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de Miranda LHM, Santiago MDA, Frankenfeld J, dos Reis EG, Menezes RC, Pereira SA, Gremião IDF, Hofmann-Lehmann R, Conceição-Silva F. Neutrophil Oxidative Burst Profile Is Related to a Satisfactory Response to Itraconazole and Clinical Cure in Feline Sporotrichosis. J Fungi (Basel) 2024; 10:422. [PMID: 38921408 PMCID: PMC11205038 DOI: 10.3390/jof10060422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
Despite the central role of cats in the transmission and amplification of Sporothrix, studies regarding immune response in feline sporotrichosis are scarce. In cats with sporotrichosis, neutrophil-rich lesions are usually associated to good general condition and lower fungal burden. However, the role of neutrophils in anti-Sporothrix immunity has been little explored in cats. Thus, the aim of this study was to evaluate the neutrophil oxidative burst in the blood of cats with sporotrichosis. Cats with sporotrichosis included in the study were treated with itraconazole (ITZ) alone or combined with potassium iodide (KI). The neutrophil oxidative burst was evaluated through a flow-cytometry-based assay using dihydrorhodamine 123 (background) and stimulation with Zymosan and heat-killed Sporothrix yeasts. The cure rate was 50.0% in cats under treatment with ITZ monotherapy and 90.9% in cats treated with ITZ + KI (p = 0.014), endorsing the combination therapy as an excellent alternative for the treatment of feline sporotrichosis. Higher percentages of Sporothrix-stimulated neutrophils were associated with good general condition (p = 0.003). Higher percentages of Sporothrix- (p = 0.05) and Zymosan-activated (p = 0.014) neutrophils before and early in the treatment were related to clinical cure in ITZ-treated cats. The correlation between oxidative burst and successful use of KI could not be properly assessed given the low number of failures (n = 2) in this treatment group. Nasal mucosa involvement, typically linked to treatment failure, was related to lower percentages of activated neutrophils in the background at the treatment outcome (p = 0.02). Our results suggest a beneficial role of neutrophils in feline sporotrichosis and a positive correlation between neutrophil activation and the cure process in ITZ-treated cats.
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Affiliation(s)
- Luisa Helena Monteiro de Miranda
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Sydney, NSW 2006, Australia
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21041-250, Brazil; (M.d.A.S.); (F.C.-S.)
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21041-250, Brazil; (E.G.d.R.); (R.C.M.); (S.A.P.); (I.D.F.G.)
| | - Marta de Almeida Santiago
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21041-250, Brazil; (M.d.A.S.); (F.C.-S.)
| | - Julia Frankenfeld
- Clinical Laboratory and Center for Clinical Studies, Vetsuisse Facility, University of Zurich, 8057 Zurich, Switzerland; (J.F.); (R.H.-L.)
| | - Erica Guerino dos Reis
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21041-250, Brazil; (E.G.d.R.); (R.C.M.); (S.A.P.); (I.D.F.G.)
| | - Rodrigo Caldas Menezes
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21041-250, Brazil; (E.G.d.R.); (R.C.M.); (S.A.P.); (I.D.F.G.)
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21041-250, Brazil; (E.G.d.R.); (R.C.M.); (S.A.P.); (I.D.F.G.)
| | - Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21041-250, Brazil; (E.G.d.R.); (R.C.M.); (S.A.P.); (I.D.F.G.)
| | - Regina Hofmann-Lehmann
- Clinical Laboratory and Center for Clinical Studies, Vetsuisse Facility, University of Zurich, 8057 Zurich, Switzerland; (J.F.); (R.H.-L.)
| | - Fátima Conceição-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21041-250, Brazil; (M.d.A.S.); (F.C.-S.)
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Dib Ferreira Gremião I, Pereira-Oliveira GR, Pereira SA, Corrêa ML, Borba-Santos LP, Viçosa AL, Garg A, Haranahalli K, Dasilva D, Pereira de Sa N, Matos GS, Silva V, Lazzarini C, Fernandes CM, Miranda K, Artunduaga Bonilla JJ, Nunes AL, Nimrichter L, Ojima I, Mallamo J, McCarthy JB, Del Poeta M. Combination therapy of itraconazole and an acylhydrazone derivative (D13) for the treatment of sporotrichosis in cats. Microbiol Spectr 2024; 12:e0396723. [PMID: 38647345 DOI: 10.1128/spectrum.03967-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Acylhydrazone (AH) derivatives represent a novel category of anti-fungal medications that exhibit potent activity against Sporothrix sp., both in vitro and in a murine model of sporotrichosis. In this study, we demonstrated the anti-fungal efficacy of the AH derivative D13 [4-bromo-N'-(3,5-dibromo-2-hydroxybenzylidene)-benzohydrazide] against both planktonic cells and biofilms formed by Sporothrix brasiliensis. In a clinical study, the effect of D13 was then tested in combination with itraconazole (ITC), with or without potassium iodide, in 10 cats with sporotrichosis refractory to the treatment of standard of care with ITC. Improvement or total clinical cure was achieved in five cases after 12 weeks of treatment. Minimal abnormal laboratory findings, e.g., elevation of alanine aminotransferase, were observed in four cats during the combination treatment and returned to normal level within a week after the treatment was ended. Although highly encouraging, a larger and randomized controlled study is required to evaluate the effectiveness and the safety of this new and exciting drug combination using ITC and D13 for the treatment of feline sporotrichosis. IMPORTANCE This paper reports the first veterinary clinical study of an acylhydrazone anti-fungal (D13) combined with itraconazole against a dimorphic fungal infection, sporotrichosis, which is highly endemic in South America in animals and humans. Overall, the results show that the combination treatment was efficacious in ~50% of the infected animals. In addition, D13 was well tolerated during the course of the study. Thus, these results warrant the continuation of the research and development of this new class of anti-fungals.
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Affiliation(s)
- Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Gabriela Reis Pereira-Oliveira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | - Maria Lopes Corrêa
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Rio de Janeiro, Brazil
| | | | - Alessandra Lifsitch Viçosa
- Laboratory of Experimental Pharmacotechnics, Institute of Drug Technology - Farmanguinhos, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Ashna Garg
- Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, New York, USA
| | - Krupanandan Haranahalli
- Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, New York, USA
- Department of Chemistry, Stony Brook University, Stony Brook, New York, USA
| | - Deveney Dasilva
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Nivea Pereira de Sa
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Gabriel S Matos
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Vanessa Silva
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Cristina Lazzarini
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Caroline Mota Fernandes
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Kildare Miranda
- Laboratory of Cellular Ultrastructure Hertha Meyer, Carlos Chagas Filho Institute of Biophysics and National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jhon Jhamilton Artunduaga Bonilla
- Laboratory of Eukaryotic Glycobiology (LaGE), Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anna Letícia Nunes
- Laboratory of Eukaryotic Glycobiology (LaGE), Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Nimrichter
- Laboratory of Eukaryotic Glycobiology (LaGE), Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Iwao Ojima
- Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, New York, USA
- Department of Chemistry, Stony Brook University, Stony Brook, New York, USA
| | - John Mallamo
- MicroRid Technologies Inc., Dix Hills, New York, USA
| | | | - Maurizio Del Poeta
- Institute of Chemical Biology and Drug Discovery, Stony Brook University, Stony Brook, New York, USA
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
- MicroRid Technologies Inc., Dix Hills, New York, USA
- Division of Infectious Diseases, School of Medicine, Stony Brook University, Stony Brook, New York, USA
- Veterans Administration Medical Center, Northport, New York, USA
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de Souza BM, Colombo SA, do Carmo Teixeira R, Coelho IMP, Barrado WDS, Ramos BOL, Araujo ÉLM, Bicalho GC, de Azevedo MI, Keller KM, Santos Monti FD, Silva Maia LDM, de Magalhães Soares DF, de Oliveira CSF. Responsible ownership and health education can reduce the time of sporotrichosis treatment in domestic cats. Prev Vet Med 2024; 227:106211. [PMID: 38691954 DOI: 10.1016/j.prevetmed.2024.106211] [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: 12/19/2023] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
Sporotrichosis is a widespread fungal infection that affects skin and subcutaneous tissues in humans and animals. In cats, it is displayed as nodules, ulcers and lesions on the nasal and respiratory mucosa. Antifungal treatment of cats is crucial but many cases are difficult, thus resulting in discontinue of the treatment, with disastrous consequences for the animal, encouraging contamination of the environment, other animals and people. The effects of responsible ownership education and health education for owners of cats with feline sporotrichosis as well as the interval between veterinary consultations on treatment outcomes for three groups of owners and their pet cats were evaluated in this study. The responsible ownership education and health education strategies consisted in videos in easy and accessible language for people with any level of education and were presented during consultations for two of the three groups included. The time between appointments was two weeks for two of the groups, and four weeks for one of the groups. The median of treatment time for the group without educational activities was 138 days, while for the other two groups it was 77.5 days and 86 days. It was found a significative reduction in the treatment time in the groups exposed to Responsible ownership education videos. There was no contamination of those responsible for home treatment, and the interval between monthly appointments did not impact on cure or death rates compared to the interval between fortnightly appointments. All these results can be applied to feline sporotrichoses treatment protocols increasing the owners treatment adherence and reducing either, the treatment discontinuation and the treatment costs and helps to control zoonotic sporotrichosis. The importance of attractive and comprehensible educational strategies as part of the feline sporotrichosis treatment protocol for the promotion of one health was highlighted.
