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Rodrigues AM, de Carvalho JA, Nery AF, Hueb M, Garcia I, Guevara A, de Camargo ZP, Hahn RC. Multifocal Sporotrichosis Associated with Armadillo Hunting in Midwest Brazil: An In-Depth Case Study and Comprehensive Literature Analysis. Mycopathologia 2024; 189:53. [PMID: 38864961 DOI: 10.1007/s11046-024-00854-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/15/2024] [Indexed: 06/13/2024]
Abstract
Sporotrichosis is a globally distributed subcutaneous mycosis caused by dimorphic Sporothrix species commonly found in soil, mosses, and decaying plant matter. The lymphocutaneous manifestation, historically associated with occupational activities and sapronotic transmission, has recently been observed to also occur through animal contact, particularly notable in Brazil. We describe a rare case of lymphocutaneous sporotrichosis with simultaneous pulmonary complications resulting from the scratching of a southern three-banded armadillo, Tolypeutes matacus, primarily inhabiting the arid forests of South America's central region. Speciation using multiplex quantitative polymerase chain reaction (qPCR) established the etiological agent as S. schenckii s. str., while amplified fragment length polymorphism (AFLP) analysis unveiled a novel genotype circulating in the Midwest of Brazil. The patient received treatment with itraconazole (200 mg/day) for two months, leading to substantial clinical improvement of cutaneous and pulmonary symptoms. This case highlights the critical role of animal-mediated transmission in sporotrichosis epidemiology, particularly within regions with diverse armadillo species. The unusual epidemiology and genetic characteristics of this case emphasize the need for enhanced awareness and diagnostic vigilance in atypical sporotrichosis presentations.
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Affiliation(s)
- Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- National Institute of Science and Technology in Human Pathogenic Fungi, São Paulo, Brazil
| | - Jamile Ambrósio de Carvalho
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Andreia Ferreira Nery
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Marcia Hueb
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Ivana Garcia
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Armando Guevara
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Rosane Christine Hahn
- Medical Mycology Laboratory/Investigation, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.
- Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.
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2
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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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3
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Santos AF, Azevedo MI, Amaral CI, Grom NA, Marinho F, de Oliveira CSF, de M Soares DF, Morais MHF, Brandão ST, Menezes RC, Ecco R. Feline sporotrichosis: Characterization of cutaneous and extracutaneous lesions using different diagnostic methods. Vet Pathol 2024; 61:221-231. [PMID: 37515437 DOI: 10.1177/03009858231189448] [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: 07/30/2023]
Abstract
Sporotrichosis is a mycotic infection of the cutaneous and subcutaneous tissues caused by Sporothrix spp. that can also cause extracutaneous manifestations. This study aimed to characterize cutaneous and extracutaneous sporotrichosis lesions in cats. Over 1 year, 102 cats rescued by the Zoonoses Control Center of Belo Horizonte, Brazil, euthanized with clinical suspicion of feline sporotrichosis were evaluated. After euthanasia, the animals were evaluated by macroscopic, cytological, histopathological, and immunohistochemistry (IHC) examinations; fungal culture; and polymerase chain reaction (PCR). Sporothrix infection was identified by at least one diagnostic technique in all cats (n = 102) evaluated by postmortem examination, including 26/28 cases (93%) evaluated by IHC, 66/90 cases (73%) evaluated by cytology, 70/102 cases (68.6%) evaluated by histopathology, and 62/74 cases (84%) evaluated by fungal culture. Two cats had positive results only by fungal culture. Cytology and histopathology examinations were effective in diagnosing sporotrichosis, although IHC was needed to confirm the diagnosis in cats with low fungal loads. Sporothrix brasiliensis was confirmed by the sequencing of 3 samples. Skin lesions were characterized mainly by pyogranulomatous to granulomatous dermatitis (frequently with subcutaneous inflammation) with different intensities of Sporothrix spp. yeast. Extracutaneous findings associated with sporotrichosis included rhinitis or rhinosinusitis, lymphadenitis, pneumonia, meningitis, periorchitis, conjunctivitis, and glossitis. Extracutaneous infections were observed in 74/102 cases, and a possible association between the chronicity of the disease and the higher pathogenicity of this fungal species in cats requires further investigation.
