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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: 2] [Impact Index Per Article: 2.0] [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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2
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Aboutalebian S, Charsizadeh A, Eshaghi H, Nikmaesh B, Mirhendi H. A case of Candida metapsilosis conjunctivitis in a neonate admitted to the cardiac heart intensive care unit. Clin Case Rep 2023; 11:e6870. [PMID: 36703771 PMCID: PMC9869643 DOI: 10.1002/ccr3.6870] [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: 06/16/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023] Open
Abstract
Harmless commensal Candida species, especially uncommon and rare ones may rarely cause a serious infection. Candida metapsilosis is a recently described yeast that is phenotypically indistinguishable from Candida parapsilosis and molecular methods are essential for its identification. We report the first case of Candida conjunctivitis due to C. metapsilosis obtained from the eye discharge of a 40-day-old girl with congenital heart disease admitted to the cardiac intensive care unit (CICU). The yeast isolate was identified by sequencing the entire ITS1-5.8 rRNA-ITS2 region. Antifungal susceptibility testing performed according to the CLSI M27-A3 showed that the isolate was susceptible to amphotericin B, fluconazole, itraconazole, voriconazole, clotrimazole, nystatin, terbinafine, 5-fluorocytosine, and caspofungin. Differentiation of the fungal new species allows us the accurate diagnosis and treatment, and a better understanding the microbial epidemiology.
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Affiliation(s)
- Shima Aboutalebian
- Department of Parasitology and Mycology, School of MedicineIsfahan University of Medical SciencesIsfahanIran,Mycology Reference Laboratory, Research Core Facilities LaboratoryIsfahan University of Medical SciencesIsfahanIran
| | - Arezoo Charsizadeh
- Immunology, Asthma, and Allergy Research InstituteTehran University of Medical SciencesTehranIran
| | - Hamid Eshaghi
- Department of Infectious DiseaseTehran University of Medical SciencesTehranIran
| | - Bahram Nikmaesh
- Department of Medical Laboratory ScienceSchool of Allied Medical Science, Tehran University of Medical ScienceTehranIran,Zoonoses Research CentreTehran University of Medical SciencesTehranIran
| | - Hossein Mirhendi
- Department of Parasitology and Mycology, School of MedicineIsfahan University of Medical SciencesIsfahanIran,Mycology Reference Laboratory, Research Core Facilities LaboratoryIsfahan University of Medical SciencesIsfahanIran
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3
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Vishwakarma P, Murthy SI, Joshi V, Mishra DK. Anterior segment optical coherence tomography and ultrasound biomicroscopy in the diagnosis of subconjunctival mycosis mimicking nodular scleritis. BMJ Case Rep 2023; 16:e253924. [PMID: 36653048 PMCID: PMC9853128 DOI: 10.1136/bcr-2022-253924] [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: 01/20/2023] Open
Abstract
A female patient in her 20s presented with a bulbar conjunctival mass lesion that was diagnosed as nodular scleritis. It was treated with topical and oral steroids in another hospital. Imaging was done using anterior segment optical coherence tomography and ultrasound biomicroscopy, which helped to rule out scleritis and subconjunctival cysticercosis. Histopathology of the excision biopsy specimen revealed fungal filaments. Topical antifungals were started, and the condition resolved without recurrence after therapy. Although rare, infections should be considered in the differential diagnosis of conjunctival mass lesions. Imaging can help to rule out other entities and guide towards appropriate management.
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Affiliation(s)
- Pratima Vishwakarma
- Shantilal Shangvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Somasheila I Murthy
- Shantilal Shangvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Vineet Joshi
- Shantilal Shangvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Dilip Kumar Mishra
- Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India
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4
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Shivaji S, Jayasudha R, Prashanthi GS, Arunasri K, Das T. Fungi of the human eye: Culture to mycobiome. Exp Eye Res 2022; 217:108968. [PMID: 35120870 DOI: 10.1016/j.exer.2022.108968] [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: 04/13/2021] [Revised: 11/02/2021] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
The focus of the current review is multi-fold and compares the diversity and abundance of fungi on the ocular surface by the conventional culture-based method with the more sensitive, high throughput, culture-independent NGS method. The aim is to highlight the existence of a core ocular mycobiome and explore the transition of the ocular fungal microbiota from the normal eye to the diseased eye. PubMed, Google Scholar and Medline were used to search for publications and reviews related to cultivable fungi and the mycobiome of the normal and diseased eye. The conventional cultivable approach and the NGS approach confirm that the eye has its own mycobiome and several confounding factors (age, gender, ethnicity etc.) influence the mycobiome. Further, dysbiosis in the mycobiome appears to be associated with ocular diseases and thus impacts the health of the human eye. Considering that the mycobiome of the eye is influenced by several confounding factors and also varies with respect to the disease status of the eye there is a need to extensively explore the mycobiome under different physiological conditions, different ethnicities, geographical regions etc. Such studies would unravel the diversity and abundance of the mycobiomes and contribute to our understanding of ocular health. Research focused on ocular mycobiomes may eventually help to build a targeted and individualized treatment.