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Affiliation(s)
- Bianca Moreira de Souza
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Salene Angelini Colombo
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Roberta do Carmo Teixeira
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isadora Martins Pinto Coelho
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Werik Dos Santos Barrado
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Breno Oliveira Lima Ramos
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Érica Lorenza Martins Araujo
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gustavo Canesso Bicalho
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Isabel de Azevedo
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Kelly Moura Keller
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Lorena Diniz Macedo Silva Maia
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Danielle Ferreira de Magalhães Soares
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila Stefanie Fonseca de Oliveira
- Department of Preventive Veterinary Medicine, School of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Morgado DS, Castro R, Ribeiro-Alves M, Corrêa-Moreira D, Silva JCADLE, Menezes RC, Oliveira MME. Systematic review of literature to evaluate global distribution of species of the Sporothrix genus stored in culture collections. Front Cell Infect Microbiol 2024; 14:1382508. [PMID: 38828263 PMCID: PMC11140055 DOI: 10.3389/fcimb.2024.1382508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Sporotrichosis is a subcutaneous mycosis caused by fungi of the genus Sporothrix sp. Phenotypic and genotypic differences have been associated with their geographic distribution, virulence, or clinical manifestation of sporotrichosis. In the past decade, the interest in identifying species of the Sporothrix sp. has been increasing, due to its epidemiological importance and, in consequence, is important to know how to preserve them for future studies, in culture collection. Aims The purposes of this study were to analyze the global distribution of environmental isolates and/or causal agents of sporotrichosis identified by polyphasic taxonomy, with mandatory use of molecular identification, and to evaluate the percentages and distribution of isolates stored in culture collections. Methods A systematic review of articles on animal and human sporotrichosis and/or environmental isolation of the fungus, from 2007 to 2023, was done. Results: Our results demonstrated that, S. globosa, S. schenckii, and S. brasiliensis were the most identified species. With respect to the deposit and maintenance of species, we observed that only 17% of the strains of Sporothrix sp. isolated in the world are preserved in a culture collection. Conclusions This systematic review confirmed a difficulty in obtaining the frequency of Sporothrix species stored in culture collection and insufficient data on the molecular identification mainly of animal sporotrichosis and isolation of Sporothrix sp. in environmental samples.
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Affiliation(s)
- Debora Salgado Morgado
- Laboratory of Taxonomy, Biochemistry and Bioprospecting of Fungi, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rodolfo Castro
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Institute of Collective Health, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Ribeiro-Alves
- Laboratory of AIDS and Molecular Immunology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Danielly Corrêa-Moreira
- Laboratory of Taxonomy, Biochemistry and Bioprospecting of Fungi, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Rodrigo Caldas Menezes
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Hennessee I, Barber E, Petro E, Lindemann S, Buss B, Santos A, Gade L, Lockhart SR, Sexton DJ, Chiller T, Toda M. Sporotrichosis Cluster in Domestic Cats and Veterinary Technician, Kansas, USA, 2022. Emerg Infect Dis 2024; 30:1053-1055. [PMID: 38666748 PMCID: PMC11060436 DOI: 10.3201/eid3005.231563] [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] [Indexed: 04/30/2024] Open
Abstract
We describe a feline sporotrichosis cluster and zoonotic transmission between one of the affected cats and a technician at a veterinary clinic in Kansas, USA. Increased awareness of sporotrichosis and the potential for zoonotic transmission could help veterinary professionals manage feline cases and take precautions to prevent human acquisition.
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Reis EGD, Pereira SA, Miranda LHMD, Oliveira RDVCD, Quintana MDSB, Viana PG, Figueiredo ABF, Honorato CCDS, Pereira-Oliveira GR, Silva JN, Schubach TMP, Gremião IDF. A Randomized Clinical Trial Comparing Itraconazole and a Combination Therapy with Itraconazole and Potassium Iodide for the Treatment of Feline Sporotrichosis. J Fungi (Basel) 2024; 10:101. [PMID: 38392773 PMCID: PMC10889782 DOI: 10.3390/jof10020101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Feline sporotrichosis is an endemic disease with high occurrence in Brazil. Itraconazole (ITZ) remains the drug of choice for treating this disease in cats, despite the increasing reports of therapeutic failure. A controlled, randomized clinical trial was performed on 166 naive cats with sporotrichosis to assess the effectiveness and safety of the combination therapy with ITZ and potassium iodide (KI) compared with ITZ monotherapy. Cats were randomly allocated into two treatment groups: G1-ITZ 100 mg/cat/day-and G2-ITZ 100 mg/cat/day + KI 2.5-20 mg/kg/day. Cats treated in G2 presented 77% more risk of reaching a clinical cure (a positive effect) than those treated in G1, even when controlled by negative predictors. The survival curves of the two treatment protocols indicate that a clinical cure was achieved faster in G2. An increase in the KI dose was necessary in 28 cats due to the persistence of clinical signs. Adverse reactions were equally frequent in both groups and manageable with a temporary drug suspension and/or a hepatoprotective therapy. The combination therapy was associated with a higher cure rate and a shorter treatment time, suggesting that ITZ+KI arises as a better option for treating feline sporotrichosis and should be considered the first-line treatment, especially in the presence of negative predictors.
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Affiliation(s)
- Erica Guerino Dos Reis
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | | | | | - Marcel de Souza Borges Quintana
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-361, Brazil
| | - Paula Gonçalves Viana
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Anna Barreto Fernandes Figueiredo
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Cindy Caroline Dos Santos Honorato
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Gabriela Reis Pereira-Oliveira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Jéssica Nunes Silva
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Tânia Maria Pacheco Schubach
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
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Barrs VR, Hobi S, Wong A, Sandy J, Shubitz LF, Bęczkowski PM. Invasive fungal infections and oomycoses in cats 2. Antifungal therapy. J Feline Med Surg 2024; 26:1098612X231220047. [PMID: 38189264 PMCID: PMC10949877 DOI: 10.1177/1098612x231220047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
CLINICAL RELEVANCE Invasive fungal infections (IFIs) and oomycoses (hereafter termed invasive fungal-like infections [IFLIs]) are characterised by penetration of tissues by fungal elements. The environment is the most common reservoir of infection. IFIs and IFLIs can be frustrating to treat because long treatment times are usually required and, even after attaining clinical cure, there may be a risk of relapse. Owner compliance with medication administration and recheck examinations can also decline over time. In addition, some antifungal drugs are expensive, have variable interpatient pharmacokinetic properties, can only be administered parenterally and/or have common adverse effects (AEs). Despite these limitations, treatment can be very rewarding, especially when an otherwise progressive and fatal disease is cured. AIM In the second of a two-part article series, the spectrum of activity, mechanisms of action, pharmacokinetic and pharmacodynamic properties, and AEs of antifungal drugs are reviewed, and the treatment and prognosis of specific IFIs/IFLIs - dermatophytic pseudomycetoma, cryptococcosis, sino-orbital aspergillosis, coccidioidomycosis, histoplasmosis, sporotrichosis, phaeohyphomycosis, mucormycosis and oomycosis - are discussed. Part 1 reviewed the diagnostic approach to IFIs and IFLIs. EVIDENCE BASE Information on antifungal drugs is drawn from pharmacokinetic studies in cats. Where such studies have not been performed, data from 'preclinical' animals (non-human studies) and human studies are reviewed. The review also draws on the wider published evidence and the authors' combined expertise in feline medicine, mycology, dermatology, clinical pathology and anatomical pathology. ABBREVIATIONS FOR ANTIFUNGAL DRUGS AMB (amphotericin B); FC (flucytosine); FCZ (fluconazole); ISA (isavuconazole); ITZ (itraconazole); KCZ (ketoconazole); PCZ (posaconazole); TRB (terbinafine); VCZ (voriconazole).