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Affiliation(s)
- Agna F Santos
- Pathology Sector and MULTILAB, Department of Clinic and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria I Azevedo
- Departamento de Medicina Veterinária Preventiva, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Camila I Amaral
- Pathology Sector and MULTILAB, Department of Clinic and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nikollye A Grom
- Pathology Sector and MULTILAB, Department of Clinic and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fabricio Marinho
- Pathology Sector and MULTILAB, Department of Clinic and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Camila S F de Oliveira
- Departamento de Medicina Veterinária Preventiva, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Danielle F de M Soares
- Departamento de Medicina Veterinária Preventiva, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria H F Morais
- Diretoria de Zoonoses, Secretaria Municipal da Saúde, Prefeitura Municipal de Belo Horizonte, Belo Horizonte, Brazil
| | - Silvana T Brandão
- Diretoria de Zoonoses, Secretaria Municipal da Saúde, Prefeitura Municipal de Belo Horizonte, Belo Horizonte, Brazil
| | - Rodrigo C Menezes
- Laboratório de Pesquisa Clínica em Dermatozoonoses em Animais Domésticos, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Roselene Ecco
- Pathology Sector and MULTILAB, Department of Clinic and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Almeida-Paes R, do Valle ACF, Freitas DFS, de Macedo PM, Zancopé-Oliveira RM, Gutierrez-Galhardo MC. The present and future research agenda of sporotrichosis on the silver anniversary of zoonotic sporotrichosis in Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz 2024; 119:e230208. [PMID: 38359307 PMCID: PMC10868377 DOI: 10.1590/0074-02760230208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Twenty-five years have passed since the initial observation of endemic zoonotic sporotrichosis in Rio de Janeiro, Brazil. Since then, this disease has spread throughout South America. Accompanying the emergence of this mycosis, some progress has been made, including the expansion of a research network in this field and higher visibility of sporotrichosis within government authorities and funding agencies. However, there are still some challenges to curbing the expansion of this disease in the coming years. These include the development of rapid and accurate diagnostic tests, new antifungal drugs, particularly for the treatment of extracutaneous manifestations of sporotrichosis, and more comprehensive care for cats with sporotrichosis. Including these actions in the sporotrichosis research agenda is required so as to change the development of this disease in the years to come.
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Affiliation(s)
- Rodrigo Almeida-Paes
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Antonio Carlos Francesconi do Valle
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| | - Dayvison Francis Saraiva Freitas
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| | - Priscila Marques de Macedo
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
| | - Rosely Maria Zancopé-Oliveira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Rio de Janeiro, RJ, Brasil
| | - Maria Clara Gutierrez-Galhardo
- Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Dermatologia Infecciosa, Rio de Janeiro, RJ, Brasil
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5
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Reis EGD, Pereira SA, Miranda LHMD, Oliveira RDVCD, Quintana MDSB, Viana PG, Figueiredo ABF, Honorato CCDS, Pereira-Oliveira GR, Silva JN, Schubach TMP, Gremião IDF. A Randomized Clinical Trial Comparing Itraconazole and a Combination Therapy with Itraconazole and Potassium Iodide for the Treatment of Feline Sporotrichosis. J Fungi (Basel) 2024; 10:101. [PMID: 38392773 PMCID: PMC10889782 DOI: 10.3390/jof10020101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Feline sporotrichosis is an endemic disease with high occurrence in Brazil. Itraconazole (ITZ) remains the drug of choice for treating this disease in cats, despite the increasing reports of therapeutic failure. A controlled, randomized clinical trial was performed on 166 naive cats with sporotrichosis to assess the effectiveness and safety of the combination therapy with ITZ and potassium iodide (KI) compared with ITZ monotherapy. Cats were randomly allocated into two treatment groups: G1-ITZ 100 mg/cat/day-and G2-ITZ 100 mg/cat/day + KI 2.5-20 mg/kg/day. Cats treated in G2 presented 77% more risk of reaching a clinical cure (a positive effect) than those treated in G1, even when controlled by negative predictors. The survival curves of the two treatment protocols indicate that a clinical cure was achieved faster in G2. An increase in the KI dose was necessary in 28 cats due to the persistence of clinical signs. Adverse reactions were equally frequent in both groups and manageable with a temporary drug suspension and/or a hepatoprotective therapy. The combination therapy was associated with a higher cure rate and a shorter treatment time, suggesting that ITZ+KI arises as a better option for treating feline sporotrichosis and should be considered the first-line treatment, especially in the presence of negative predictors.