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Affiliation(s)
- Sisinthy Shivaji
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Rajagopalaboopathi Jayasudha
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Gumpili Sai Prashanthi
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Kotakonda Arunasri
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
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5
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Muhammed J, Ahmad-Fauzi S, Abd-Manan N, Yusof NS, Ibrahim M, Mohamad SA. Ocular sporotrichosis from a tertiary referral center in Malaysia and review of literature in Southeast Asia. Taiwan J Ophthalmol 2022; 12:237-241. [PMID: 35813792 PMCID: PMC9262025 DOI: 10.4103/tjo.tjo_93_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
Ocular sporotrichosis is rare in Malaysia and Southeast Asia and is increasingly reported in endemic areas of Brazil and Peru. We describe six cases of ocular sporotrichosis involving the bulbar conjunctiva and lid with a literature review on ocular sporotrichosis in Southeast Asia. In these series, four patients presented with similar findings of granulomatous lesion at the palpebral conjunctiva within 1–3 weeks. There was one case mistakenly diagnosed as conjunctival concretion due to its multiple yellowish nodules on the palpebral conjunctiva and another case as chalazion due to swelling of the lower lid. All patients showed immunocompetence. Four patients had an immediate contact with sick cats, one patient had a history of skin scratched by a healthy cat, and another patient had a history of gardening without direct contact with cat. Culture from conjunctival biopsy obtained from five patients and from ruptured lower lid nodules of one patient yielded Sporothrix schenckii. The patients were successfully treated with oral itraconazole 200 mg twice daily. Two patients developed symblepharon after completing treatment, while four patients showed good results without any sequelae.
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6
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Mohamad SA, Muhammed J, Ibrahim M. Ocular sporotrichosis with limbal stem cell deficiency: An impostor with blinding sequelae. Middle East Afr J Ophthalmol 2022; 29:96-99. [PMID: 37123421 PMCID: PMC10138130 DOI: 10.4103/meajo.meajo_94_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 02/26/2023] Open
Abstract
Sporotrichosis is a chronic granulomatous fungal infection caused by Sporothrix schenckii. Inoculation of the fungus through breached skin or mucosa typically results in nodular ulceration of the cutaneous and subcutaneous tissue as well as its draining lymphatic nodules. However, reports on ocular involvement have recently increased. We describe a severe case of diffuse granulomatous conjunctivitis involving bulbar and palpebral conjunctiva, resulting in inevitable damage to the limbal stem cells. Isolation of S. schenckii from a conjunctival swab confirmed the diagnosis of sporotrichosis. A 6-month course of oral antifungal therapy was given through which the patient fully recovered. However, extensive corneal conjunctivalization secondary to total limbal stem cell deficiency has caused almost complete blindness in the affected eye. Clinical suspicion of this zoonotic disease is essential for early diagnosis and prompt treatment to prevent ocular surface complication and blindness.
