History of Lacazia loboi in Humans and P. brasiliensis var. ceti in Dolphins

The first case of Iacaziosis (lobomycosis) in humans was reported by Jorge de Oliveira Lobo in a male patient from the Amazon basin with chronic (19 years) nodular lesions on his sacral anatomical area, in Recife, Pernambuco, Brazil (Lobo 1931).

In the following years, it was evident that, despite the numerous yeast-like cells present in the infected tissue of humans with lacaziosis, L. loboi resisted culture on most mycological media (Almeida and Lacaz 1948-49; Borelli 1968; Fonseca and Lacaz 1971; Furtado et al. 1967; Lacaz 1996). This unique feature of the pathogen led to false claims on its isolation in pure culture (Fonseca and Area 1940; Lacaz et al. 1986). However, those claims were challenged, and their isolates later identified as contaminating fungi (Fonseca and Lacaz 1971; Lacaz 1996; Vilela et al. 2007). Even today, allegations on the isolation of contaminating fungi from cases of human lacaziosis persist (Costa 2015).

The pathogen was known under names such as Blastomyces brasiliensis, B. loboi, Glenosporella loboi, G. amazonica, Lobomyces loboi, Loboa loboi, and Paracoccidioides loboi (Camargo et al. 1998; Fonseca and Lacaz 1971; Furtado et al. 1967; Lacaz 1996). Due to many taxonomic uncertainties surrounding the etiologic agent of cutaneous granulomas in humans, Taborda et al. (1999a, b) proposed the genus Lacazia (genus name dedicated to Dr. Carlos da Silva Lacaz, for his contribution on L. loboi), ending 70 years of taxonomic uncertainties. Likewise, the disease name periodically changed according to the proposed taxon­omy. Examples of these are lobomycosis (Lobomyces, Borelli 1968) and lacaziosis (Lacazia, Vilela et al. 2005).

The first report of a common bottlenose dolphin (Tursiops truncatus) displaying cutaneous lesions similar to human lacaziosis took place in the coastal areas of Florida, USA (Migaki et al. 1971). The following year, Woodard (1972) reported the second case on the same dolphin species and again in Florida. In 1973, De Vries and Laarman reported cutaneous lesions in a Guiana dolphin (Sotalia guianensis). As many others, the latter authors isolated fungal contaminants (Scedosporium apiospermum and Candida haemulonis) that they believed were the etiologic agents of the granulomas in dolphins. These cases were soon followed by reports of severe skin infections in several dolphin species. Most of them diagnosed around the US coastal areas, South America, and in other oceans (Bermudez et al. 2009; Dudok van Heel 1977; Kiszka et al. 2009; Lane et al. 2014; Symmers 1983; Tajima et al. 2015; Van Bressem et al. 2009). More recently, Minakawa et al. (2016) reported the infection in a new dolphin species (the Pacific white-sided dolphin, Lagenorhynchus

Table 9.1 Names applied to uncultivated types of humans and dolphins during the past 70 years

√ = misapplied or synonymous name; + = correct name

obliquidens) suggesting that other cetacean species should also be investigated. Reports of infections are consistently diagnosed every year in different geographical areas, confirming the importance of the disease in this protected species (Table 9.1).

There are several reports of the unculturable nature of L. loboi in humans (Azulay et al. 1976; Borelli 1962; Fonseca and Area 1940; Furtado et al. 1967; Lacaz et al. 1986), but only two in dolphins. The first study indicated culture failure from an infected dolphin (Caldwell et al. 1975); the second is a recent well-documented study confirming its unculturable nature (Schaefer et al. 2016). In that study, Schaefer et al. (2016) tested fresh samples from common bottlenose dolphins (T. truncatus) collected at the Indian River Lagoon, Florida, USA. This study concluded that the etiologic agent was an unculturable version of P. brasiliensis. Based on phylogenetic analyses, in the interim, we use the name P. brasiliensis var. ceti to identify properly this unique type within the culturable P. brasiliensis as proposed by Vilela et al. (2016).

9.2