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Affiliation(s)
- Erica Guerino Dos Reis
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | | | | | - Marcel de Souza Borges Quintana
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-361, Brazil
| | - Paula Gonçalves Viana
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Anna Barreto Fernandes Figueiredo
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Cindy Caroline Dos Santos Honorato
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Gabriela Reis Pereira-Oliveira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Jéssica Nunes Silva
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Tânia Maria Pacheco Schubach
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
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Magalhães VCR, Colombo SA, Peres NTA, Moura AS, Lyon AC, Lyon S, Dutra MRT, Fereguetti TO, Andrade VA, Azevedo MI, Santos DA. Clinical factors associated with systemic sporotrichosis in Brazil. Mycoses 2024; 67:e13656. [PMID: 37743555 DOI: 10.1111/myc.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Systemic sporotrichosis occurs when organs, other than subcutaneous tissues and lymph nodes, are infected. Interestingly, systemic sporotrichosis in apparently immunocompetent individuals is increasing in Brazil, but data on clinical manifestations and risk factors are scarce. Most of the existing data on such condition relate to people living with HIV. We aimed to study the risk factors associated with systemic sporotrichosis among HIV-negative and HIV-positive patients. METHODS We performed a retrospective cross-sectional study with 80 patients from Brazil, diagnosed between 2014 and 2021. The association between disease classification, clinical presentation and risk factors were analysed by logistic regression. RESULTS Of the 80 patients, 29 (36.3%) presented with systemic sporotrichosis. All HIV-positive patients developed the systemic form, with increased mortality (p = .002). Alcohol ingestion (p = .009) and diabetes (p = .010) were associated with systemic disease. Alcohol ingestion seemed to favour pulmonary infection (p = .013) and, diabetes favoured osteoarticular (p = .009) and ocular involvement (p = .033). The occurrence of fever (p = .001) and weight loss (p = .006) were significantly associated with systemic sporotrichosis, while meningeal involvement (p = .001) increased mortality risk. Nine (11.3%) patients died from sporotrichosis. The presence of fungal structures in the mycological examination of the patients' lesions were associated with the systemic form (p = .017) and death (p = .002). CONCLUSION Our study points to the factors that drive systemic sporotrichosis other than HIV, such as alcohol ingestion and diabetes. Considering the high number of patients presenting severe sporotrichosis, the recognising these factors may contribute to timely diagnosis and proper treatment.