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Affiliation(s)
- Vanessa R Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
- Centre for Animal Health and Welfare, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Stefan Hobi
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Angeline Wong
- Shatin Animal Hospital, Tai Wai, New Territories, Hong Kong, SAR China
| | - Jeanine Sandy
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Lisa F Shubitz
- Valley Fever Center for Excellence, The University of Arizona, AZ, USA
| | - Paweł M Bęczkowski
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
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Roldán Villalobos W, Monti F, Ferreira T, Sato S, Telles F, Farias M. Therapeutic efficacy of isavuconazole and potassium iodide in a cat with refractory sporotrichosis. Vet Dermatol 2023; 34:624-628. [PMID: 37357375 DOI: 10.1111/vde.13188] [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: 02/09/2023] [Revised: 04/24/2023] [Accepted: 06/11/2023] [Indexed: 06/27/2023]
Abstract
A seven-month-old, male, domestic short-hair cat was presented with nodular and ulcerative lesions, as well as respiratory signs, caused by Sporothrix brasiliensis infection. Owing to lack of response to oral itraconazole and potassium iodide, isavuconazole was substituted for itraconazole, leading to clinical cure after three months of treatment without adverse effects.
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Affiliation(s)
- Wendie Roldán Villalobos
- Department of Veterinary Medicine, School of Medicine and Life and Sciences, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Fabiana Monti
- Department of Veterinary Medicine, School of Medicine and Life and Sciences, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Tássia Ferreira
- Department of Veterinary Medicine, School of Medicine and Life and Sciences, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Sabrina Sato
- Department of Public Health, Faculty of Medicine, Federal University of Paraná, Curitiba, Brazil
| | - Flávio Telles
- Department of Public Health, Faculty of Medicine, Federal University of Paraná, Curitiba, Brazil
| | - Marconi Farias
- Department of Veterinary Medicine, School of Medicine and Life and Sciences, Pontifical Catholic University of Paraná, Curitiba, Brazil
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Thomson P, González C, Blank O, Ramírez V, del Río C, Santibáñez S, Pena P. Sporotrichosis Outbreak Due to Sporothrix brasiliensis in Domestic Cats in Magallanes, Chile: A One-Health-Approach Study. J Fungi (Basel) 2023; 9:jof9020226. [PMID: 36836340 PMCID: PMC9962391 DOI: 10.3390/jof9020226] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Sporotrichosis is an implantation mycosis with subcutaneo-lymphatic or, more rarely, a viscerally disseminated affection; it can be acquired through traumatic percutaneous inoculation of the fungus present in soil or plant matter, or by feline scratching. Among the causative agents, Sporothrix brasiliensis is considered the most virulent species with a high prevalence in Brazil and recently in Argentina. OBJECTIVE To describe a S. brasiliensis outbreak in domestic and feral cats detected in the Magallanes region of southern Chile. MATERIALS AND METHODS Between the months of July and September 2022, three cats presented with suppurative subcutaneous lesions located mainly on the head and thoracic limbs. The cytology revealed the presence of yeasts with morphological characteristics suggestive of Sporothrix spp. The histopathology confirmed pyogranulomatous subcutaneous lesions associated with the presence of the same yeasts. The fungal culture followed by the partial gene sequence and analysis of the ITS region confirmed the diagnosis of the S. brasiliensis as the causative agent. The cats were treated with itraconazole associated in one case with potassium iodide. The evolution of the patients was favorable in all cases. CONCLUSIONS An outbreak caused by S. brasiliensis was detected in domestic and feral cats in austral Chile. The correct identification of this fungus and antifungigram is essential for treatment decisions and for designing dissemination control and prevention programs under a one health approach that consider the health of people, animals, and the environment.
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Affiliation(s)
- Pamela Thomson
- Laboratorio de Microbiología Clínica y Microbioma, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8370134, Chile
- Correspondence: ; Tel.: +56-227-703-688
| | - Carlos González
- Laboratorio de Anatomía e Histopatología, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8370134, Chile
- Laboratorio de Histopatología, CITOVET, Ñuñoa, Santiago 7750538, Chile
| | - Olivia Blank
- Clínica Veterinaria Timaukel, Punta Arenas 6210648, Chile
| | | | - Camila del Río
- Laboratorio de Microbiología Clínica y Microbioma, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8370134, Chile
| | - Sebastián Santibáñez
- Laboratorio de Microbiología Clínica y Microbioma, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago 8370134, Chile
| | - Pamela Pena
- Clínica Veterinaria Timaukel, Punta Arenas 6210648, Chile
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Ribeiro DSC, Machado LJ, Pereira JG, Baptista ARDS, da Rocha EMDS. Laser therapy in the treatment of feline sporotrichosis: A case series. BRAZILIAN JOURNAL OF VETERINARY MEDICINE 2023; 45:e005822. [PMID: 37146090 PMCID: PMC10153455 DOI: 10.29374/2527-2179.bjvm005822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/03/2023] [Indexed: 05/07/2023] Open
Abstract
Sporotrichosis is the most prevalent subcutaneous mycosis in Latin America and is an important zoonosis in expansion throughout all the brazilian territory. Domestic cats are highly susceptible to the disease and play an important role in the spread of the agent to both other animals and humans. Sporothrix brasiliensis, the predominant species in the country, has greater virulence and some isolates also showed resistance to azoles, the class of antifungals of choice for treatment. Because it is a long-duration treatment, of high cost, and oral use, sick animals are often abandoned, which contributes to the spread and permanence of the infection as an important public health problem. Therefore, new therapeutic alternatives or adjuncts to treatment with antifungals may contribute to combating this zoonotic agent. In this work we describe the result of the treatment with laser therapy of eight Sporothrix spp infected cats. Our findings show the efficacy of the laser treatment even in different clinical forms. This technique has the potential to decrease the time length and costs of conventional treatment as well as the improvement of the treatment results.
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Affiliation(s)
- Daniella Souther Carvalho Ribeiro
- Veterinarian, MSc. Programa de Pós-graduação em Microbiologia e Parasitologia Aplicadas (PPGMPA),Departamento de Microbiologia e Parasitologia,Instituto Biomédico, Universidade Federal Fluminense (UFF)- Niterói, RJ, Brazil.
| | | | | | | | - Elisabeth Martins da Silva da Rocha
- Veterinarian, DSc., Departamento de Microbiologia e Parasitologia (MIP), Instituto Biomédico. Universidade Federal Fluminense (UFF). Niterói, RJ, Brazil.
- Correspondence
Elisabeth Martins da Silva da Rocha
Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense - UFF, Campus Valonguinho
Alameda Barros Terra, s/nº, Bloco E, Quinto Pavimento
CEP 24020-150 - Niterói (RJ), Brasil
E-mail:
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11
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Alvarez CM, Oliveira MME, Pires RH. Sporotrichosis: A Review of a Neglected Disease in the Last 50 Years in Brazil. Microorganisms 2022; 10:2152. [PMID: 36363744 PMCID: PMC9695284 DOI: 10.3390/microorganisms10112152] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 08/15/2023] Open
Abstract
Sporotrichosis is caused by fungi belonging to the genus Sporothrix, which saprophytically are found in plants and organic matter. However, cats are highly susceptible to contamination with fungal spores and, when they become sick, they can transmit it to other animals and to man. The objective of this study is to carry out a systematic review on the emergency, diagnosis, clinical symptoms, therapeutics, and control of zoonotic sporotrichosis. Published data covering the last 50 years using a combination of keywords were selected to answer the question: Why has the zoonotic sporotrichosis been a neglected disease up to now? A total of 135 studies were included in this review. The studies emphasize that in recent decades, Brazil has experienced an unprecedented zoonotic outbreak of sporotrichosis. Advances on the genus Sporothrix allowed one to associate thermotolerance, capacity for melanin synthesis, potential for adhesion to tissue macromolecules, ergosterol peroxide production, and expression of virulence proteins as tools for infection and invasion in S. brasiliensis, the main species involved, although cases with S. schenckii or S. lurei were also reported. Correct diagnosis, early treatment, basic educational measures that emphasize responsible ownership of animals and reproductive control programs for felines can contribute to the control of zoonosis.