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7
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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: 5] [Impact Index Per Article: 1.7] [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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8
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Shimokawa A, Kobayashi A, Saeki Y, Uchio E. A case of fungal conjunctivitis with giant papillae treated surgically. Taiwan J Ophthalmol 2021; 11:417-420. [PMID: 35070676 PMCID: PMC8757520 DOI: 10.4103/tjo.tjo_46_20] [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: 05/25/2020] [Accepted: 07/11/2020] [Indexed: 12/03/2022] Open
Abstract
Fungal conjunctivitis is a rare disorder, with low incidence and difficulty in diagnosis due to a lack of specific clinical findings. We report a case of fungal conjunctivitis which exhibited a specific clinical feature of giant papilla formation, and its diagnosis was a complex process. A 19-year-old woman with a history of atopic dermatitis and hard contact lens use was referred to us with a 3-month history of giant papillary conjunctivitis of the right eye in spite of treatment with antiallergic and corticosteroid eye drops, complicated by intraocular pressure elevation. The left eye showed no symptom of ocular surface disorder throughout the clinical course. The right eye did not respond to oral corticosteroid. Polymerase chain reaction of conjunctival scrapings against Chlamydia trachomatis was negative, and she was treated surgically by total papilla resection. Conjunctival giant papilla recurrence was not observed after surgery. Although the primary histopathological diagnosis was chronic inflammation due to atopic keratoconjunctivitis, repeated histopathological survey of excised conjunctival tissue including immunohistochemical staining revealed histiocytes, yeast type spores and hyphae, and phagocytosed spores and hyphae in macrophages. The causative organism was identified morphologically as a Candida species. Later, histopathological examination of a cervical swab revealed the presence of Candida sp. This rare case indicates that a fungal organism may underlie refractory conjunctivitis with specific giant papillary hypertrophy mimicking vernal keratoconjunctivitis.
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Affiliation(s)
- Asami Shimokawa
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ayaka Kobayashi
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yusuke Saeki
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
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9
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Liborio Neto AO, Rubim Caetano T, Pestana Gervasio NH, Camargo Carneiro R. Conjunctival and bulbar sporotrichosis as Parinaud's oculoglandular syndrome acquired by blood inoculation. GMS OPHTHALMOLOGY CASES 2021; 11:Doc02. [PMID: 33654649 PMCID: PMC7894194 DOI: 10.3205/oc000175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Parinaud's oculoglandular syndrome (POS) is a clinical condition characterized by granulomatous conjunctivitis associated with homolateral neck pain and anterior preauricular lymphadenopathy. Several reports of this condition occurred and some bacterial etiological agents were identified. However, fungal infections have also been associated, especially sporotrichosis. A 40-year-old female patient complained about a "little ball" in the lower eyelid of the left eye. On ocular examination, visual acuity and fundoscopy were normal. The biomicroscopy revealed a granulomatous lesion in the lower eyelid of the left eye associated with yellowish discharge. The patient returned the next day, reporting worsening of the condition accompanied by low fever, malaise, preauricular and submandibular lymphadenomegaly. The examination showed the evolution of conjunctival edema and various conjunctival granulomas in the lower and upper tarsus of the left eye, a clinical picture compatible with POS. In the investigation of the clinical history, the patient remembered an episode of contact with blood of cats. During the investigation, we discarded differential diagnoses such as tuberculosis, toxoplasmosis, CMV, herpes virus and Bartonella. Serology was positive for Sporothrix. Treatment with itraconazole 100 mg once daily was started. By the eighth week, the conjunctival granulomas had disappeared, and the medication was discontinued after 90 days of treatment, after about 2 weeks of total remission. According to the literature, there are no cases of primarily ocular manifestation of blood sporotrichosis transmission. However, in the report, the form of transmission of the disease occurred by inoculation by direct contact with the blood of contaminated cats.
