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Poester VR, Xavier MO, Munhoz LS, Basso RP, Zancopé-Oliveira RM, Freitas DFS, Pasqualotto AC. Sporothrix brasiliensis Causing Atypical Sporotrichosis in Brazil: A Systematic Review. J Fungi (Basel) 2024; 10:287. [PMID: 38667958 PMCID: PMC11051268 DOI: 10.3390/jof10040287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Zoonotic sporotrichosis, a subcutaneous mycosis caused by Sporothrix brasiliensis, has become hyperendemic and a serious public health issue in Brazil and an emerging disease throughout the world. Typical sporotrichosis is defined as fixed or lymphocutaneous lesion development, however, reports of atypical presentations have been described in hyperendemic areas, which may result in a worse prognosis. Thus, considering an increase in atypical cases and in more severe extracutaneous cases and hospitalizations reported in Brazil, we aimed to perform a systematic review to search for hypersensitivity reactions (HRs) and extracutaneous presentations associated with zoonotic sporotrichosis. A systematic review was performed, following the PRISMA guidelines to search for atypical/extracutaneous cases (mucosal, osteoarthritis, HRs, pulmonary, meningeal) of zoonotic sporotrichosis. A total of 791 published cases over 26 years (1998-2023) in eleven Brazilian states were reviewed. Most cases corresponded to a HR (47%; n = 370), followed by mucosal (32%; n = 256), multifocal (8%; n = 60), osteoarthritis (7%; n = 59), meningeal (4%; n = 32), and pulmonary (2%; n = 14) infections. When available (n = 607), the outcome was death in 7% (n = 43) of cases. Here, we show a frequent and worrisome scenario of zoonotic sporotrichosis in Brazil, with a high and dispersed incidence of atypical/extracutaneous cases throughout the Brazilian territory. Therefore, educational measures are necessary to make health professionals and the overall population aware of this fungal pathogen in Brazil as well as in other countries in the Americas.
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Affiliation(s)
- Vanice Rodrigues Poester
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, Rio Grande do Sul (RS), Brazil; (V.R.P.); (M.O.X.); (L.S.M.); (R.P.B.)
- Mycology Laboratory of FAMED-FURG, Rio Grande 96200-190, RS, Brazil
| | - Melissa Orzechowski Xavier
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, Rio Grande do Sul (RS), Brazil; (V.R.P.); (M.O.X.); (L.S.M.); (R.P.B.)
- Mycology Laboratory of FAMED-FURG, Rio Grande 96200-190, RS, Brazil
| | - Lívia Silveira Munhoz
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, Rio Grande do Sul (RS), Brazil; (V.R.P.); (M.O.X.); (L.S.M.); (R.P.B.)
- Mycology Laboratory of FAMED-FURG, Rio Grande 96200-190, RS, Brazil
| | - Rossana Patricia Basso
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, Rio Grande do Sul (RS), Brazil; (V.R.P.); (M.O.X.); (L.S.M.); (R.P.B.)
- Mycology Laboratory of FAMED-FURG, Rio Grande 96200-190, RS, Brazil
- Hospital Universitário Dr. Miguel Riet Correa Jr., FURG/Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio Grande 96200-190, RS, Brazil
| | - Rosely Maria Zancopé-Oliveira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Rio de Janeiro (RJ), Brazil; (R.M.Z.-O.); (D.F.S.F.)
| | - Dayvison Francis Saraiva Freitas
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Rio de Janeiro (RJ), Brazil; (R.M.Z.-O.); (D.F.S.F.)
| | - Alessandro Comarú Pasqualotto
- Molecular Biology Laboratory, Hospital Dom Vicente Scherer, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Medicine Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90035-075, RS, Brazil
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Torshina IE, Lugovaya AA, Malakhova AI, Filichkina NS, Nguyễn Phùng M. [Diagnosis of combined ophthalmic and dermatological manifestations of HIV]. Vestn Oftalmol 2024; 140:79-85. [PMID: 38450470 DOI: 10.17116/oftalma202414001179] [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: 03/08/2024]
Abstract
This article contains up-to-date information on the features of ophthalmological and dermatological manifestations of human immunodeficiency virus (HIV) infection based on the analysis of studies published in 2018-2022. The article also presents a description of a clinical case of HIV infection in a 54-year-old female patient with synchronous manifestation of eye symptoms in the form of retinal vasculitis of the optic nerve head and Kaposi's sarcoma localized on the skin of the face.
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Affiliation(s)
- I E Torshina
- Smolensk State Medical University, Smolensk, Russia
| | - A A Lugovaya
- Smolensk State Medical University, Smolensk, Russia
| | - A I Malakhova
- Smolensk Regional Clinical Hospital, Smolensk, Russia
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Freitas HM, da Rocha RCB, de Farias MR, Moore BA, Montiani-Ferreira F. Ocular lesions in cats diagnosed with systemic sporotrichosis. Vet Ophthalmol 2023; 26:476-488. [PMID: 35960710 DOI: 10.1111/vop.13019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/28/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the most common ocular lesions and demonstrate the frequency of ophthalmic involvement in a group of cats with systemic sporotrichosis. ANIMALS STUDIED Two hundred seventy-four cats diagnosed with systemic sporotrichosis. The inclusion criteria included previous positive cytopathological examination, histopathological examination, or fungal culture. PROCEDURES In a prospective case-control study, 274 cats diagnosed with systemic sporotrichosis underwent ophthalmic evaluation and received treatment for systemic sporotrichosis. Of these animals, 63 had ocular abnormalities which were recorded, and conjunctivitis was scored from 0 to 5. Diagnostic techniques utilized included fungal culture, as well as cytopathological (10 eyes; 10 cats), and histopathological examination of the palpebral conjunctiva and eyes (2 eyes). RESULTS Cytopathological and histopathological examination of the conjunctiva, as well as fungal culture, proved to be important tests for the detection of Sporothrix sp. Five cats without the evidence of ophthalmic abnormalities also had a positive fungal culture. The identified ocular lesions in animals with systemic sporotrichosis included increased serous discharge (79 eyes; 53 cats), blepharoconjunctivitis (33 eyes; 25 cats), conjunctivitis (39 eyes, 20 cats), blepharitis (9 eyes; 8 cats), uveitis (5 eyes; 3 cats), and Florida keratopathy-like lesions (2 eyes; 1 cat). CONCLUSION Sporotrichosis should be considered a differential diagnosis for conjunctivitis and blepharoconjunctivitis, especially in endemic areas. Fungal culture and cytopathology of ocular discharge and histopathological examinations of the conjunctiva are important for the diagnosis of ophthalmic sporotrichosis, although not all cats underwent laboratory testing in this study. Ocular discharge could be a source of contagion transmission.