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Affiliation(s)
- Carmen Magaly Alvarez
- Laboratory of Mycology and Environmental Diagnosis, Postgraduate Program in Health Promotion, University of Franca, Franca 14404-600, SP, Brazil
- Faculty of Veterinary Medicine, Universidad Agraria del Ecuador, Guayaquil 090104, Ecuador
| | | | - Regina Helena Pires
- Laboratory of Mycology and Environmental Diagnosis, Postgraduate Program in Health Promotion, University of Franca, Franca 14404-600, SP, Brazil
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12
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Sporothrix brasiliensis and Feline Sporotrichosis in the Metropolitan Region of Rio de Janeiro, Brazil (1998–2018). J Fungi (Basel) 2022; 8:jof8070749. [PMID: 35887504 PMCID: PMC9325134 DOI: 10.3390/jof8070749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Feline sporotrichosis is enzootic in different regions of Brazil, especially in Rio de Janeiro. This study compared the genotype profiles of Sporothrix sp. isolated from cats in Rio de Janeiro between 1998 and 2018 and evaluated their association with clinical and epidemiological characteristics. One hundred nineteen Sporothrix sp. isolates from a cohort of cats with sporotrichosis seen at INI/Fiocruz were included. Clinical and epidemiological data were obtained from the medical records of the animals. T3B PCR fingerprinting was used for molecular identification of the Sporothrix species. All isolates were characterized as Sporothrix brasiliensis, with the observation of low intraspecific variation in 31 isolates (31.3%). The interval between lesion onset and first medical visit at INI/Fiocruz, as well as treatment duration until clinical cure, was longer in cats from the first decade of the epizootic. In addition, the frequency of the variables “good general status” and “presence of lymphadenomegaly” was higher among cats whose strains did not exhibit intraspecific variation. So far, S. brasiliensis has been the only species identified in feline cases of sporotrichosis since the beginning of the epizootic in Rio de Janeiro at INI/Fiocruz.
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13
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Gremião IDF, Miranda LHMD, Pereira-Oliveira GR, Menezes RC, Machado ACDS, Rodrigues AM, Pereira SA. Advances and challenges in the management of feline sporotrichosis. Rev Iberoam Micol 2022; 39:61-67. [PMID: 35840526 DOI: 10.1016/j.riam.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/12/2022] Open
Abstract
The domestic cat is the most susceptible host to Sporothrix infection, developing severe clinical forms. Few effective antifungal agents are available for treating feline sporotrichosis, and cases of treatment failure are common. Treatment success depends on cat health status, therapy-related factors, as well as social/economic issues, but it is mainly contingent upon the host-fungus interaction. The owner's adherence is critical and should be reinforced throughout the treatment to increase the chances of a successful outcome. The antifungal agents described for feline sporotrichosis are most often used in monotherapy regimens. Due to cases in which the treatment with itraconazole failed, the use of antifungal agents in combination should be considered to achieve synergy. The combination of itraconazole and potassium iodide represents an important option for the treatment of naïve cats presenting multiple cutaneous lesions, nasal mucosal lesions and/or respiratory signs, as well as for refractory cases. However, the therapeutic options for unsuccessfully treated cases are scarce. Therefore new options are needed, even more taking into account that there are many in vitro potential molecules not available for use in cats yet. More studies are necessary to correlate in vitro antifungal susceptibility tests results and the outcome of cats treated due to sporotrichosis. This review will briefly discuss both the antifungal drugs and treatment protocols used in cats with sporotrichosis, as well as the determinants of treatment failure.
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Affiliation(s)
- Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.
| | | | - Gabriela Reis Pereira-Oliveira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Rodrigo Caldas Menezes
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Ana Caroline de Sá Machado
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | | | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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14
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Artunduaga Bonilla JJ, Honorato L, Guimarães AJ, Miranda K, Nimrichter L. Silver Chitosan Nanocomposites are Effective to Combat Sporotrichosis. FRONTIERS IN NANOTECHNOLOGY 2022. [DOI: 10.3389/fnano.2022.857681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of silver nanoparticles (AgNPs) embedded in polymeric matrix has acquired special attention as a strategy to reduce metal toxicity without losing its antimicrobial effect. In this work, the green synthesis of AgNPs and their functionalization with chitosan (AgNPs@Chi) was performed, and their antifungal activity investigated against the foremost species responsible for causing sporotrichosis, Sporothrix brasiliensis and Sporothrix schenckii. In vitro studies revealed inhibitory concentrations ranging from 0.12–1 μg/ml for both nanocomposites (NCs). Silver release in suspension displayed chitosan as a potential vehicle for continuous silver discharge, with a complete release after 52 days. No synergistic effects were observed in vitro when the NCs were combined with itraconazole or amphotericin B. Treatment of S. brasiliensis with NCs caused morphological deformities, cell membrane discontinuity and an intense cytoplasmic degeneration. Remarkably, both NCs induced the growth and migration of keratinocytes and fibroblasts when compared to control conditions. In addition, functionalization of AgNPs with chitosan significantly reduced its hemolytic activity, suggesting their potential use in vivo. Finally, silver nanocomposites were used as a daily topical treatment in a murine model of subcutaneous sporotrichosis, showing the ability to reduce the Sporothrix infection and stimulate tissue repair. In combination, our results demonstrate that AgNPs@Chi can be a non-toxic and efficient alternative for sporotrichosis.
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15
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Santi JP, Santos CRGR, dos Santos AS, Souza HJM. Intranasal clotrimazole spray 1% associated with oral itraconazole for nasal feline sporotrichosis: a case series. BRAZILIAN JOURNAL OF VETERINARY MEDICINE 2022; 44:e004821. [PMID: 35749092 PMCID: PMC9179194 DOI: 10.29374/2527-2179.bjvm004821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
Feline sporotrichosis is a major clinical problem among cats in Brazil and is also a neglected, but important, public health issue, due to its zoonotic potential. The nasal clinical form of the disease is particularly challenging, having treatment refractoriness and clinical signs relapse as common features. This case series study aimed to preliminarily describe the effects of the azolic antifungal drug, clotrimazole, as a topical 1% solution spray, together with per os itraconazole on inducing disease remission, as well as treatment tolerability and safety. Medical records of the Feline Medicine Service from the Universidade Federal Rural do Rio de Janeiro were reviewed, and 7 feline patients met the inclusion criteria (confirmatory diagnostic reached, available follow-up records, and use of intranasal clotrimazole 1% solution -1 spray per nostril every 24 hours- as adjunctive therapy to itraconazole - 100 mg/cat per os every 24 hours). Among these, 4 had a history of treatment refractoriness done until then. Follow-up records included clinical evaluation, along with complementary tests and owner reports on tolerability and occurrence of adverse reactions. All patients have undergone clinical remission within 60 days. Tolerability were satisfactory, and adverse reactions were only found on complementary tests (hepatic enzyme elevation), without clinical repercussion. The intranasal use of 1% clotrimazole solution has shown as a promising adjunctive therapy to itraconazole for feline nasal sporotrichosis, even in previous refractory cases.
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Affiliation(s)
- Julia Possebon Santi
- Veterinarian, Resident, Programa de Residência em Medicina Veterinária – Clínica Médica dos Gatos Domésticos. Departamento de Medicina e Cirurgia Veterinária (DMCV), Instituto de Veterinária (IV), Universidade Federal Rural do Rio de Janeiro (UFRJ). Seropédica, RJ, Brazil.
- Correspondence Julia Possebon Santi Departamento de Medicina e Cirurgia Veterinária, Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro – UFRRJ Rodovia BR 465, Km 7, Campus Universitário, Bairro Zona Rural CEP 23897-000 - Seropédica (RJ), Brasil E-mail:
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16
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Clinical and epidemiological aspects of feline sporotrichosis caused by Sporothrix brasiliensis and in vitro antifungal susceptibility. Vet Res Commun 2021; 45:171-179. [PMID: 34129207 DOI: 10.1007/s11259-021-09795-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/03/2021] [Indexed: 01/19/2023]
Abstract
Sporotrichosis is a subcutaneous mycosis resulting from the traumatic implantation of pathogenic Sporothrix species. In Brazil, zoonotic transmission plays an important role in the epidemiology of the disease, involving especially cats. The objective of this study was to isolate Sporothrix spp. from cats with signs of sporotrichosis, determining the causative species, clinical and epidemiological aspects, and the in vitro susceptibility profile of the isolates against antifungal drugs. From September 2017 to February 2019, 245 samples of lesions were collected from symptomatic cats in São José do Rio Preto, Brazil. Identification of the isolates was performed by morphophysiological parameters and species-specific polymerase chain reaction. The susceptibility profile of the isolates was determined for five drugs (amphotericin B, itraconazole, ketoconazole, potassium iodide and terbinafine), using the broth microdilution method. Clinical and epidemiological aspects were analyzed based on data contained on investigation forms filled by the veterinarians at moment of collection. Sporothrix spp. were isolated in 189 (77.2%) of the samples. Phenotypic and molecular analyses revealed S. brasiliensis as the only causative agent. In vitro susceptibility testing showed lower MIC values for terbinafine (MIC = 0.03-2 μg/ml), ketoconazole (MIC = 0.03-2 μg/ml), and itraconazole (MIC = 0.03-4 μg/ml). Most of the animals were male (73.5%), adults (96.3%), stray (53.5%), and uncastrated (69.8%). Our results show the expansion of the S. brasiliensis epidemic to an area nearly 840 km apart from the epicenter of the long-lasting outbreak of cat-transmitted sporotrichosis in Rio de Janeiro.