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Affiliation(s)
- Vanessa C R Magalhães
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
| | - Salene A Colombo
- Department of Preventive Veterinary Medicine, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nalu T A Peres
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre S Moura
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
| | - Ana C Lyon
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
| | - Sandra Lyon
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
| | - Maria R T Dutra
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
| | - Tatiani O Fereguetti
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
| | - Virginia A Andrade
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Brazil
| | - Maria I Azevedo
- Department of Preventive Veterinary Medicine, School of Veterinary, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniel A Santos
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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España AG, Pimentel MIF, Lyra JPDM, Valete-Rosalino CM, Lyra MR. Description of the dermatoscopic features observed in sporotrichosis and American cutaneous leishmaniasis in a reference center in Rio de Janeiro, Brazil. An Bras Dermatol 2023; 98:764-773. [PMID: 37481377 PMCID: PMC10589486 DOI: 10.1016/j.abd.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/14/2022] [Accepted: 09/05/2022] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND The evaluation of American cutaneous leishmaniasis (CL) and sporotrichosis (SP) with dermoscopy may improve the diagnosis accuracy and clinical monitoring. OBJECTIVES To describe the dermoscopic findings and patterns of skin lesions of patients with CL and SP followed up at the Laboratory of Clinical Research and Surveillance in Leishmaniasis (LaPClinVigiLeish), Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. METHODS The authors included patients with a diagnosis of CL or SP, who attended at INI/ Fiocruz, between 2019‒2021. All patients had 3 dermoscopic examinations (DermLite DL4): before treatment (T0), during treatment (T1), and after healing (T2). Up to three lesions per patient were evaluated. RESULTS The authors studied 47 patients with CL (74 lesions), and 19 patients with SP (24 lesions). The authors described dermoscopic structures such as rosettes, white lines, white dots, brown focal structureless areas, brown lines and dots, white perilesional circles, perilesional hyperchromic circles, microulcerations and the rainbow patterns. The authors created specific patterns; in CL: CL-T0 "central yellow scales with a white perilesional circle pattern", CL-T1 "diffuse structureless white area pattern" and CL-T2 "white and brown focal structureless areas pattern". In SP: SP-T0 the "pustule with erythema pattern"; SP-T1 the "focal structureless white areas with erythema pattern" and SP-T2 the "white linear pattern". STUDY LIMITATIONS This study does not correlate dermoscopic findings with time of disease evolution at the first medical examination. CONCLUSIONS The recognition of CL and SP dermoscopy patterns may be helpful tool for the differential diagnosis and monitoring of disease evolution.
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Affiliation(s)
- Alejandra Galeano España
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Maria Inês Fernandes Pimentel
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Cláudia Maria Valete-Rosalino
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil; Otolaryngology Department and Ophthalmology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcelo Rosandiski Lyra
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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8
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Izoton CF, de Macedo PM, do Valle AC, Almeida-Paes R, Figueiredo-Carvalho MH, Rabello VB, Martins AC, Freitas DF. Adjunctive methylene blue antimicrobial photodynamic therapy for mucocutaneous lesions of mycoses: three case reports. Future Microbiol 2023; 18:1017-1024. [PMID: 37702055 DOI: 10.2217/fmb-2023-0074] [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: 09/14/2023] Open
Abstract
Dermatophytosis, paracoccidioidomycosis and sporotrichosis are mycoses caused by different fungal species with significant prevalence in Brazil and other countries. In some situations, they affect quality of life, especially in the most vulnerable populations. Antifungal drug therapy is the conventional treatment for these diseases, although some difficulties may occur. Adjunctive use of antimicrobial photodynamic therapy (aPDT) may reduce these challenges. Three patients were treated with aPDT and conventional antifungals. In all cases, the patients did not report pain, discomfort or side effects during or after the aPDT intervention. The adjunctive use of aPDT in the cases presented proved to be a safe, low-cost tool that may be promising for the treatment of different mycoses.
