Minimally invasive punch cytology with maceration for diagnosing Jorge Lobo disease in the Brazilian Amazon

Jorge Lobo disease (JLD) is a neglected cutaneous mycosis prevalent in the Brazilian Amazon, where limited access to histopathology delays diagnosis and care. We assessed minimally invasive punch cytology with maceration (MIPC-M), a simple procedure that uses a 1-mm punch followed by potassium hydroxide maceration and light microscopy, as a field-ready alternative. In a prospective, cross-sectional study (2014-2019) across 11 municipalities in the Brazilian Amazon, individuals ≥12 years with clinically suggestive lesions underwent three cytological approaches in parallel-adhesive tape cytology, exfoliative cytology, and MIPC-M-while histopathology served as the reference. Among 27 participants, MIPC-M identified yeast-like structures compatible with the JLD agent in 27/27 cases, yielding 100% sensitivity (95% CI, 87.2-100) versus histopathology. Adhesive tape and exfoliative cytology detected 3/27 (11.1%; 95% CI, 3.9-28.1) and 1/27 (3.7%; 95% CI, 0.7-18.3) cases, respectively. No adverse events occurred. These data support MIPC-M as a sensitive, rapid, and low-resource diagnostic option for JLD screening in remote settings. Larger studies should estimate specificity, evaluate inter-operator performance, and determine impacts on time-to-diagnosis and surgical management in Amazonian communities.