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17
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Antifungal activity of Acylhydrazone derivatives against Sporothrix spp. Antimicrob Agents Chemother 2021; 65:AAC.02593-20. [PMID: 33593845 PMCID: PMC8092869 DOI: 10.1128/aac.02593-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Sporotrichosis is an emerging mycosis caused by members of the genus Sporothrix The disease affects humans and animals, particularly cats, which plays an important role in the zoonotic transmission. Feline sporotrichosis treatment options include itraconazole (ITC), potassium iodide and amphotericin B, drugs usually associated with deleterious adverse reactions and refractoriness in cats, especially when using ITC. Thus, affordable, non-toxic and clinically effective anti-Sporothrix agents are needed. Recently, acylhydrazones (AH), molecules targeting vesicular transport and cell cycle progression, exhibited a potent antifungal activity against several fungal species and displayed low toxicity when compared to the current drugs. In this work, the AH derivatives D13 and SB-AF-1002 were tested against Sporothrix schenckii and Sporothrix brasiliensis Minimal inhibitory concentrations of 0.12 - 1 μg/mL were observed for both species in vitro D13 and SB-AF-1002 showed an additive effect with itraconazole. Treatment with D13 promoted yeast disruption with release of intracellular components, as confirmed by transmission electron microscopy of S. brasiliensis exposed to the AH derivatives. AH-treated cells displayed thickening of the cell wall, discontinuity of the cell membrane and an intense cytoplasmic degeneration. In a murine model of sporotrichosis, treatment with AH derivatives was more efficient than ITC, the drug of choice for sporotrichosis. The results of the preliminary clinical study in cats indicate that D13 is safe and has potential to become a therapeutic option for sporotrichosis when associated to ITC. Our results expand the antifungal broadness of AH derivatives and suggest that these drugs could be exploited to combat sporotrichosis.
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Abstract
Sporothrix schenckii sensu lato is currently recognized as a species complex with only Sporothrix brasiliensis, Sporothrix schenckii sensu stricto, Sporothrix globosa and Sporothrix pallida identified to cause disease in the cat. Feline sporotrichosis in Asia is mainly reported from Malaysia where a single clonal strain of clinical clade D, Sporothrix schenckii sensu stricto manifesting low susceptibility to major antifungal classes, has been identified as the agent of the disease. Sporothrix globosa has been identified to cause disease from a single cat in Japan while the specific species of agent has not been identified yet for the disease in Thailand. Despite efforts to elucidate and describe the pathogenicity of the agent and the disease it causes, the paucity of data highlights the need for further molecular epidemiological studies to characterize this fungus and the disease it causes in Asia. Its prognosis remains guarded to poor due to issues pertaining to cost, protracted treatment course, zoonotic potential and low susceptibility of some strains to antifungals.
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Affiliation(s)
- Hock Siew Han
- Vetderm Animal Skin and Ear Specialist Clinic, 9-1 JLN 23/70A, Plaza Crystalville 1, Desa Sri Hartamas, 50480, Kuala Lumpur, Malaysia.
| | - Rui Kano
- Department of Veterinary Dermatology, Nihon University College of Bioresource Sciences, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
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Gremião IDF, Martins da Silva da Rocha E, Montenegro H, Carneiro AJB, Xavier MO, de Farias MR, Monti F, Mansho W, de Macedo Assunção Pereira RH, Pereira SA, Lopes-Bezerra LM. Guideline for the management of feline sporotrichosis caused by Sporothrix brasiliensis and literature revision. Braz J Microbiol 2021; 52:107-124. [PMID: 32990922 PMCID: PMC7966609 DOI: 10.1007/s42770-020-00365-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
We herein present a Brazilian guideline for the management of feline sporotrichosis, a mycosis caused by Sporothrix brasiliensis. This guideline is an effort of a national technical group organized by the Working Group on Sporothrix and Sporotrichosis of the International Society for Human and Animal Mycology (ISHAM). This publication intends to provide information on clinical-epidemiological aspects of this zoonosis, as well as a literature revision. Moreover, it gives some practical information on diagnosis and treatment of feline sporotrichosis. It also contains information that can be helpful for the prevention and control of S. brasiliensis transmission.
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Affiliation(s)
- Isabella Dib Ferreira Gremião
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro. Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil.
| | | | - Hildebrando Montenegro
- Laboratório de Diagnóstico de Zoonoses, Divisão de Vigilância de Zoonoses (COVISA/SMS/PMSP), São Paulo, Brazil
| | - Aroldo José Borges Carneiro
- Secretaria Municipal da Saúde de Salvador (SMS), Salvador, Brazil
- Instituto de Saúde Coletiva (ISC), Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Melissa Orzechowski Xavier
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FURG), Rio Grande do Sul, Brazil
| | | | - Fabiana Monti
- Pós-graduação em Ciência Animal, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Wilson Mansho
- Centro de Controle de Zoonoses (CCZ), Secretaria Municipal de Saúde de Guarulhos, São Paulo, Brazil
| | | | - Sandro Antonio Pereira
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro. Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Leila M Lopes-Bezerra
- BIDiagnostics, Centro de Inovação, Empreendedorismo e Tecnologia (CIETEC)/Universidade de São Paulo, São Paulo, Brazil
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Rossow JA, Queiroz-Telles F, Caceres DH, Beer KD, Jackson BR, Pereira JG, Ferreira Gremião ID, Pereira SA. A One Health Approach to Combatting Sporothrix brasiliensis: Narrative Review of an Emerging Zoonotic Fungal Pathogen in South America. J Fungi (Basel) 2020; 6:E247. [PMID: 33114609 PMCID: PMC7712324 DOI: 10.3390/jof6040247] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022] Open
Abstract
Cat-transmitted sporotrichosis caused by Sporothrix brasiliensis has become a major public health concern and presents a distinct divergence from the traditional epidemiology of sporotrichosis. This emerging fungal pathogen spreads readily among cat populations, and human infections occur exclusively via zoonotic transmission. While sporotrichosis is an implantation mycosis that typically manifests as cutaneous lesions in humans and cats, severe extracutaneous manifestations are more common with S. brasiliensis than other Sporothrix species infections. Rapid diagnosis and appropriate treatment regimens are critical for successful clinical resolution of sporotrichosis in both cats and humans. Species-level identification of Sporothrix is possible with molecular diagnostics and necessary for tracking the geographic expansion of S. brasiliensis and better understanding its epidemiology. Combatting cat-transmitted sporotrichosis requires a One Health approach to successfully implement public health control measures.
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Affiliation(s)
- John A. Rossow
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.R.); (D.H.C.); (K.D.B.)
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Flavio Queiroz-Telles
- Department of Public Health, Hospital de Cíinicas, Federal University of Parana, Curitiba 82015-154, Brazil;
| | - Diego H. Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.R.); (D.H.C.); (K.D.B.)
- Center of Expertise in Mycology, Radboudumc/CWZ, 6532 SZ Nijmegen, The Netherlands
| | - Karlyn D. Beer
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.R.); (D.H.C.); (K.D.B.)
| | - Brendan R. Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.R.); (D.H.C.); (K.D.B.)
| | - Jose Guillermo Pereira
- Ministry of Public Health and Social Welfare, National Leprosy Control Program, National Directorate of Health Surveillance, Dermatology Specialty Center, San Lorenzo 2160, Paraguay;
| | - Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro 21040-360, Brazil; (I.D.F.G.); (S.A.P.)
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro 21040-360, Brazil; (I.D.F.G.); (S.A.P.)