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Affiliation(s)
- Adail Orrith Liborio Neto
- Federal University of Rio de Janeiro, Campus Macaé (UFRJ), Rio de Janeiro, Brazil,*To whom correspondence should be addressed: Adail Orrith Liborio Neto, Federal University of Rio de Janeiro, Campus Macaé (UFRJ), Av. Aluizio da Silva Gomes, 50 – Novo Cavaleiros, Macaé, Rio de Janeiro 27930-560, Brazil, E-mail:
| | - Tiago Rubim Caetano
- Federal University of Rio de Janeiro, Campus Macaé (UFRJ), Rio de Janeiro, Brazil
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10
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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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Rammohan R, Suneetha V, Sen S, Rameshkumar G, Lalitha P. Fungal Infections of the Eye. CURRENT CLINICAL MICROBIOLOGY REPORTS 2020. [DOI: 10.1007/s40588-020-00142-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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12
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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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13
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Arinelli A, Aleixo ALQDC, Freitas DFS, do Valle ACF, Almeida-Paes R, Gutierrez-Galhardo MC, Curi ALL. Ocular Sporotrichosis: 26 Cases with Bulbar Involvement in a Hyperendemic Area of Zoonotic Transmission. Ocul Immunol Inflamm 2019; 28:764-771. [PMID: 31411512 DOI: 10.1080/09273948.2019.1624779] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe 26 cases of bulbar conjunctival sporotrichosis. METHODS Review of clinical records of patients with bulbar conjunctivitis due to culture-proven Sporothrix spp. infection, in Rio de Janeiro, from 2007 to 2017. RESULTS Twenty-six patients were identified. Median age was 25 years. Adults were more affected (53.8%), followed by adolescents (26.9%). There was a predominance of women (73.1%). Twenty-four patients (96%) reported contact with cats with sporotrichosis. Twenty-one patients (80.8%) presented a primary ocular sporotrichosis. Five patients presented associated eyelid lesions, and 21 (80.8%) tarsal conjunctivitis. Parinaud oculoglandular syndrome was observed in 17 (81%) patients. Eight patients (36.4%) reported the use of steroid drops before diagnosis was made. All patients but one were treated with oral itraconazole. Twenty-three patients (88.5%) were completely cured and three (11.5%) were lost to follow-up. Eight patients (34.8%) developed ocular sequelae. CONCLUSION Bulbar conjunctivitis is an important clinical presentation of ocular sporotrichosis. It can lead to ocular sequelae. Sporotrichosis should be considered in the differential diagnosis of ophthalmic external diseases, especially in patients with cat contact history.
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Affiliation(s)
- Andrea Arinelli
- Laboratory of Clinical Research in Infectious Ophthalmology, Oswaldo Cruz Foundation (FIOCRUZ) , Rio de Janeiro, Brazil
| | | | | | | | - Rodrigo Almeida-Paes
- Laboratory of Mycology, at Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ) , Rio de Janeiro, Brazil
| | | | - André Luiz Land Curi
- Laboratory of Clinical Research in Infectious Ophthalmology, Oswaldo Cruz Foundation (FIOCRUZ) , Rio de Janeiro, Brazil
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Abstract
RATIONALE Sporotrichosis is the most common subcutaneous mycosis. It is caused by the dimorphic fungus Sporothrix schenckii. Ocular sporotrichosis is uncommon and has been rarely reported. PATIENT CONCERNS We describe a 34-year-old female who presented with a nodule increasing in size near the medial angle of the left eye. Originally, she was misdiagnosed with a dacryocyst space-occupying lesion, and the lesion was removed by surgery. DIAGNOSES Findings of fungal structures in the histopathological examination contributed to the diagnosis of Sporothrix dacryocystitis. Further culture of conjunctival secretions and contact lens storage solution was positive for Sporothrix. INTERVENTIONS She was treated with oral itraconazole, 200 mg by mouth twice daily. OUTCOMES After 3 months of treatment with oral itraconazole, culture of the conjunctival secretions was negative. LESSONS It is of paramount importance to clinically suspect mycosis, even in unusual locations or in the absence of the typical epidemiological history.
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Affiliation(s)
- Lixia Sun
- Department of Ophthalmology, Yanbian University Affiliated Hospital, Yanbian University, Yanji
| | - Yaru Dong
- Department of Ophthalmology, Second Hospital of Jilin University, Jilin University, Changchun
| | - Xin Wang
- Department of Ophthalmology, Jiin Guowen Hospital, Gongzhuling
| | | | - Min Zhang
- Department of Pathology, Second Hospital of Jilin University, Jilin University, Changchun, Jilin, P.R. China
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15
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Ferreira TA, Sodré CT, Costa JM, Setta CRP, Ramos-e-Silva M. Primary conjunctival sporotrichosis: An atypical presentation of the disease. JAAD Case Rep 2018; 4:497-499. [PMID: 29984295 PMCID: PMC6031559 DOI: 10.1016/j.jdcr.2018.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Thiago Amparo Ferreira
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Celso Tavares Sodré
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Julia Magarão Costa
- Sector of Endocrinology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Regina Pimenta Setta
- Sector of Medical Clinics, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-e-Silva
- Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Correspondence to: Marcia Ramos-e-Silva, MD, PhD, Rua Dona Mariana 143/C-32, 22280-020, Rio de Janeiro, Brazil.