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Affiliation(s)
- Henrique M Freitas
- Veterinary Medicine Department, Comparative Ophthalmology Laboratory (LABOCO, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Renata C B da Rocha
- School of Life Sciences, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | - Marconi R de Farias
- School of Life Sciences, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | - Bret A Moore
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida (UF), Gainesville, Florida, USA
| | - Fabiano Montiani-Ferreira
- Veterinary Medicine Department, Comparative Ophthalmology Laboratory (LABOCO, Federal University of Paraná (UFPR), Curitiba, Brazil
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Pinto-Almazán R, Sandoval-Navarro KA, Damián-Magaña EJ, Arenas R, Fuentes-Venado CE, Zárate-Segura PB, Martínez-Herrera E, Rodríguez-Cerdeira C. Relationship of Sporotrichosis and Infected Patients with HIV-AIDS: An Actual Systematic Review. J Fungi (Basel) 2023; 9:jof9040396. [PMID: 37108851 PMCID: PMC10143772 DOI: 10.3390/jof9040396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Sporotrichosis is a fungal infection that can affect both humans and animals, caused by a species of thermo-dimorphic fungi of the genus Sporothrix. This pathology can be acquired by subcutaneous traumatic inoculation through contact with contaminated plants, soil or decomposing organic matter, and/or by inhalation of conidia. The infection can progress to chronic skin infection, or it can even spread to blood vessels, lymph, muscles, bones, and other organs, such as the lungs and nervous system. Those disseminated types are usually associated with cellular immunodeficiency and infection by inhalation, which explains why people living with human immunodeficiency virus (PLHIV) get infected in such a manner. This virus changes the natural history of sporotrichosis, producing a greater fungal load. Methods: The search was carried out in three databases: Pubmed, Scopus, and Scielo. Eligible articles were considered as those that described sporotrichosis in patients infected with HIV-AIDS, as well as case series. Results: A total of 24 articles were selected, with a sum of 37 patients with sporotrichosis and HIV infection. Of these patients, 31 came from Brazil, two from the United States, one from South Africa, one from Bangladesh, and two from an unspecified region. Regarding epidemiology, a predominance of the male sex was found in 28 of the 37 cases (75.6%), while nine were female (24.3%). Conclusions: Sporotrichosis infection continues to present in a more severe and disseminated way among HIV-positive subjects with lower CD4+ counts.
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Affiliation(s)
- Rodolfo Pinto-Almazán
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (R.P.-A.); (C.E.F.-V.); (P.B.Z.-S.)
| | - Karla A. Sandoval-Navarro
- Hospital Central Norte Pemex, Campo Matillas 52, San Antonio, Azcapotzalco, Ciudad de México 02720, Mexico;
| | - Erika J. Damián-Magaña
- Centro Médico Nacional La Raza, Paseo de las Jacarandas S/N, La Raza, Azcapotzalco, Ciudad de México 02990, Mexico;
| | - Roberto Arenas
- Sección de Micología, Hospital General “Dr. Manuel Gea González”, Tlalpan, Ciudad de México 14080, Mexico;
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IISGS), Servizo Galego de Saúde-Universidade de Vigo (UVIGO), 36213 Vigo, Spain
| | - Claudia Erika Fuentes-Venado
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (R.P.-A.); (C.E.F.-V.); (P.B.Z.-S.)
- Servicio de Medicina Física y Rehabilitación, Hospital General de Zona No 197, Texcoco 56108, Mexico
| | - Paola Berenice Zárate-Segura
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (R.P.-A.); (C.E.F.-V.); (P.B.Z.-S.)
| | - Erick Martínez-Herrera
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (R.P.-A.); (C.E.F.-V.); (P.B.Z.-S.)
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IISGS), Servizo Galego de Saúde-Universidade de Vigo (UVIGO), 36213 Vigo, Spain
- Correspondence: (C.R.-C.); (E.M.-H.); Tel.: +34-600536114 (C.R.-C.)
| | - Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IISGS), Servizo Galego de Saúde-Universidade de Vigo (UVIGO), 36213 Vigo, Spain
- Dermatology Department, Hospital do Vithas, 36206 Vigo, Spain
- Fundación Vithas, Grupo Hospitalario Vithas, 28043 Madrid, Spain
- Department of Health Sciences, University of Vigo, Campus of Vigo, As Lagoas, 36310 Vigo, Spain
- Correspondence: (C.R.-C.); (E.M.-H.); Tel.: +34-600536114 (C.R.-C.)