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Paiva MT, de Oliveira CSF, Nicolino RR, Bastos CV, Lecca LO, de Azevedo MI, Keller KM, Salvato LA, Brandão ST, de Oliveira HMR, Morais MHF, Ecco R, Lech AJZ, Haddad JPA, de Magalhães Soares DF. Spatial association between sporotrichosis in cats and in human during a Brazilian epidemics. Prev Vet Med 2020; 183:105125. [PMID: 32891900 DOI: 10.1016/j.prevetmed.2020.105125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/15/2020] [Accepted: 08/15/2020] [Indexed: 12/31/2022]
Abstract
Sporotrichosis is a subcutaneous granulomatous disease caused by the fungus Sporothrix spp. In Brazil, S. brasiliensis is reported in regions of outbreaks and epidemics in the zoonotic form of the disease where cats play an important role in the transmission of the disease to humans. Therefore, it is important to assess how the presence of infected cats impacts the risk for sporotrichosis in humans. The objective of this study was to analyze the spatial association of sporotrichosis in cats and in humans from Belo Horizonte, a Brazilian city where an epidemics of sporotrichosis occurs since the first human case register in 2015, through an inhomogeneous Poisson process model. Feline and human cases of sporotrichosis recorded between January 2016 and June 2019 were georeferenced by address and spatial point patterns were generated. Feline case intensity and human demographic density were calculated using a kernel smoothed estimate. The distance to the nearest feline case was also compute. Model parameters were estimated by Maximum Likelihood Estimate. The model validation was performed by the evaluation of partial residual, leverage and influence measure. There were 343 cases of cats and 135 human cases of sporotrichosis. The average incidence of human sporotrichosis in the period was 1.343 per 100 thousand inhabitants, which is relatively low in relation to the population, but higher than that observed in other regions in zoonotic outbreak of the disease. The southern region of the municipality has a higher intensity of feline cases. According to the fitted model, the risk for human sporotrichosis is greater when at distances very close to a feline case, with a virtually stable effect for distances greater than 1 km. Regarding the intensity of feline cases there is a gradual increase in risk as the intensity of cases increases. From the leverage analysis it was observed that the model was particularly sensitive to the occurrence of human cases in the south and east regions, places with extreme values of covariates. Poisson point process model seems to be a reasonable approach in spatial epidemiology when multiple sources of infection are involved, and there is a low incidence of the disease as long as it is reasonable to assume independence between cases. Interventions for disease prevention and control in humans are suggested to encompass disease control in cats and the search for feline cases, focused on diagnosis and control, close to reported human cases.
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Affiliation(s)
- Marcelo Teixeira Paiva
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Camila Stefanie Fonseca de Oliveira
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafael Romero Nicolino
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila Valgas Bastos
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lívian Otávio Lecca
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Isabel de Azevedo
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Kelly Moura Keller
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lauranne Alves Salvato
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Silvana Tecles Brandão
- Secretaria Municipal da Saúde, Prefeitura Municipal de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maria Helena Franco Morais
- Secretaria Municipal da Saúde, Prefeitura Municipal de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Roselene Ecco
- Departamento de Clínica e Cirurgia Veterinária. Escola de Veterinária da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Anna Julia Zilli Lech
- Universidade Federal do Paraná, Departamento de Medicina Veterinária, Curitiba, Paraná, Brazil
| | - João Paulo Amaral Haddad
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Promising application of the SsCBF ELISA test to monitor the therapeutic response of feline sporotrichosis caused by Sporothrix brasiliensis from Brazilian epidemics. Braz J Microbiol 2020; 52:145-153. [PMID: 32812211 DOI: 10.1007/s42770-020-00362-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 08/08/2020] [Indexed: 10/23/2022] Open
Abstract
Sporotrichosis zoonotic transmission by cats has obtained hyperendemic magnitude in Rio de Janeiro, Brazil. Atypical cases, relapses, and reinfections as well as reduced diagnostic sensitivity of conventional methods have been reported. Previously, the anti-SsCBF enzyme-linked immunosorbent assay (ELISA) test was shown to be useful as a diagnostic tool for human sporotrichosis. Effective diagnosis and treatment are critical to interrupt the chain of transmission of this major pathogen in Brazilian Public Health. To evaluate its applicability for feline sporotrichosis diagnosis and/or therapeutic follow-up, 15 domestic cats from Rio de Janeiro were clinically and laboratory monitored by cytopathology, culture, Sporothrix genotyping, and anti-SsCBF IgG levels. Subsequently, animals were divided into satisfactory and non-satisfactory therapeutic responders. Averages of antibody serum levels obtained for diagnosis (first consultation) compared with the levels found after follow-up (last consultation) were significantly different in both groups (p = 0.0002 and p = 0.038, respectively). We conclude that the SsCBF ELISA test can predict feline sporotrichosis therapeutic responses even for animals with distinct clinical evolutions.
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Feline sporotrichosis: a case series of itraconazole-resistant Sporothrix brasiliensis infection. Braz J Microbiol 2020; 52:163-171. [PMID: 32388779 DOI: 10.1007/s42770-020-00290-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/30/2020] [Indexed: 12/15/2022] Open
Abstract
The treatment of feline sporotrichosis is a challenge for veterinary clinicians since refractory cases may occur, due either to patient and/or to pharmacological management errors or due to the development of antifungal resistance. Thus, we aimed to describe the therapeutic history of feline cases infected by itraconazole-resistant Sporothrix brasiliensis in an endemic region of Southern Brazil. Medical records of cats attended at the Veterinary Clinic Hospital (Pelotas/RS, Brazil) between 2016 and 2017 were reviewed. Twelve cases of infection by S. brasiliensis with that showed high minimum inhibitory concentration (MIC) values (≥ 4 μg/mL) to itraconazole by M38-A2 of CLSI were selected. At the hospital consultation, disseminated (cats 1-l0, 12) and localized (cat 11) skin lesions remained in the cats, even after treatment with fluconazole, ketoconazole (02/12), and itraconazole (ITZ, 09/12) performed before this study. High doses (25-100 mg/kg/day) of ITZ for up to 4 months (03/12, cats 2, 6, 12) or over 12 months (05/12, cats 1, 5, 7, 8, 11) did not provide a clinical cure, except for the association of ITZ plus potassium iodide (01/12, cat 12) for 3 months, which proved useful in infections with itraconazole-resistant S. brasiliensis. However, the combined issues of abandonment of therapy by owners for financial reasons, difficulties surrounding therapy administration (03/12, cats 6, 11, 12), and the inappropriate choice of medication (01/12, cat 6), together reflect the reality of this endemic region, which greatly compromises clinical healing. This study highlighted the occurrence of refractory cases by itraconazole-resistant S. brasiliensis in cats from Southern Brazil, as well as the abandonment of treatment and therapeutic errors. We warn of the need for antifungal susceptibility tests to adapt therapeutic protocols in feline sporotrichosis.
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Waller SB, Ripoll MK, Madrid IM, Acunha T, Cleff MB, Chaves FC, de Mello JRB, de Faria RO, Meireles MCA. Susceptibility and resistance of Sporothrix brasiliensis to branded and compounded itraconazole formulations. Braz J Microbiol 2020; 52:155-162. [PMID: 32333272 DOI: 10.1007/s42770-020-00280-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 04/16/2020] [Indexed: 01/06/2023] Open
Abstract
Itraconazole is the first drug of choice for the treatment of sporotrichosis and it is available at different concentrations for veterinary patients. However, therapeutic failure has been reported, limiting clinical treatment. This study evaluated the in vitro efficacy of brand-name and compounded itraconazole formulations against Sporothrix brasiliensis and estimated the itraconazole content in each tested formulation. Oral capsules were acquired from two brand-name products for human (H-IND) and veterinary (V-IND) uses, and three from compounding pharmacies in Pelotas, RS, for human (H-COMP1/H-COMP2) and veterinary (V-COMP) uses. Capsule purity was analyzed by liquid chromatography-electrospray ionization quadrupole time-of-flight mass spectrometry (LC-ESI-QTOF-MS). Antifungal activity was determined against 29 Sporothrix brasiliensis by the M38-A2 guideline of CLSI. H-IND/H-COMP1/H-COMP2 had high efficacy against S. brasiliensis (approximately 70% of total isolated susceptible), V-COMP showed moderate efficacy (51.7%), and V-IND was the least effective formulation (37.9%). Thirty-four percent of the total isolates were resistant to all formulations. Furthermore, itraconazole content did not match the concentration indicated by the manufacturers, ranging from 387.70 to 7.81 μg/mg (H-COMP2 > V-COMP > H-IND > H-COMP1 > V-IND). Therefore, it is possible that the formulations showed different in vitro efficacy due to the difference in their itraconazole contents. Given the emergence of antifungal resistance for all formulations, the choice product to be used must follow susceptibility testing. Stringent quality control measures are recommended for product manufactures to assure drug content uniformity.