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16
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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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17
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Freitas DFS, Lima IAR, Curi CL, Jordão L, Zancopé-Oliveira RM, Valle ACFD, Galhardo MCG, Curi ALL. Acute dacryocystitis: another clinical manifestation of sporotrichosis. Mem Inst Oswaldo Cruz 2016; 109:262-4. [PMID: 24810176 PMCID: PMC4015260 DOI: 10.1590/0074-0276130304] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/22/2013] [Indexed: 11/22/2022] Open
Abstract
Sporotrichosis associated with exposure to domestic cats is hyperendemic in Rio de Janeiro, Brazil. A review of the clinical records at our institute revealed four patients with clinical signs of dacryocystitis and a positive conjunctival culture for Sporothrix who were diagnosed with Sporothrix dacryocystitis. Three patients were children (< 13 years of age) and one patient was an adult. Two patients reported contact with a cat that had sporotrichosis. Dacryocystitis was associated with nodular, ulcerated lesions on the face of one patient and with granulomatous conjunctivitis in two patients; however, this condition manifested as an isolated disease in another patient. All of the patients were cured of the fungal infections, but three patients had chronic dacryocystitis and one patient developed a cutaneous fistula. Sporotrichosis is usually a benign disease, but may cause severe complications when the eye and the adnexa are affected. Physicians, especially ophthalmologists in endemic areas, should be aware of the ophthalmological manifestations and complications of sporotrichosis.
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Affiliation(s)
| | | | - Carolina Lemos Curi
- Departamento de Oftalmologia, Hospital da Polícia Militar de Niterói, Niterói, RJ, Brasil
| | - Livia Jordão
- Departamento de Oftalmologia, Hospital da Polícia Militar de Niterói, Niterói, RJ, Brasil
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18
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Ramírez Soto MC. Sporotrichosis in the Ocular Adnexa: 21 Cases in an Endemic Area in Peru and Review of the Literature. Am J Ophthalmol 2016; 162:173-179.e3. [PMID: 26585212 DOI: 10.1016/j.ajo.2015.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the clinical and epidemiologic characteristics of sporotrichosis in ocular adnexa and give an insight into factors associated with this condition. DESIGN Retrospective case series and literature review. METHODS We retrospectively reviewed all cases of sporotrichosis in ocular adnexa between 2004 and 2014 in the Santa Teresa Clinic of Abancay, Peru and reviewed all case reports of sporotrichosis in ocular adnexa in the literature. RESULTS We reviewed records of 21 patients with sporotrichosis in ocular adnexa; 12 (57.1%) of them were male and their median age surrounded 9 years. In our series, 19 patients had lesions in the eyelids and 2 in the eyebrows. The lymphocutaneous form occurred in 62% of them. Ten patients (47.6%) were cured with potassium iodide. Among 65 patients with sporotrichosis in ocular adnexa (our 21 patients and 44 from the literature), the average age was 9 years, and 78% were ≤15 years of age; 54% were male. The lesions were more frequent on the eyelids (n = 53 [82%]), followed by the lacrimal gland (n = 5), conjunctiva (n = 4), and eyebrows (n = 3). The lymphocutaneous clinical form (54%) was the most frequent. Fifty patients were cured: 31 of them with potassium iodide, 16 with itraconazole, and 3 with a combination including potassium iodide, itraconazole, and fluconazole. Twenty-nine patients (44.6%) resided in a hyperendemic region, and 5 patients reported contact with cats that had sporotrichosis. CONCLUSIONS Sporotrichosis in ocular adnexa is associated with children ≤15 years of age, and in 82% of these cases the disease is limited to the eyelids.
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Affiliation(s)
- Max Carlos Ramírez Soto
- Unidad de Postgrado, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru.
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19
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Zhang Y, Wang Y, Cong L, Yang H, Cong X. Eyelid sporotrichosis: Unique clinical findings in 72 patients. Australas J Dermatol 2015; 57:44-7. [PMID: 25757013 DOI: 10.1111/ajd.12286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/28/2014] [Indexed: 11/26/2022]
Abstract
Sporotrichosis on the eyelids is uncommon and has been rarely reported. As the largest series of 72 adults and children with eyelid sporotrichosis from Jilin ̀P̀̀rovince in China, this study provides useful information for the improved diagnosis and treatment of sporotrichosis.