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Affiliation(s)
- Carlos Fg Izoton
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Priscila M de Macedo
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Antonio Cf do Valle
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Maria Hg Figueiredo-Carvalho
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Vanessa Bs Rabello
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Ana Cc Martins
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Dayvison Fs Freitas
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
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Colombo SA, Bicalho GC, de Oliveira CSF, de Magalhães Soares DF, Salvato LA, Keller KM, Bastos CDVE, Morais MHF, Rodrigues AM, Cunha JLR, de Azevedo MI. Emergence of zoonotic sporotrichosis due to Sporothrix brasiliensis in Minas Gerais, Brazil: A molecular approach to the current animal disease. Mycoses 2023; 66:911-922. [PMID: 37452233 DOI: 10.1111/myc.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
Sporotrichosis is a neglected fungal zoonosis with significant impacts on human and animal health. Accurate diagnosis, treatment, and understanding of the transmission dynamics of Sporothrix species are essential for mitigating the spread of sporotrichosis. This study aimed to identify the Sporothrix species involved in the ongoing outbreaks of animal sporotrichosis in the metropolitan region of Belo Horizonte, Minas Gerais, Brazil, and analyse the phylogenetic relationships between pathogenic species to investigate the outbreak origin. Additionally, to better understand the evolution of the disease, we conducted a retrospective survey of positive feline and canine cases from November 2017 to July 2021 with proven cultures for Sporothrix. A significant increase in animal cases over the last 4 years was observed, with cats being the most affected host. Sporothrix brasiliensis was the predominant agent in 100% of the clinical isolates (n = 180) molecularly identified. Phylogenetic and haplotype analysis points towards the cases isolated from Minas Gerais sharing the haplotype originating from a long-lasting outbreak of cat-transmitted sporotrichosis in Rio de Janeiro, however, with a secondary contribution from genotypes circulating in other outbreaks in Brazil. Thus, we present clear evidence of the circulation of different S. brasiliensis genotypes associated with animal sporotrichosis in the metropolitan region of Belo Horizonte. Genetic monitoring can contribute to understanding the causal agent for zoonotic sporotrichosis in epidemiological processes and help to implement disease prevention and control measures.
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Affiliation(s)
- Salene Angelini Colombo
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo Canesso Bicalho
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Lauranne Alves Salvato
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kelly Moura Keller
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Camila de Valgas E Bastos
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Anderson Messias Rodrigues
- Departamento de Microbiologia, Imunologia e Parasitologia, Disciplina de Biologia Celular, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - João Luis Reis Cunha
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Isabel de Azevedo
- Departamento de Medicina Veterinária Preventiva, Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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de Sousa BIC, Ferreira LCF, de Lima MMR, Netto JDSB, Astacio GSM, Bernardes-Engemann AR, de Macedo PM, Gutierrez-Galhardo MC, Freitas DFS. Osteoarticular Sporotrichosis of the Knee Caused by Sporothrix brasiliensis: Two Similar Cases with Different Outcomes. J Fungi (Basel) 2023; 9:956. [PMID: 37888212 PMCID: PMC10607728 DOI: 10.3390/jof9100956] [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: 08/23/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
Sporotrichosis is the most frequent subcutaneous or implantation mycosis in Latin America, and its transmission occurs as a result of traumatic inoculation into the skin by organic matter containing the thermodimorphic fungi of the genus Sporothrix. Although cutaneous forms are more common, another important site is the osteoarticular system, whose hematogenous involvement is commonly associated with disseminated forms, especially in people who have an immunosuppressive condition, such as HIV/AIDS, chronic steroid use, and alcohol abuse. We present two cases of osteoarticular sporotrichosis of the knee caused by Sporothrix brasiliensis and followed up at our institution, with different outcomes. In the cases presented here, aging, anatomical sites, comorbidities, subtherapeutic serum levels, low adherence to treatment, and late diagnosis for different reasons may explain the observed outcomes. Early diagnosis of Sporothrix infection is critical in preventing complications, including death. We also highlight the importance of multidisciplinary follow-up and adherence to treatment for a favorable outcome.