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Kongwattananon W, Rattanaphong T. Granulomatous panuveitis in disseminated sporotrichosis: case report and review of the literature. J Ophthalmic Inflamm Infect 2023; 13:11. [PMID: 36892661 PMCID: PMC9998770 DOI: 10.1186/s12348-023-00330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/04/2023] [Indexed: 03/10/2023] Open
Abstract
PURPOSE To report a case of intraocular sporotrichosis presenting with bilateral granulomatous panuveitis. METHODS Observational case report and literature review. CASE PRESENTATION A 62-year-old woman with a history of polycythemia vera presented with a non-healing ulcer at the left index finger, generalized erythematous papules, and bilateral granulomatous panuveitis. Cultures of skin and amputated finger identified Sporothrix schenckii. The diagnosis of intraocular sporotrichosis secondary to disseminated sporotrichosis was made. Intravenous liposomal Amphotericin B and intravitreal Amphotericin B were used to control systemic and ocular disease resulting in resolution of the skin lesions and intraocular inflammation. CONCLUSIONS Intraocular sporotrichosis can manifest as bilateral granulomatous panuveitis in the setting of disseminated sporotrichosis. Treatment with intravenous and intravitreal antifungal therapy is useful for controlling intraocular infection.
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Affiliation(s)
- Wijak Kongwattananon
- Center of Excellence in Retina, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society 1873,, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Tanavadee Rattanaphong
- Center of Excellence in Retina, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society 1873,, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
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Yeow YY, Tan XT, Low LL. Mucosal Sporotrichosis from Zoonotic Transmission: Descriptions of Four Case Reports. Infect Dis Rep 2023; 15:102-111. [PMID: 36826351 PMCID: PMC9956378 DOI: 10.3390/idr15010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sporotrichosis is a subacute or chronic mycosis caused by a dimorphic fungus of the genus Sporothrix. Zoonotic-transmitted sporotrichosis has become a major public health concern and is characterised by a different clinical pattern from the traditional epidemiology of sporotrichosis. CASE PRESENTATION We present the details of four patients with mucosal sporotrichosis with regional lymphadenopathy (three cases of granulomatous conjunctivitis and one case of nasal sporotrichosis). The patients' age range was between 23 to 46 years old and their gender was three female and one male patient. All four patients shared the same ethnicity, Malay, and they had a common history of owning domestic cats as pets. Sporothrix schenckii were isolated from all the culture samples and its antifungal susceptibility patterns were compared in the mycelial and yeast phases. All four patients recovered with oral itraconazole treatment, but the treatment duration was variable among patients. CONCLUSIONS People who have a history of contact with domestic cats should be aware of the possibility of sporotrichosis infection. It can present in cutaneous, lymphocutaneous, disseminated, or systemic forms. Early treatment and the prevention of disease progression are more beneficial to patients. The published data concludes that antifungal treatment is highly efficacious, although the reported treatment duration is variable.
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Affiliation(s)
- Yong Yaw Yeow
- Infectious Diseases Unit, Department of Medicine, Hospital Sultanah Bahiyah, Alor Setar 05460, Malaysia
- Correspondence:
| | - Xue Ting Tan
- Infectious Diseases Research Center, Institute for Medical Research, National Institutes of Health, Kuala Lumpur 50588, Malaysia
| | - Lee Lee Low
- Infectious Diseases Unit, Department of Medicine, Hospital Sultanah Bahiyah, Alor Setar 05460, Malaysia
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Arinelli A, Aleixo ALQC, Freitas DFS, do Valle ACF, Almeida-Paes R, Nobre Guimarães AL, Oliveira RVC, Gutierrez-Galhardo MC, Curi ALL. Ocular Manifestations of Sporotrichosis in a Hyperendemic Region in Brazil: Description of a Series of 120 Cases. Ocul Immunol Inflamm 2023; 31:329-337. [PMID: 35080998 DOI: 10.1080/09273948.2022.2027465] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe 120 cases of ocular sporotrichosis. METHODS Review of medical records of patients with culture-proven (from eye specimen) ocular sporotrichosis, in Rio de Janeiro, from 2007 to 2017. RESULTS Women were more affected (61.7%) and median age was 24 years. The isolated ocular form was more frequent (75.8%). Fixed cutaneous sporotrichosis was the most commonly associated form (48.3%). Hypersensitivity reactions were observed in 10% of patients. Ocular involvement was unilateral in 98.3% of the cases, and the most frequent clinical presentation was granulomatous conjunctivitis (86.7%), followed by eyelid lesion (25%). Dacryocystitis represented 7.5% of the cases, predominantly in children (55.6%). Itraconazole was the first choice treatment (95.8%). Sequelae were observed in 23 patients (22.5%), and surgical treatment was required for most of them. CONCLUSION Ocular sporotrichosis can be considered a characteristic form of the zoonotic transmission, with high morbidity. Delay in initiating specific treatment is likely to increase the risk of progression to more severe forms of the disease, and development of ocular sequelae.
