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.

Keywords: Jorge Lobo’s Disease; Lacazia; Lacaziosis; keloidal blastomycosis; lobomycosis.

Figure 1

WHO/MDT/MB standard protocol for lobomycosis treatment, SDPA, Acre state, 2020 [71]. (A) localized lobomycosis before and (B) after WHO/MDT/MB treatment for four years. (C) disseminated lobomycosis before and (D) after WHO/MDT/MB treatment for four years plus lesion resection twice a week for one year.