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Affiliation(s)
- Stefanie Bressan Waller
- Departamento de Clínicas Veterinária, Faculdade de Veterinária, Universidade Federal de Pelotas, Campus Universitário Capão do Leão, n° 1, Pelotas, Rio Grande do Sul, Brazil. .,Departamento de Veterinária Preventiva, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil.
| | - Márcia Kutscher Ripoll
- Departamento de Veterinária Preventiva, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Tanize Acunha
- Departamento de Ciência e Tecnologia Agroindustrial, Faculdade de Agronomia, Programa de Pós-Graduação em Ciência e Tecnologia de Alimentos, Pelotas, Rio Grande do Sul, Brazil
| | - Marlete Brum Cleff
- Departamento de Clínicas Veterinária, Faculdade de Veterinária, Universidade Federal de Pelotas, Campus Universitário Capão do Leão, n° 1, Pelotas, Rio Grande do Sul, Brazil
| | - Fábio Clasen Chaves
- Departamento de Ciência e Tecnologia Agroindustrial, Faculdade de Agronomia, Programa de Pós-Graduação em Ciência e Tecnologia de Alimentos, Pelotas, Rio Grande do Sul, Brazil
| | - João Roberto Braga de Mello
- Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Renata Osório de Faria
- Departamento de Veterinária Preventiva, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Mário Carlos Araújo Meireles
- Departamento de Veterinária Preventiva, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Lecca LO, Paiva MT, de Oliveira CSF, Morais MHF, de Azevedo MI, Bastos CDVE, Keller KM, Ecco R, Alves MRS, Pais GCT, Salvato LA, Xaulim GDMD, Barbosa DS, Brandão ST, Soares DFDM. Associated factors and spatial patterns of the epidemic sporotrichosis in a high density human populated area: A cross-sectional study from 2016 to 2018. Prev Vet Med 2020; 176:104939. [PMID: 32143029 DOI: 10.1016/j.prevetmed.2020.104939] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/17/2020] [Accepted: 02/23/2020] [Indexed: 12/19/2022]
Abstract
An epidemiological characterization of human and feline sporotrichosis was carried out between 2016 and 2018, in a high density-populated area in Brazil. Professionals were trained to identify suspect cats and notify vets to interview the owners and collect swabs of the wounds from these animals. Mycological cultures were performed, and colonies identified as Sporothrix spp. Subsequently, data regarding the outcome from suspect animals were collected. Confirmed cases of human sporotrichosis (56) were also counted and analyzed for spatial distribution. 118 positive animals were observed. The prevalence of feline sporotrichosis was 8.36 ‰ (CI 95 %, 5.38-9.55 ‰). The odds for being positive in animals that lived only partially at home were 3.02 times greater than for those cats without access to the street (OR 3.02, CI 95 % 1,96-10,43). There was no statistically significant association between environmental variables and positive diagnosis, corroborating the hypothesis that direct transmission by infected cats plays a greater role in the occurrence and continuous outbreaks of sporotrichosis in Brazil. Among the positive animals, 61.90 % (CI 95 % 58.95-64.96) died, and they had an odds to die in the next six months 6.30 times greater than negative animals (p < 0.05, OR 6.30, CI 95 % 2,79-14,42). The case fatality rate was 55.08 % in cats (CI 95 % 49.20-51.15). The cause-specific death rate was 4.6 ‰ in cats (CI 95 % 3.4-6 ‰). Only 7.62 % (CI 95 % 7.12-8.16) positive cats were treated and cured. Among dead positive animals, 29.23 % were inappropriately discarded. In the study period 56 human cases were recorded in the Barreiro region. Regions with highest prevalence of feline sporotrichosis, had greater frequencies of both human and feline cases. This is the first report on the epidemic of sporotrichosis in Minas Gerais, Brazil. The free offer for treatment and veterinary care for these animals should be taken into consideration, as well as the collection and incineration of the dead ones, as measures of public health, followed by the guidance and care for the human patient.
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Affiliation(s)
- Lívian Otávio Lecca
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Teixeira Paiva
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Camila Stefanie Fonseca de Oliveira
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Helena Franco Morais
- Diretoria de Zoonoses, Secretaria Municipal da Saúde, Prefeitura Municipal de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Isabel de Azevedo
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila de Valgas E Bastos
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Kelly Moura Keller
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Roselene Ecco
- Departamento de Clínica e Cirurgia Veterinária, Escola de Veterinária da Universidade Federal de Minas Gerais Belo Horizonte, Minas Gerais, Brazil
| | - Márcia Regina Silva Alves
- Diretoria de Zoonoses, Secretaria Municipal da Saúde, Prefeitura Municipal de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Graziella Coelho Tavares Pais
- Diretoria de Zoonoses, Secretaria Municipal da Saúde, Prefeitura Municipal de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Lauranne Alves Salvato
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gustavo de Morais Donancio Xaulim
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - David Soeiro Barbosa
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais Belo Horizonte, Minas Gerais, Brazil
| | - Silvana Tecles Brandão
- Diretoria de Zoonoses, Secretaria Municipal da Saúde, Prefeitura Municipal de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
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Makri N, Paterson GK, Gregge F, Urquhart C, Nuttall T. First case report of cutaneous sporotrichosis ( Sporothrix species) in a cat in the UK. JFMS Open Rep 2020; 6:2055116920906001. [PMID: 32110427 PMCID: PMC7025424 DOI: 10.1177/2055116920906001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Case summary A 12-year-old female neutered indoor-outdoor domestic longhair cat presented with frequent sneezing and a nodular, suppurative lesion on its dorsal nose. Histopathological examination revealed a fungal granuloma. PCR and sequencing of the ribosomal internal transcribed spacers (ITS) regions (ITS-F and ITS-R) confirmed an infection with a Sporothrix species. Further sequencing of the beta-tubulin and calmodulin genes confirmed Sporothrix humicola, which lies within the Sporothrix pallida complex. The cat had concurrent diabetes mellitus, which responded to insulin therapy and diet. Oral itraconazole at 10 mg/kg PO q24h resulted in resolution of the lesions after 12 months. Treatment was well tolerated. Relevance and novel information This is the first report of sporotrichosis in a cat in the UK and only the fifth worldwide involving the S pallida complex. Clinicians, pathologists and microbiologists need to be aware of the potential of Sporothrix infections in the UK and the ability of S pallida complex to cause opportunistic infections. Molecular techniques can achieve rapid and accurate identification of rare fungal organisms. A precise diagnosis with molecular testing can provide information regarding prognosis, treatment and zoonotic implications.
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Affiliation(s)
- Nikoleta Makri
- Dermatology Service, Hospital for Small Animals, University of Edinburgh, Royal (Dick) School of Veterinary Studies, Roslin, UK
| | - Gavin K Paterson
- Easter Bush Pathology, University of Edinburgh, Royal (Dick) School of Veterinary Studies, Roslin, UK
| | | | | | - Tim Nuttall
- Dermatology Service, Hospital for Small Animals, University of Edinburgh, Royal (Dick) School of Veterinary Studies, Roslin, UK
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Rodrigues AM, Della Terra PP, Gremião ID, Pereira SA, Orofino-Costa R, de Camargo ZP. The threat of emerging and re-emerging pathogenic Sporothrix species. Mycopathologia 2020; 185:813-842. [PMID: 32052359 DOI: 10.1007/s11046-020-00425-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/09/2020] [Indexed: 01/19/2023]
Abstract
Sporotrichosis is a neglected subcutaneous mycosis of humans and animals acquired by traumatic inoculation of soil and plant material (classical route) contaminated with infectious propagules of the pathogen or being bitten/scratched by infected cats (alternative route). Within a genus composed of 53 species displaying an essentially environmental core, there are only a few members which have considerable impacts on human or animal health. Infections are typically caused by S. brasiliensis, S. schenckii or S. globosa. Rare mammal pathogens include members of the S. pallida and S. stenocereus complexes. To illustrate the tremendous impact of emerging zoonotic sporotrichosis on public health, we discuss the main features of the expanding epidemics driven by S. brasiliensis in cats and humans. The cat entry in the transmission chain of sporotrichosis, causing epizooties (cat-cat) or zoonosis (cat-human), has contributed to the definition of new paradigms in Sporothrix transmission, reaching epidemic levels, making the disease a serious public health problem. Indeed, S. brasiliensis infection in humans and animals is likely to become even more important in the future, with projections of its expansion in biogeographic domains and host range, as well as greater virulence in mammals. Therefore, lessons from a long-standing outbreak in the state of Rio de Janeiro about the source and distribution of the etiological agents among outbreak areas can be used to create better control and prevention plans and increase awareness of sporotrichosis as a serious emerging zoonotic disease.