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Affiliation(s)
- Andrea Arinelli
- Laboratory of Clinical Research in Infectious Ophthalmology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ana L Q C Aleixo
- Laboratory of Clinical Research in Infectious Ophthalmology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Dayvison F S Freitas
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Antonio C F do Valle
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ana L Nobre Guimarães
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Raquel V C Oliveira
- Laboratory of Epidemiology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria Clara Gutierrez-Galhardo
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - André L L Curi
- Laboratory of Clinical Research in Infectious Ophthalmology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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Zhuang K, Dai Y, Zhou Y, Ke Y, Ran X, Ran Y. Oral treatment with 10% potassium iodide solution for refractory cutaneous-disseminated sporotrichosis in an immunocompetent adult: Case report. Front Microbiol 2022; 13:994197. [PMID: 36386665 PMCID: PMC9650217 DOI: 10.3389/fmicb.2022.994197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/23/2022] [Indexed: 05/29/2024] Open
Abstract
Sporotrichosis has multiple clinical manifestations, and its cutaneous-disseminated form is uncommon and, in most cases, related to immunosuppressive conditions. We report the case of a 47-year-old male patient who presented with multiple cutaneous nodules and ulcers on the left upper limb and the right thigh, with no other comorbidities. Until the diagnosis was confirmed, the patient was initially given empiric antifungal treatment with itraconazole, which showed unsatisfactory results at a local hospital. Then, he was treated with voriconazole, which led to the slow improvement of his skin lesions. At one point during the voriconazole treatment course, the patient briefly self-discontinued voriconazole for economic reasons, and the lesions recurred and worsened. The patient was finally diagnosed with cutaneous-disseminated sporotrichosis based on the isolation and identification of Sporothrix globosa. Susceptibility testing revealed that the isolate was resistant to itraconazole, fluconazole, voriconazole, terbinafine, and amphotericin. Considering the patient's poor financial condition, potassium iodide was administered. After 1-month of therapy with potassium iodide, he reported rapid improvement of his skin lesions. The patient continued potassium iodide treatment for another 5 months until the full resolution of lesions was achieved.
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Affiliation(s)
- Kaiwen Zhuang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yaling Dai
- Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yike Zhou
- West China Hospital, West China School Medicine, Sichuan University, Chengdu, China
| | - Yujing Ke
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Ran
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yuping Ran
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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Epidemiology of Clinical Sporotrichosis in the Americas in the Last Ten Years. J Fungi (Basel) 2022; 8:jof8060588. [PMID: 35736071 PMCID: PMC9224952 DOI: 10.3390/jof8060588] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sporotrichosis is a fungal infection caused by species of the Sporothrix genus. Presently, the prevalence of sporotrichosis in the Americas is unknown, so this study aims to analyze the cases reported in the past 10 years. METHODS An advanced search was conducted from 2012 to 2022 in English and Spanish in PUBMED, SciELO, and Cochrane, with the terms: "sporotrichosis", "lymphocutaneous sporotrichosis", "fixed sporotrichosis", "mycosis", "Sporothrix spp.", "Sporothrix complex", "S. schenckii sensu stricto", "S. schenckii sensu lato", "S. globose", "S. brasiliensis", "S. luriei". Sporotrichosis is a fungal infection caused by species of the Sporothrix genus associated with "pathogenicity" or "epidemiology". RESULTS A total of 124 articles were found in the Americas, corresponding to 12,568 patients. Of these, 87.38% of cases were reported in South America, 11.62% in North America, and 1.00% in Central America and the Caribbean. Brazil, Peru, and Mexico had the highest number of cases. The most prevalent etiological agents were S. schenckii complex/Sporothrix spp. (52.91%), S. schenckii (42.38%), others (4.68%), and Not Determined (ND) (0.03%). The most frequent form of the disease was lymphocutaneous infection; however, the infection type was not determined in 5639 cases. Among the diagnostic methods, culture was the most used. CONCLUSIONS There is a high occurrence of cases reported in the literature. South America is the region with the highest number of reports because of its environment (climate, inhalation of spores, etc.), zoonotic transmission (scratches and sneezes from contaminated animals), and possible traumatic inoculation due to outdoor activities (agriculture, gardening, and related occupations). Molecular diagnosis has not been sufficiently developed due to its high cost.
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Human sporotrichosis: recommendations from the Brazilian Society of Dermatology for the clinical, diagnostic and therapeutic management. An Bras Dermatol 2022; 97:757-777. [PMID: 36155712 PMCID: PMC9582924 DOI: 10.1016/j.abd.2022.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The increase in the zoonotic epidemic of sporotrichosis caused by Sporothrix brasiliensis, which started in the late 1990s in Rio de Janeiro and is now found in almost all Brazilian states, has been equally advancing in neighboring countries of Brazil. Changes in the clinical-epidemiological profile, advances in the laboratory diagnosis of the disease, and therapeutic difficulties have been observed throughout these almost 25 years of the epidemic, although there is no national consensus. The last international guideline dates from 2007. OBJECTIVES Update the clinical classification, diagnostic methods and recommendations on the therapeutic management of patients with sporotrichosis. METHODS Twelve experts in human sporotrichosis were selected from different Brazilian regions, and divided into three work groups: clinical, diagnosis and treatment. The bibliographic research was carried out on the EBSCOHost platform. Meetings took place via electronic mail and remote/face-to-face and hybrid settings, resulting in a questionnaire which pointed out 13 divergences, resolved based on the opinion of the majority of the participants. RESULTS The clinical classification and laboratory diagnosis were updated. Therapeutic recommendations were made for the different clinical forms. CONCLUSION Publication of the first national recommendation, carried out by the Brazilian Society of Dermatology, aimed at the Brazilian scientific community, especially dermatologists, infectologists, pediatricians, family medicine personnel, and laboratory professionals who work in the management of human sporotrichosis.
