PDF(Pubmed)
Abstract：
BACKGROUND: Lobomycosis is a rare cutaneous tropical neglected disease caused by the fungal agent Lacazia loboi, recently renamed Paracoccidioides lobogeorgii. Our objectives were to present all cases of lobomycosis diagnosed in French Guiana, to offer a precise description of their histopathological features and to propose a new clinico-histological prognostic classification.
METHODS: All cases of lobomycosis diagnosed in French Guiana between 1959 and 2022 were included. We looked for associations between the occurrence of relapses and the clinic-histological form.
RESULTS: 31 patients diagnosed with lobomycosis were included. An epidemiological shift was observed in the 2000s as Brazilian patients became the most important ethnic group. Gold mining, forestry and fishing/sailing were reported as professional exposures. New histological features, such as inflammatory \"rosettes\" formations were described. We describe two clinic-histological patterns: a major form (high fungal density and/or multifocal lesions) and a minor form (low fungal density, unifocal lesions, association with fewer relapses).
CONCLUSIONS: The changing epidemiology of lobomycosis in French Guiana is characterized by a shift towards Brazilian patients, mostly gold miners. Minor forms should be treated with surgery, major forms with a combination of surgery followed by nultiple drug therapy (MDT) or posaconazole.
METHODS: All cases of lobomycosis diagnosed in French Guiana between 1959 and 2022 were included. We looked for associations between the occurrence of relapses and the clinic-histological form.
RESULTS: 31 patients diagnosed with lobomycosis were included. An epidemiological shift was observed in the 2000s as Brazilian patients became the most important ethnic group. Gold mining, forestry and fishing/sailing were reported as professional exposures. New histological features, such as inflammatory \"rosettes\" formations were described. We describe two clinic-histological patterns: a major form (high fungal density and/or multifocal lesions) and a minor form (low fungal density, unifocal lesions, association with fewer relapses).
CONCLUSIONS: The changing epidemiology of lobomycosis in French Guiana is characterized by a shift towards Brazilian patients, mostly gold miners. Minor forms should be treated with surgery, major forms with a combination of surgery followed by nultiple drug therapy (MDT) or posaconazole.
摘要：
背景：白霉菌病是一种罕见的皮肤热带被忽视的疾病，由真菌剂拉卡齐亚引起，最近更名为Paracoccidioideslobogeorgii。我们的目标是介绍在法属圭亚那诊断出的所有小叶真菌病病例，提供其组织病理学特征的精确描述，并提出新的临床组织学预后分类。
方法：包括1959年至2022年在法属圭亚那诊断的所有小叶真菌病病例。我们寻找复发的发生与临床组织学形式之间的关联。
结果：纳入31例诊断为大叶真菌病的患者。在2000年代，随着巴西患者成为最重要的种族群体，流行病学发生了变化。金矿开采,林业和渔业/帆船被报告为专业暴露。新的组织学特征,如炎症性的“玫瑰花结”地层被描述。我们描述了两种临床组织学模式：主要形式（高真菌密度和/或多灶性病变）和次要形式（低真菌密度，单眼病变,与较少复发的关联)。
结论：法属圭亚那大孢子菌病流行病学的变化特征是向巴西患者转移，主要是黄金矿工。次要形式应通过手术治疗，主要形式结合手术，然后进行多重药物治疗（MDT）或泊沙康唑。
方法：包括1959年至2022年在法属圭亚那诊断的所有小叶真菌病病例。我们寻找复发的发生与临床组织学形式之间的关联。
结果：纳入31例诊断为大叶真菌病的患者。在2000年代，随着巴西患者成为最重要的种族群体，流行病学发生了变化。金矿开采,林业和渔业/帆船被报告为专业暴露。新的组织学特征,如炎症性的“玫瑰花结”地层被描述。我们描述了两种临床组织学模式：主要形式（高真菌密度和/或多灶性病变）和次要形式（低真菌密度，单眼病变,与较少复发的关联)。
结论：法属圭亚那大孢子菌病流行病学的变化特征是向巴西患者转移，主要是黄金矿工。次要形式应通过手术治疗，主要形式结合手术，然后进行多重药物治疗（MDT）或泊沙康唑。