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Affiliation(s)
- Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, 04023-062, Brazil.
| | - Paula Portella Della Terra
- Laboratory of Emerging Fungal Pathogens, Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, 04023-062, Brazil
| | - Isabella Dib Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Rosane Orofino-Costa
- Dermatology Department, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (FCM-UERJ), Rio de Janeiro, RJ, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, 04023-062, Brazil
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29
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de Miranda LHM, Meli M, Conceição-Silva F, Novacco M, Menezes RC, Pereira SA, Sugiarto S, dos Reis ÉG, Gremião IDF, Hofmann-Lehmann R. Co-infection with feline retrovirus is related to changes in immunological parameters of cats with sporotrichosis. PLoS One 2018; 13:e0207644. [PMID: 30500849 PMCID: PMC6267967 DOI: 10.1371/journal.pone.0207644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 11/04/2018] [Indexed: 02/03/2023] Open
Abstract
Feline sporotrichosis due to Sporothrix brasiliensis is frequently severe and often correlated to zoonotic transmission. Feline Immunodeficiency Virus (FIV) and Feline Leukemia Virus (FeLV) cause immunodeficiency in cats; no association has been identified with critical cases of sporotrichosis. Moreover, the cytokine profile in Sporothrix-infected cats and a potential impact of retrovirus co-infections on their immunity is unknown. This study assessed immunological parameters in cats with sporotrichosis with and without FIV or FeLV co-infection. FeLV infection was detected by antigen ELISA and by provirus PCR. FIV infection was investigated through ELISA and Western blot. Cytokine transcription (IFN-γ, IL-4, IL-5, IL-6, IL-10, IL-12, TNF-α) was quantified using RT-qPCR and lymphocyte subpopulations (CD4, CD8, CD5 and CD21) were assessed by flow cytometry. Thirty cats with sporotrichosis were recruited to the study, including three FIV-positive and five FeLV-positive (progressive infection) cats. One cat with regressive FeLV infection was excluded from statistics. In comparison to retrovirus-negative cats, FIV-positive cats and FeLV-positive cats had higher IL-10 levels, FeLV-positive cats had lower IL-4 levels and FIV-positive cats had lower IL-12 levels and a lower CD4+/CD8+ ratio. Remarkably, all cats with poor general condition were FeLV (progressive infection) or FIV-positive, but the retrovirus status was not associated with the sporotrichosis treatment length or outcome. The immunological changes and the more severe clinical presentation observed in cats with retrovirus co-infections encourage future prospective studies that address the impact of these changes on prognostic determinants of feline sporotrichosis and the development of new therapy strategies that control disease spread.
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Affiliation(s)
- Luisa Helena Monteiro de Miranda
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Clinical Laboratory and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Marina Meli
- Clinical Laboratory and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Fátima Conceição-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marilisa Novacco
- Clinical Laboratory and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Rodrigo Caldas Menezes
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sarah Sugiarto
- Clinical Laboratory and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Érica Guerino dos Reis
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Regina Hofmann-Lehmann
- Clinical Laboratory and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Anzengruber F, Mergenthaler C, Murer C, Dummer R. Potassium Iodide for Cutaneous Inflammatory Disorders: A Monocentric, Retrospective Study. Dermatology 2018; 235:137-143. [PMID: 30463069 DOI: 10.1159/000494614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/16/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Potassium iodide (KI) is a medication that has been used for decades in dermatology and it is mentioned as a treatment option in all major dermatology textbooks. Yet, there is little recent information on its efficacy. In our study, we wanted to retrospectively evaluate the therapy response to KI in our patients. METHODS The hospital information system was searched for patients treated with KI at the Department of Dermatology (University Hospital Zurich) in the last 20 years (January 1, 1998 to December 31, 2017). A total of 52 patients were found and, subsequently, 35 patients were included in our study. RESULTS KI was prescribed for the following skin conditions: erythema nodosum, disseminated granuloma anulare, necrobiosis lipoidica, nodular vasculitis, cutaneous sarcoidosis, and granulomatous perioral dermatitis/ rosacea. The median duration of KI intake was 5 ± 7.7 weeks (range 1-26). The global assessment of efficacy by the treating physician showed an improvement of disease in about a third of all patients. No response was seen in 14 patients and 9 even had a progression of disease. An adverse event was documented in 16 cases. CONCLUSIONS Our findings show that an improvement was reached in only about a third of all cases. High response rates with only mild side effects (in 16 out of 35 patients) were observed.
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Affiliation(s)
- Florian Anzengruber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland, .,Faculty of Medicine, University of Zurich, Zurich, Switzerland,
| | - Caroline Mergenthaler
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Carla Murer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Monitoring Fungal Burden and Viability of Sporothrix spp. in Skin Lesions of Cats for Predicting Antifungal Treatment Response. J Fungi (Basel) 2018; 4:jof4030092. [PMID: 30087237 PMCID: PMC6162451 DOI: 10.3390/jof4030092] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023] Open
Abstract
Skin lesions in feline sporotrichosis usually present a high fungal burden, making cats an important source of infection. This study evaluated the fungal burden and isolation in skin lesions of feline sporotrichosis during treatment with itraconazole (ITZ), combined with or without potassium iodide (KI). Treatment-naïve cats with culture-confirmed sporotrichosis and presenting skin ulcers were treated for up to 40 weeks with oral ITZ alone (n = 74) or combined with KI (n = 56). These cats were submitted to monthly sampling of the same lesion for mycological culture and cytopathology until healing of lesion or up to twelve weeks. The fungal burden was expressed as the mean yeast cell count in three microscopic fields from imprint smears. The fungal burden before treatment was significantly higher in cats in which the lesion persisted and in cases of treatment failure when using ITZ alone. After twelve weeks, the median fungal burden decreased to zero in both treatment protocols, suggesting a potential decrease in the risk of transmission of Sporothrix spp. from cats. These findings encourage the early treatment of feline sporotrichosis as a control measure. Moreover, the fungal burden in feline sporotrichosis lesions can be a prognostic indicator and a parameter for choosing appropriate therapeutic regimen.
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de Souza EW, Borba CDM, Pereira SA, Gremião IDF, Langohr IM, Oliveira MME, de Oliveira RDVC, da Cunha CR, Zancopé-Oliveira RM, de Miranda LHM, Menezes RC. Clinical features, fungal load, coinfections, histological skin changes, and itraconazole treatment response of cats with sporotrichosis caused by Sporothrix brasiliensis. Sci Rep 2018; 8:9074. [PMID: 29899416 PMCID: PMC5998065 DOI: 10.1038/s41598-018-27447-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/04/2018] [Indexed: 11/09/2022] Open
Abstract
Zoonotic sporotrichosis caused by the fungus Sporothrix brasiliensis is usually severe in cats. This study investigated the associations between clinical features, fungal load, coinfections, histological skin changes, and response to itraconazole in cats with sporotrichosis caused by S. brasiliensis. Fifty-two cats with skin lesions and a definitive diagnosis of sporotrichosis were treated with itraconazole for a maximum period of 36 weeks. The animals were submitted to clinical examination and two subsequent collections of samples from the same skin lesion for fungal diagnosis and histopathology, as well as serology for feline immunodeficiency (FIV) and leukaemia (FeLV) viruses. Thirty-seven (71%) cats were clinically cured. Nasal mucosa lesions and respiratory signs were associated with treatment failure. Cats coinfected with FIV/FeLV (n = 12) had a lower neutrophil count in the lesion. A high fungal load in skin lesions was linked to young age and treatment failure, as well as to a longer time of wound healing, poorly formed granulomas and fewer neutrophils, macrophages and lymphocytes in these lesions. These results indicate that itraconazole is effective, but nasal mucosal involvement, respiratory signs and high fungal loads in skin lesions are predictors of treatment failure that will assist in the development of better treatment protocols for cats.
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Affiliation(s)
- Elaine Waite de Souza
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Sandro Antonio Pereira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Ingeborg Maria Langohr
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States of America
| | | | | | - Camila Rocha da Cunha
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Rodrigo Caldas Menezes
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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da Rocha RFDB, Schubach TMP, Pereira SA, Dos Reis ÉG, Carvalho BW, Gremião IDF. Refractory feline sporotrichosis treated with itraconazole combined with potassium iodide. J Small Anim Pract 2018; 59:720-721. [PMID: 29708594 DOI: 10.1111/jsap.12852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- R F D B da Rocha
- Laboratory of Clinical Research on Dermatozoonosis in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (Fiocruz), 21045-900 Rio de Janeiro, Brazil
| | - T M P Schubach
- Laboratory of Clinical Research on Dermatozoonosis in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (Fiocruz), 21045-900 Rio de Janeiro, Brazil
| | - S A Pereira
- Laboratory of Clinical Research on Dermatozoonosis in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (Fiocruz), 21045-900 Rio de Janeiro, Brazil
| | - É G Dos Reis
- Laboratory of Clinical Research on Dermatozoonosis in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (Fiocruz), 21045-900 Rio de Janeiro, Brazil
| | - B W Carvalho
- Laboratory of Clinical Research on Dermatozoonosis in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (Fiocruz), 21045-900 Rio de Janeiro, Brazil
| | - I D F Gremião
- Laboratory of Clinical Research on Dermatozoonosis in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (Fiocruz), 21045-900 Rio de Janeiro, Brazil
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