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Ramírez-Soto MC, Tirado-Sánchez A, Bonifaz A. Ocular Sporotrichosis. J Fungi (Basel) 2021; 7:951. [PMID: 34829238 PMCID: PMC8621225 DOI: 10.3390/jof7110951] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 12/27/2022] Open
Abstract
Sporotrichosis is a subacute or chronic mycosis predominant in tropical and subtropical regions. It is an infection of subcutaneous tissue caused by Sporothrix fungus species, but occasionally resulting in an extracutaneous condition, including osteoarticular, pulmonary, nervous central system, and ocular disease. Cases of ocular sporotrichosis are rare, but reports have been increasing in recent decades. Ocular infections usually occur in hyperendemic areas of sporotrichosis. For its classification, anatomic criteria are used. The clinical presentation is the infection in the ocular adnexal and intraocular infection. Ocular adnexa infections include palpebral, conjunctivitis, and infections of the lacrimal sac. Intraocular infection includes exogenous or endogenous endophthalmitis. Most infections in the ocular adnexal have been reported in Brazil, China and Peru, and intraocular infections are limited to the USA and Brazil. Diagnosis is performed from Sporothrix isolation in the mycological examination from ocular or skin samples. Both sporotrichosis in the ocular adnexa and intraocular infection can mimic several infectious and non-infectious medical conditions. Ocular adnexa infections are treated with potassium iodide and itraconazole. The intraocular infection is treated with amphotericin B. This review describes the clinical findings and epidemiological, diagnosis, and treatment of ocular sporotrichosis.
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Affiliation(s)
- Max Carlos Ramírez-Soto
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
- Facultad de Ciencias de la Salud, Universidad Tecnológica del Perú, Lima 15046, Peru
| | - Andrés Tirado-Sánchez
- Internal Medicine Department, Hospital General de Zona 29, Instituto Mexicano del Seguro Social, Ciudad de México 07950, Mexico;
- Dermatology Service & Mycology Department, Hospital General de México, “Dr. Eduardo Liceaga”, Balmis 148, Colonia Doctores, Ciudad de México 06726, Mexico;
| | - Alexandro Bonifaz
- Dermatology Service & Mycology Department, Hospital General de México, “Dr. Eduardo Liceaga”, Balmis 148, Colonia Doctores, Ciudad de México 06726, Mexico;
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Bone sporotrichosis: 41 cases from a reference hospital in Rio de Janeiro, Brazil. PLoS Negl Trop Dis 2021; 15:e0009250. [PMID: 33730026 PMCID: PMC8007180 DOI: 10.1371/journal.pntd.0009250] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/29/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background Bone sporotrichosis is rare. The metropolitan region of Rio de Janeiro is hyperendemic for zoonotic sporotrichosis and the bone presentations are increasing. Methods We studied a retrospective cohort of 41 cases of bone sporotrichosis, diagnosed from 1999–2016. The inclusion criteria was fungal culture isolation from any clinical specimen associated to bone involvement (radiography and/or computed tomography) compatible with fungal osteomyelitis or histopathological findings of bone material compatible with sporotrichosis. Molecular identification was performed when possible. Results Male patients represented 58.5% of the cases, with a cohort median age of 43 years. Immunosuppressive conditions were present in 68.3% of the patients, mostly HIV coinfection (51.2%). Multifocal bone involvement (more than one anatomical segment) was diagnosed in 61% of the patients, while 39% presented unifocal involvement. The bones of the hands were the most affected (58.5%), followed by the feet (41.5%) and tibia (26.8%). Multifocal group was characterized by a higher proportion of males (p = 0.0045) with immunosuppressive conditions (p = 0.0014). Amphotericin B followed by oral itraconazole was the main treatment, with a median time of 16.7 months (1.5 to 99.2 months), and cure of 53.7% of the patients (84.6% of immunocompetent and 39.3% of immunocompromised patients). Sequelae occurred in 12.2% of the patients—amputations (7.3%) and ankylosis (4.9%), while 22% died in the course of the disease. Sporothrix brasiliensis was the causative agent in all the 9 (22%) performed cases. Conclusions Bone sporotrichosis is a chronic, challenging condition with prolonged treatment, often with poor results and sequelae. Sporotrichosis is a subcutaneous mycosis, more common in tropical and subtropical countries, and the involvement of bones is rare. The metropolitan region of Rio de Janeiro is hyperendemic for zoonotic sporotrichosis and the bone presentations are increasing. We evaluated 41 cases of bone sporotrichosis at a reference center in infectious diseases. There was a predominance of men with immunosuppressive conditions, notably HIV infection and alcoholism. Immunosuppression was related to multifocal bone involvement and more severe disease. This form of the disease is a chronic, challenging condition with prolonged treatment, often with poor results and sequelae.
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Etchecopaz A, Toscanini MA, Gisbert A, Mas J, Scarpa M, Iovannitti CA, Bendezú K, Nusblat AD, Iachini R, Cuestas ML. Sporothrix Brasiliensis: A Review of an Emerging South American Fungal Pathogen, Its Related Disease, Presentation and Spread in Argentina. J Fungi (Basel) 2021; 7:jof7030170. [PMID: 33652625 PMCID: PMC7996880 DOI: 10.3390/jof7030170] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Sporotrichosis, caused by Sporothrix schenckii and related species, is the most frequent implantation mycosis in Latin America. In Argentina, over the last 8 years, there have been 0.16 new cases per month of feline sporotrichosis in 2011, increasing to 0.75 cases per month in 2019 and involving zoonotic transmission to humans. Molecular identification by polymerase chain reaction (PCR) detected Sporothrix brasiliensis in these feline and zoonotic outbreaks. This study will focus on different feline and human sporotrichosis outbreaks caused by S. brasiliensis in Argentina during 2011–2019. We will address the sources of infection and environmental hotspots, as well as the application of several treatment strategies for improving the pharmacotherapy of the different clinical forms of the disease. Finally, we will provide a detailed summary of the clinical aspects and new advances in host–pathogen interactions, virulence factors and immune response, focusing on state-of-the-art diagnostic tools and potential vaccine candidates.