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Affiliation(s)
- Bruno Ivanovinsky Costa de Sousa
- Vice-Direção de Ensino, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Livia Cristina Fonseca Ferreira
- Vice-Direção de Ensino, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Marcella Morgado Ramiro de Lima
- Vice-Direção de Ensino, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Juliana dos Santos Barbosa Netto
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Guis Saint-Martin Astacio
- Serviço de Imagem, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Andréa Reis Bernardes-Engemann
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Priscila Marques de Macedo
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Maria Clara Gutierrez-Galhardo
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Dayvison Francis Saraiva Freitas
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
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11
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Xavier MO, Poester VR, Trápaga MR, Stevens DA. Sporothrix brasiliensis: Epidemiology, Therapy, and Recent Developments. J Fungi (Basel) 2023; 9:921. [PMID: 37755029 PMCID: PMC10532502 DOI: 10.3390/jof9090921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
Sporotrichosis caused by Sporothrix brasiliensis is an emergent mycosis that is now a worldwide concern. One important step to sporotrichosis control is its correct treatment. However, limitations abound; thus, new antifungals, mainly focused on S. brasiliensis, are urgently needed. We performed a systematic review (following the PRISMA guideline) focused on (1) the global distribution of human and animal sporotrichosis by S. brasiliensis, especially outside of Brazil; (2) appraising therapies tested against this pathogen. We identified sporotrichosis caused by S. brasiliensis reported in five countries (Paraguay, Chile, Argentina, the United Kingdom, and the United States) in addition to Brazil, occurring on three continents, highlighting the epidemiological scenario in Argentina with an important increase in reported cases in recent years. Regarding the antifungal activity of drugs, 25 articles described the in vitro action of 20 unique chemicals and eight repurposed drugs against S. brasiliensis. Only five studies reported in vivo activity against S. brasiliensis (five drugs) using invertebrate and vertebrate models. Sporotrichosis caused by S. brasiliensis has a global impact and it is no longer specifically a Brazilian problem. We review the need for understanding the disease epidemiology, education of clinicians and of the populace, organization of health care delivery to respond to a spreading epidemic, and research on therapy for sporotrichosis.
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Affiliation(s)
- 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, RS, Brazil; (M.O.X.); (V.R.P.); (M.R.T.)
- Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil
| | - 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, RS, Brazil; (M.O.X.); (V.R.P.); (M.R.T.)
- Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil
| | - Mariana Rodrigues Trápaga
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil; (M.O.X.); (V.R.P.); (M.R.T.)
- Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA 94305, USA
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Gomes RDSR, do Valle ACF, Freitas DFS, de Macedo PM, Oliveira RDVC, Almeida-Paes R, Zancopé-Oliveira RM, Gutierrez-Galhardo MC. Sporotrichosis in Older Adults: A Cohort Study of 911 Patients from a Hyperendemic Area of Zoonotic Transmission in Rio de Janeiro, Brazil. J Fungi (Basel) 2023; 9:804. [PMID: 37623575 PMCID: PMC10455193 DOI: 10.3390/jof9080804] [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: 06/26/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Generally, older people tend to suffer from more severe infections than younger adults. In addition, there are accumulations of comorbidities and immune senescence in some cases. This cohort study evaluated the clinical and epidemiological characteristics of older adults (≥60 years old) with sporotrichosis. The cohort consisted of 911 patients with a median age of 67 years, most of whom were female (72.6%), white (62.1%), and afflicted with comorbidities (64.5%). The lymphocutaneous form occurred in 62% of the patients, followed by the fixed form (25.7%), cutaneous disseminated form (8.9%), and extracutaneous/disseminated forms (3.3%). In this study, we draw attention to the frequency of osteoarticular involvement (2.1%) secondary to skin lesions such as osteomyelitis and/or tenosynovitis. A clinical cure was achieved in 87.3% of cases. Itraconazole was used in 81.1% of cases, while terbinafine was used in 22.7% of cases, usually in low doses. Survival analysis showed that the median treatment time was 119 days, and the multiple Cox model demonstrated that the presentation of a black coloration and diabetes was associated with a longer treatment time required to establish a cure. Therefore, these subgroups should be monitored more closely to reduce possible difficulties during treatment. It would be interesting to conduct more studies analyzing older adults with sporotrichosis from different geographic areas to better comprehend the disease in this group.
