian River Lagoon had lobomycosis, whereas none of the 45 dolphins captured in the northern portion of the lagoon or of the 71 dolphins captured near Charleston, SC, did. Affected dolphins had low serum alkaline phosphatase activities and high acute-phase protein concentrations. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that lobomycosis may be occurring in epidemic proportions among dolphins in the Indian River Lagoon. Localization of the disease to the southern portion of the lagoon, an area characterized by freshwater intrusion and lower salinity, suggests that exposure to environmental stressors may be contributing to the high prevalence of the disease, but specific factors are unknown. Because only dolphins and humans are naturally susceptible to infection, dolphins may represent a sentinel species for an emerging infectious disease.
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Affiliation(s)
- John S Reif
- Division of Marine Mammal Research and Conservation, Harbor Branch Oceanographic Institution, 5600 US 1 North, Fort Pierce, FL 34946, USA
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Vilela R, Mendoza L, Rosa PS, Belone AFF, Madeira S, Opromolla DVA, de Resende MA. Molecular model for studying the uncultivated fungal pathogen Lacazia loboi. J Clin Microbiol 2005; 43:3657-61. [PMID: 16081893 PMCID: PMC1233932 DOI: 10.1128/jcm.43.8.3657-3661.2005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lacazia loboi is an uncultivated fungal pathogen of humans and dolphins that causes cutaneous and subcutaneous infections only in the tropical areas of the Americas. It was recently found by phylogenetic analysis that this unusual pathogen is closely related to Paracoccidioides brasiliensis and to the other fungal dimorphic members of the order Onygenales. That original phylogenetic study used universal primers to amplify well-known genes. However, this approach cannot be applied to the study of other proteins. We have developed a strategy for studying the gene encoding the gp43 homologous protein of P. brasiliensis in L. loboi. The gp43 protein was selected because it has been found that this P. brasiliensis antigen strongly reacts when it is used to test sera from patients with lacaziosis. The principle behind this idea was to obtain the gp43 amino acid sequence of P. brasiliensis and other homologous fungal sequences from GenBank and design primers from their aligned conserved regions. These sets of primers were used to amplify the selected regions with genomic DNA extracted from the yeast-like cells of L. loboi from experimentally infected mice. Using this approach, we amplified 483 bp of the L. loboi gp43-like gene. These sequences had 85% identity at the nucleotide level and 75% identity with the deduced amino acid sequences of the P. brasiliensis gp43 protein. The identity of the 483-bp DNA fragment was confirmed by phylogenetic analysis. This analysis revealed that the L. loboi gp43-like deduced amino acid sequence formed a strongly supported (100%) sister group with several P. brasiliensis gp43 sequences and that this taxon in turn was linked to the other fungal sequences used in this analysis. This study shows that the use of a molecular model for investigation of the genes encoding important proteins in L. loboi is feasible.
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Affiliation(s)
- Raquel Vilela
- Department of Microbiology, Universidade Federal de Minas Gerais, Minas Gerais, Brazil, Medical Technology Program, Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, Instituto Lauro De Souza Lima, Bauru, São Paulo, Brazil
| | - Leonel Mendoza
- Department of Microbiology, Universidade Federal de Minas Gerais, Minas Gerais, Brazil, Medical Technology Program, Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, Instituto Lauro De Souza Lima, Bauru, São Paulo, Brazil
- Corresponding author. Mailing address: Medical Technology Program, Michigan State University, 322 North Kedzie Hall, East Lansing, MI 48824-1031. Phone: (517) 353-7800. Fax: (517) 432-2006. E-mail:
| | - Patricia S. Rosa
- Department of Microbiology, Universidade Federal de Minas Gerais, Minas Gerais, Brazil, Medical Technology Program, Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, Instituto Lauro De Souza Lima, Bauru, São Paulo, Brazil
| | - Andréa Faria Fernandes Belone
- Department of Microbiology, Universidade Federal de Minas Gerais, Minas Gerais, Brazil, Medical Technology Program, Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, Instituto Lauro De Souza Lima, Bauru, São Paulo, Brazil
| | - Suzana Madeira
- Department of Microbiology, Universidade Federal de Minas Gerais, Minas Gerais, Brazil, Medical Technology Program, Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, Instituto Lauro De Souza Lima, Bauru, São Paulo, Brazil
| | - Diltor Vladimir Araújo Opromolla
- Department of Microbiology, Universidade Federal de Minas Gerais, Minas Gerais, Brazil, Medical Technology Program, Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, Instituto Lauro De Souza Lima, Bauru, São Paulo, Brazil
| | - Maria Aparecida de Resende
- Department of Microbiology, Universidade Federal de Minas Gerais, Minas Gerais, Brazil, Medical Technology Program, Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, Instituto Lauro De Souza Lima, Bauru, São Paulo, Brazil
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