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Affiliation(s)
- Alejandro Etchecopaz
- Cátedra de Enfermedades Infecciosas, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427 CWN, Argentina; (A.E.); (M.S.)
| | - María A. Toscanini
- Instituto de Nanobiotecnología (Nanobiotec), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad de Buenos Aires, Buenos Aires C1113 AAD, Argentina; (M.A.T.); (A.D.N.)
| | - Amelia Gisbert
- Cátedra de Clínica Médica, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427 CWN, Argentina; (A.G.); (J.M.)
| | - Javier Mas
- Cátedra de Clínica Médica, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427 CWN, Argentina; (A.G.); (J.M.)
| | - Miguel Scarpa
- Cátedra de Enfermedades Infecciosas, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427 CWN, Argentina; (A.E.); (M.S.)
| | - Cristina A. Iovannitti
- Centro de Micología, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad de Buenos Aires, Buenos Aires C1121ABG, Argentina; (C.A.I.); (K.B.)
| | - Karla Bendezú
- Centro de Micología, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad de Buenos Aires, Buenos Aires C1121ABG, Argentina; (C.A.I.); (K.B.)
| | - Alejandro D. Nusblat
- Instituto de Nanobiotecnología (Nanobiotec), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad de Buenos Aires, Buenos Aires C1113 AAD, Argentina; (M.A.T.); (A.D.N.)
| | - Ricardo Iachini
- Instituto de Zoonosis «Luis Pasteur», Buenos Aires C1405 DCD, Argentina;
| | - María L. Cuestas
- Cátedra de Enfermedades Infecciosas, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427 CWN, Argentina; (A.E.); (M.S.)
- Centro de Micología, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Universidad de Buenos Aires, Buenos Aires C1121ABG, Argentina; (C.A.I.); (K.B.)
- Correspondence: ; Tel.: +54-11-59509500 (ext. 2176/77)
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Spinelli TP, Bezerra LM, de Souza BOF, Rocha A, Neto JE, Sá FB. Primary conjunctival sporotrichosis in three cats from Northeastern Brazil. Vet Ophthalmol 2021; 24:209-215. [PMID: 33608958 DOI: 10.1111/vop.12865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Classically, sporotrichosis occurs as a chronic granulomatous lymphocutaneous infection. The extracutaneous form is uncommon and may affect the eye without cutaneous involvement. The most frequent form of ocular sporotrichosis reported in humans is a granulomatous conjunctivitis. There are no previous reports on primary ocular sporotrichosis in cats. PROCEDURES Three mixed breed cats rescued from shelters were referred by the veterinarian for ophthalmic evaluation with a complaint of conjunctivitis nonresponsive to treatment with no evidence of skin disease or systemic disease. Complete ophthalmic examination, conjunctival cytology, and microbiological analysis were performed. RESULTS Ophthalmic examinations revealed epiphora, purulent ocular discharge, conjunctival hyperemia, and a mass in the palpebral conjunctiva. Conjunctival cytology revealed segmented and degenerated neutrophils, conjunctival epithelial cells, and an abundant number of round and oval cells compatible with Sporothrix spp. Microbiological culture was performed and confirmed the presence of fungi from the Sporothrix schenckii complex. All animals were treated with oral itraconazole; two animals received topical itraconazole in association with oral treatment. Case 1 was refractory to treatment, and iodate potassium was combined with itraconazole therapy without resolution at the time of this publication. Cases 2 and 3 had complete resolution of conjunctival lesions with four months of oral and topical itraconazole therapy. CONCLUSION Conjunctival sporotrichosis should be considered as a differential diagnosis of conjunctivitis in cats from endemic regions. Conjunctival cytology is an important tool that can aid early diagnosis.
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Affiliation(s)
- Taciana P Spinelli
- Departamento de Medicina Veterinária, Universidade Federal Rural de Pernambuco, Recife, Brasil
| | - Leticia M Bezerra
- Departamento de Medicina Veterinária, Universidade Federal Rural de Pernambuco, Recife, Brasil
| | | | - Angelica Rocha
- Departamento de Medicina Veterinária, Universidade Federal Rural de Pernambuco, Recife, Brasil
| | - Joaquim E Neto
- Departamento de Morfologia e Fisiologia Animal, Universidade Federal Rural de Pernambuco, Brasil
| | - Fabrício B Sá
- Departamento de Morfologia e Fisiologia Animal, Universidade Federal Rural de Pernambuco, Brasil
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Ocular and cutaneous sporotrichosis. Am J Ophthalmol Case Rep 2020; 20:100885. [PMID: 32875162 PMCID: PMC7452058 DOI: 10.1016/j.ajoc.2020.100885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 01/19/2023] Open
Abstract
Purpose Sporotrichosis is the most common subcutaneous mycosis in the world and it is presented usually in the lymphocutaneous form. When the eye is involved, it typically includes the conjunctival and periorbital tissues or even the intraocular tissues. Observations We present a case of a 13-year-old girl complaining about nodules in the left malar region and in both the outer nasal corner and the lower eyelid of the left eye, which had appeared one month earlier. Conclusions and significance: Sporotrichosis is a hyperendemic disease in Brazil and its diagnosis is based on clinical aspects, epidemiological history, and culture. Ophthalmologists and other professionals should be aware of this condition.