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Affiliation(s)
- Rachel da Silva Ribeiro Gomes
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil
| | - Antonio Carlos Francesconi do Valle
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil
| | - Dayvison Francis Saraiva Freitas
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil
| | - Priscila Marques de Macedo
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil
| | | | - Rodrigo Almeida-Paes
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil
| | - Rosely Maria Zancopé-Oliveira
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil
| | - Maria Clara Gutierrez-Galhardo
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil
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13
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Procópio-Azevedo AC, de Abreu Almeida M, Almeida-Paes R, Zancopé-Oliveira RM, Gutierrez-Galhardo MC, de Macedo PM, Novaes E, Bailão AM, de Almeida Soares CM, Freitas DFS. The State of the Art in Transcriptomics and Proteomics of Clinically Relevant Sporothrix Species. J Fungi (Basel) 2023; 9:790. [PMID: 37623561 PMCID: PMC10455387 DOI: 10.3390/jof9080790] [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: 06/28/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Proteomics provide a robust approach to profile and quantify proteins within cells, organs, or tissues, providing comprehensive insights about the dynamics of cellular processes, modifications, and interactions. Similarly, understanding the transcriptome is essential to decipher functional elements of the genome, unraveling the mechanisms of disease development and the molecular constituents of cells and tissues. Some thermodimorphic fungi of the genus Sporothrix cause sporotrichosis, a subcutaneous mycosis of worldwide relevance. The transcriptome and proteome of the main Sporothrix species of clinical interest can elucidate the mechanisms underlying pathogenesis and host interactions. Studies of these techniques can contribute to the advancement of novel diagnostic and therapeutic strategies. A literature review was carried out, addressing all articles based on proteomics using mass spectrometry and transcriptomics of Sporothrix spp. Twenty-one studies were eligible for this review. The main findings include proteins and genes involved in dimorphism, cell differentiation, thermotolerance, virulence, immune evasion, metabolism, cell adhesion, cell transport, and biosynthesis. With the spread and emergence of sporotrichosis in different countries, ongoing research efforts and new discoveries are welcome to advance knowledge about this mycosis and its agents.
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Affiliation(s)
- Anna Carolina Procópio-Azevedo
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Marcos de Abreu Almeida
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Rosely Maria Zancopé-Oliveira
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Maria Clara Gutierrez-Galhardo
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Priscila Marques de Macedo
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
| | - Evandro Novaes
- Setor de Genética, Departamento de Biologia, Universidade Federal de Lavras, Lavras 37203-202, MG, Brazil
| | - Alexandre Melo Bailão
- Laboratório de Biologia Molecular, Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
| | - Célia Maria de Almeida Soares
- Laboratório de Biologia Molecular, Instituto de Ciências Biológicas, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
| | - Dayvison Francis Saraiva Freitas
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, RJ, Brazil
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Cognialli RCR, Cáceres DH, Bastos FDAGD, Cavassin FB, Lustosa BPR, Vicente VA, Breda GL, Santos-Weiss I, Queiroz-Telles F. Rising Incidence of Sporothrix brasiliensis Infections, Curitiba, Brazil, 2011-2022. Emerg Infect Dis 2023; 29:1330-1339. [PMID: 37347527 PMCID: PMC10310366 DOI: 10.3201/eid2907.230155] [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: 06/23/2023] Open
Abstract
Zoonotic outbreaks of sporotrichosis are increasing in Brazil. We examined and described the emergence of cat-transmitted sporotrichosis (CTS) caused by the fungal pathogen Sporothrix brasiliensis. We calculated incidence and mapped geographic distribution of cases in Curitiba, Brazil, by reviewing medical records from 216 sporotrichosis cases diagnosed during 2011-May 2022. Proven sporotrichosis was established in 84 (39%) patients and probable sporotrichosis in 132 (61%). Incidence increased from 0.3 cases/100,000 outpatient visit-years in 2011 to 21.4 cases/100,000 outpatient visit-years in 2021; of the 216 cases, 58% (n = 126) were diagnosed during 2019-2021. The main clinical form of sporotrichosis was lymphocutaneous (63%), followed by localized cutaneous (24%), ocular (10%), multisite infections (3%), and cutaneous disseminated (<0.5%). Since the first report of CTS in Curitiba in 2011, sporotrichosis has increased substantially, indicating continuous disease transmission. Clinician and public awareness of CTS and efforts to prevent transmission are needed.