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Affiliation(s)
- Yaqin Zhang
- Department of Dermatology, Second Hospital of Jilin University, Changchun, China.,Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuqian Wang
- Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lele Cong
- Health Science Center, Yanbian University, Yanji, China
| | - Hongfeng Yang
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xianling Cong
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, China
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20
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Abstract
Subcutaneous mycoses are common in tropical and subtropical regions of the world. These infections have multiple features in common, including similar epidemiology, mode of transmission, indolent chronic presentation with low potential for dissemination in immunocompetent hosts, and pyogranulomatous lesions on histopathology. Herein, we provide up-to-date epidemiologic, clinical, diagnostic, and therapeutic data for three important subcutaneous mycoses: chromoblastomycosis, mycetoma, and sporotrichosis.
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Affiliation(s)
- Ricardo M La Hoz
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, Tinsley Harrison Tower 229, Birmingham, AL, 35294-0006, USA
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21
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Support of the laboratory in the diagnosis of fungal ocular infections. Int J Inflam 2012; 2012:643104. [PMID: 22518339 PMCID: PMC3303867 DOI: 10.1155/2012/643104] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 12/06/2011] [Accepted: 12/17/2011] [Indexed: 11/18/2022] Open
Abstract
This is a retrospective, and descriptive study about the support that the laboratory of microbiology aids can provide in the diagnosis of ocular infections in patients whom were attended a tertiary-care hospital in México City in a 10-year-time period. We describe the microbiological diagnosis in palpebral mycose; in keratitis caused by Fusarium, Aspergillus, Candida, and melanized fungi; endophthalmitis; one Histoplasma scleritis and one mucormycosis.
Nowadays, ocular fungal infections are more often diagnosed, because there is more clinical suspicion and there are easy laboratory confirmations. Correct diagnosis is important because an early medical treatment gives a better prognosis for visual acuity. In some cases, fungal infections are misdiagnosed and the antifungal treatment is delayed.
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22
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Abstract
Sporotrichosis, which is caused by the dimorphic fungus Sporothrix schenckii, is currently distributed throughout the world, especially in tropical and subtropical zones. Infection generally occurs by traumatic inoculation of soil, plants, and organic matter contaminated with the fungus. Certain leisure and occupational activities, such as floriculture, agriculture, mining, and wood exploitation, are traditionally associated with the mycosis. Zoonotic transmission has been described in isolated cases or in small outbreaks. Since the end of the 1990s there has been an epidemic of sporotrichosis associated with transmission by cats in Rio de Janeiro, Brazil. More than 2,000 human cases and 3,000 animal cases have been reported. In humans, the lesions are usually restricted to the skin, subcutaneous cellular tissue, and adjacent lymphatic vessels. In cats, the disease can evolve with severe clinical manifestations and frequent systemic involvement. The gold standard for sporotrichosis diagnosis is culture. However, serological, histopathological, and molecular approaches have been recently adopted as auxiliary tools for the diagnosis of this mycotic infection. The first-choice treatment for both humans and cats is itraconazole.
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23
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Abstract
Endemic mycoses are important fungal infections in their respective habitats. In the Asia-Pacific region, an accurate epidemiological picture of endemic mycoses is elusive; few epidemiological surveys have been performed, and limited laboratory facilities and experience with fungal infections have further hampered recognition of infection. However, pockets of endemicity do indeed exist, and endemic fungal infections can have a significant impact on public health. This article reviews the most common endemic mycoses in the Asia-Pacific region: histoplasmosis, penicilliosis, and sporotrichosis. Blastomycosis, which has been infrequently reported within the region, is also briefly discussed. Certain areas of the Asia-Pacific region are endemic for histoplasmosis; however, the ecologic niche for this infection remains unclear. Penicilliosis is restricted to Southeast and Eastern Asia, whereas sporotrichosis is encountered in tropical areas of the Asia-Pacific region linked to environmental reservoirs distinct from those seen in the Western world. Before the advent of acquired immune deficiency syndrome (AIDS), histoplasmosis and penicilliosis were only occasionally reported; however, the incidence of both mycoses has increased with the rise in the incidence of AIDS. Comprehensive studies are needed to fully assess the areas of endemicity and the impact of endemic mycoses in the Asia-Pacific region.
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Affiliation(s)
- A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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