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M. F. Matos A, M. Moreira L, F. Barczewski B, X. de Matos L, B. V. de Oliveira J, F. Pimentel MI, Almeida-Paes R, G. Oliveira M, C. A. Pinto T, Lima N, de O. Matos M, de M. e Costa LG, Santos C, Marques Evangelista Oliveira M. Identification by MALDI-TOF MS of Sporothrix brasiliensis Isolated from a Subconjunctival Infiltrative Lesion in an Immunocompetent Patient. Microorganisms 2019; 8:microorganisms8010022. [PMID: 31877698 PMCID: PMC7023001 DOI: 10.3390/microorganisms8010022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/16/2022] Open
Abstract
Sporotrichosis is a globally distributed subcutaneous fungal infection caused by dimorphic fungi belonging to the Sporothrix species complex that affects the skin of limbs predominantly, but not exclusively. A rare case of ocular sporotrichosis in an immunocompetent Brazilian patient from the countryside of Rio de Janeiro State is reported. A 68-year-old woman presented with a subconjunctival infiltrative lesion in the right eye with pre-auricular lymphadenopathy of onset 4 months ago that evolved to suppurative nodular lesions on the eyelids. Conjunctival secretion was evaluated by histopathological examination and inoculated on Sabouraud Dextrose Agar (SDA). Histopathology showed oval bodies within giant cells and other mononucleated histiocytes. Fungus grown on SDA was identified as Sporothrix sp. by morphological observations. The isolated strain was finally identified by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) associated with an in-house database enriched with reference Sporothrix complex spectra. The strain presented a MALDI spectrum with the ion peaks of the molecular mass profile of S. brasiliensis. The patient was adequately treated with amphotericin B subsequently replaced by itraconazole. Due to scars left by the suppurative process, the patient presented poor final visual acuity. The present work presents an overview of ocular sporotrichosis and discusses the diagnostic difficulty that can lead to visual sequelae in these cases.
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Affiliation(s)
- Aline M. F. Matos
- Department of Ophthalmology, University Hospital of the Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil; (A.M.F.M.); (B.F.B.); (L.X.d.M.); (J.B.V.d.O.)
| | - Lucas M. Moreira
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil; (L.M.M.); (R.A.-P.)
| | - Bianca F. Barczewski
- Department of Ophthalmology, University Hospital of the Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil; (A.M.F.M.); (B.F.B.); (L.X.d.M.); (J.B.V.d.O.)
| | - Lucas X. de Matos
- Department of Ophthalmology, University Hospital of the Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil; (A.M.F.M.); (B.F.B.); (L.X.d.M.); (J.B.V.d.O.)
| | - Jordane B. V. de Oliveira
- Department of Ophthalmology, University Hospital of the Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil; (A.M.F.M.); (B.F.B.); (L.X.d.M.); (J.B.V.d.O.)
| | - Maria Ines F. Pimentel
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil;
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil; (L.M.M.); (R.A.-P.)
| | - Murilo G. Oliveira
- Department of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil;
| | - Tatiana C. A. Pinto
- Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil;
| | - Nelson Lima
- CEB—Biological Engineering Centre, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
| | - Magnum de O. Matos
- Imaging Department of Instituto Oncológico, Hospital Nove de Julho, Juiz de Fora 36010-510, Brazil;
| | - Louise G. de M. e Costa
- Department of Pathology, Faculty of Medicine of Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil;
| | - Cledir Santos
- Department of Chemical Science and Natural Resources, BIOREN-UFRO, Universidad de La Frontera, 4811-230 Temuco, Chile
- Correspondence: (C.S.); (M.M.E.O.)
| | - Manoel Marques Evangelista Oliveira
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil
- Laboratório de Taxonomia, Bioquímica e Bioprospecção de Fungos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil
- Correspondence: (C.S.); (M.M.E.O.)
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Ramírez-Soto MC, Bonifaz A, Tirado-Sánchez A. Endophthalmitis in patients co-infected by HIV and sporotrichosis: a systematic review of published case reports. Eye (Lond) 2018; 32:1678-1680. [DOI: 10.1038/s41433-018-0145-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/26/2018] [Indexed: 11/09/2022] Open
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Conceição-Silva F, Morgado FN. Immunopathogenesis of Human Sporotrichosis: What We Already Know. J Fungi (Basel) 2018; 4:jof4030089. [PMID: 30065160 PMCID: PMC6162489 DOI: 10.3390/jof4030089] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 12/19/2022] Open
Abstract
Sporotrichosis is a subacute/chronic mycosis caused by dimorphic fungus of the genus Sporothrix. This mycosis may affect both human and domestic animals and in the last few years, the geographic dispersion and increase of sporotrichosis worldwide has been observed. The occurrence of cases related to scratching/bites of domestic felines have increased, characterizing the disease as predominantly a zoonosis. In humans, sporotrichosis mainly involves the cutaneous tegument of infected patients, but other tissues may also present the infection. The main forms of clinical presentation are lymphocutanous sporotrichosis (LC) and fixed sporotrichosis (F). Although less common, mucosal, cutaneous disseminated, and extracutaneous forms have also been described. Multiple factors from the fungus and host can play a role in driving the clinical evolution of sporotrichosis to benign or severe disease. In this review, we discuss the immunopathological aspects involved in human sporotrichosis. Putting together the two branches of knowledge—host immune response and fungal evading mechanisms—we may perceive new possibilities in understanding the fungus–host interaction in order to be in a position to go further in the control of sporotrichosis.
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Affiliation(s)
- Fatima Conceição-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute, IOC/Fiocruz, Avenida Brasil 4365 Pavilhão 26 sala 408-Manguinhos, Rio de Janeiro 21040-360, Brazil.
| | - Fernanda Nazaré Morgado
- Laboratory of Leishmaniasis Research, Oswaldo Cruz Institute, IOC/Fiocruz, Avenida Brasil 4365 Pavilhão 26 sala 509-Manguinhos, Rio de Janeiro 21040-360, Brazil.
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Manente FA, Quinello C, Ferreira LS, de Andrade CR, Jellmayer JA, Portuondo DL, Batista-Duharte A, Carlos IZ. Experimental sporotrichosis in a cyclophosphamide-induced immunosuppressed mice model. Med Mycol 2017; 56:711-722. [DOI: 10.1093/mmy/myx098] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/06/2017] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Camila Quinello
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
| | - Lucas Souza Ferreira
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
| | | | | | | | - Alexander Batista-Duharte
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
| | - Iracilda Zeppone Carlos
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
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Ramírez Soto MC. Differences in clinical ocular outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix: a systematic review of published literature. Br J Ophthalmol 2017; 102:977-982. [PMID: 28972025 DOI: 10.1136/bjophthalmol-2017-310581] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/04/2017] [Accepted: 09/08/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sporotrichosis is an implantation mycosis caused by Sporothrix species prevalent worldwide, which occasionally can also result in intraocular infection presenting as an exogenous or endogenous infection (disseminated sporotrichosis). Knowledge in its clinical recognition and management is limited. AIMS To systematically review and analyse data from published literature with a view to comparing clinical outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix. METHODS Case reports of intraocular sporotrichosis, published from 1960 to 2016, were retrieved from MEDLINE, Embase, Cochrane, LILACS and SciELO databases. The entire data set was divided into two patient groups: (1) exogenous endophthalmitis and (2) endogenous endophthalmitis. Primary outcomes were differences in ocular findings and clinical ocular outcomes between the two groups. RESULTS From 16 publications retrieved, a total of 8 eyes of 8 patients with exogenous endophthalmitis and 13 eyes of 10 patients with endogenous endophthalmitis were identified. Compared with exogenous endophthalmitis, endogenous endophthalmitis was more common in patients infected with HIV (p=0.001) and those from hyperendemic areas (p=0.036). Anterior uveitis (p=0.015) and posterior uveitis (p=0.04) were more common in the exogenous and endogenous endophthalmitis groups, respectively. The majority of patients with endogenous endophthalmitis had partial or full clinical resolution of ocular lesions with systemic amphotericin B alone or in combination with an oral antifungal, whereas patients with exogenous endophthalmitis had poor outcomes with irreversible vision loss, enucleation and evisceration. CONCLUSIONS Anterior uveitis is more common in exogenous endophthalmitis with worse overall outcomes and complications, compared with endogenous endophthalmitis where posterior uveitis is the most common clinical manifestation, especially in patients infected with HIV and those from hyperendemic areas. Sporothrix infection should be included in the differential diagnosis for ocular inflammation, regardless of the presence or absence of autoimmune comorbidities and whether the patient resides in an endemic area or not. Ophthalmologists should consider intravitreal and systemic antifungal therapy for exogenous and endogenous endophthalmitis caused by Sporothrix.
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Affiliation(s)
- Max Carlos Ramírez Soto
- Medicine School, Universidad Nacional Mayor de San Marcos, Lima, Peru.,Fondo Nacional de Desarrollo Científico y Tecnológico y de Innovación Tecnológica (FONDECYT), CONCYTEC, Lima, Peru
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Ocular sporotrichosis: A frequently misdiagnosed cause of granulomatous conjunctivitis in epidemic areas. Am J Ophthalmol Case Rep 2017; 8:35-38. [PMID: 29260114 PMCID: PMC5731672 DOI: 10.1016/j.ajoc.2017.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 08/30/2017] [Accepted: 09/21/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose Sporotrichosis is a subcutaneous mycosis caused by Sporothrix sp., a dimorphic fungus. Although the cutaneous form is the most frequent form, the ocular presentation has been increasingly diagnosed in epidemic areas. We describe three cases of ocular sporotrichosis with the involvement of the ocular adnexa due to autoinoculation without trauma with successful antifungal treatment. Observations Patient 1: A 68-year-old woman presented with granulomatous conjunctivitis of the right eye with an ulcerated nodule on the right temporal region for 5 months. Patient 2: A 46-year-old woman with conjunctival hyperemia of the left eye with associated periorbital edema and erythema for the past 4 months was referred to the Dermatology Department due to an ulcerated nodule on the left malar region. Patient 3: A 14-year-old boy presented to the emergency department with inferior palpebral edema with a 5-day evolution. Specimens were obtained from the lesions of the three patients, and the cultures were positive for Sporothrix sp. The three cases were diagnosed as ocular sporotrichosis and were successfully treated with itraconazole (200–400 mg/d). Two of the three patients developed sequelae such as conjunctival fibrosis and symblepharon. Conclusions and importance We emphasize the importance of the ophthalmologist being familiar with the diagnosis and management of this rare and frequently misdiagnosed form of sporotrichosis.
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Yagnik KJ, Skelton WP, Olson A, Trillo CA, Lascano J. A rare case of disseminated Sporothrix schenckii with bone marrow involvement in a patient with idiopathic CD4 lymphocytopenia. IDCases 2017; 9:70-72. [PMID: 28706855 PMCID: PMC5503829 DOI: 10.1016/j.idcr.2017.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 11/04/2022] Open
Abstract
Sporothrix schenckii is a pathogen with a predilection for dissemination in immunocompromised individuals, often with HIV. We report a case of disseminated sporotrichosis in an unfortunate 25 year old male (without HIV) who was originally treated for presumed pneumonia. The patient continued to worsen clinically and further work-up eventually revealed Sporothrix schenckii species with involvement of multiple organs including the skin, heart, lungs and bone marrow. Despite treatment with multiple antibacterials and antifungals, he ultimately passed away. This case illustrates the aggressive nature of this disease along with the importance of early/proper diagnosis and treatment.
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Affiliation(s)
- Kruti J Yagnik
- Department of Internal Medicine, University of Florida, Gainesville, FL, United States
| | - William Paul Skelton
- Department of Internal Medicine, University of Florida, Gainesville, FL, United States
| | - Angela Olson
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Florida, Gainesville, FL, United States
| | - Cesar A Trillo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Florida, Gainesville, FL, United States
| | - Jorge Lascano
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Florida, Gainesville, FL, United States
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