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Silva Neto F, Gadelha C, Silva L, Pazos N, Silva A, Silva M, Sousa B, Bernardes Dulgheroff AC, Guerra F, Magalhães da Silveira V, Oliveira M, Lima Neto R. Case Report: Ocular Sporotrichosis-A Seven-Case Series. Am J Trop Med Hyg 2023; 108:1109-1114. [PMID: 37188341 PMCID: PMC10540119 DOI: 10.4269/ajtmh.22-0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/19/2022] [Indexed: 05/17/2023] Open
Abstract
Ocular infections associated with sporotrichosis can present four clinical manifestations: granulomatous conjunctivitis, dacryocystitis, Parinaud oculoglandular syndrome, and bulbar conjunctivitis. The incidence of ocular sporotrichosis related to zoonotic transmission has significantly increased in endemic regions and is a frequently misdiagnosed cause of granulomatous conjuntivitis. Therefore, we present a series of seven cases of eye injury by Sporothrix strains, including clinical forms, therapeutic approaches, and laboratory procedures to alert health professionals who provide care to these patients.
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Affiliation(s)
- Francisco Silva Neto
- Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Brazil
- Department of Infectious, Parasitic and Inflammatory Diseases, Center for Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil
| | - Camila Gadelha
- Undergraduated Course in Medicine, Center for Medical Sciences, Federal University of Paraíba, João Pessoa, Brazil
| | - Larissa Silva
- Post-Graduate Program in Bioactive Synthetic Natural products, Federal University of Paraíba, João Pessoa, Brazil
| | - Natália Pazos
- Post-Graduate Program in Bioactive Synthetic Natural products, Federal University of Paraíba, João Pessoa, Brazil
| | - Alan Silva
- Technical Health School, Federal University of Paraíba, João Pessoa, Brazil
| | - Mayara Silva
- Post-Graduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Brazil
| | - Bruna Sousa
- Post-Graduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Brazil
| | | | - Felipe Guerra
- Post-Graduate Program in Bioactive Synthetic Natural products, Federal University of Paraíba, João Pessoa, Brazil
| | - Vera Magalhães da Silveira
- Department of Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, Brazil
| | - Manoel Oliveira
- Instituto Oswaldo Cruz (IOC/FIOCRUZ), Rio de Janeiro, Brazil
| | - Reginaldo Lima Neto
- Post-Graduate Program in Fungal Biology, Federal University of Pernambuco, Recife, Brazil
- Department of Tropical Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, Brazil
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16
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de Freitas VLT, Rocha FMM, Ribeiro EN, Lindoso JAL, Bittencourt AA, Pivetta DNAG, Benard G, de Freitas-Xavier RS. Seasonality of sporotrichosis in Brazil: A modelled analysis of the epidemic in São Paulo, 2011-2020. Mycoses 2023. [PMID: 37198141 DOI: 10.1111/myc.13594] [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: 03/21/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Sporotrichosis is an endemic subcutaneous mycosis classically caused by the Sporothrix schenckii species complex. Recently, sporotrichosis has emerged in Brazil as a cat-transmitted epidemic caused by a new species, Sporothrix brasiliensis. OBJECTIVES To survey the clinical-epidemiological profile of all sporotrichosis cases diagnosed between 2011 and 2020 at a reference hospital in São Paulo metropolitan area and evaluate the annual distribution of cases in relation to seasonality. METHODS Patients' demographic and clinical-epidemiological data were surveyed. A generalized linear model was fitted to relate the quarterly number of sporotrichosis cases detected between 2015 and 2019 with precipitation and temperature series. Prediction of the number of cases from 2011 to 2014 was attempted based on the fitted model without the trend component that appears from 2015. RESULTS Among 271 suspected cases admitted during 2011-2020, 254 were confirmed by fungal isolation and/or clinical-epidemiological criteria. We observed that 2015 onwards the number of cases regularly increased during Autumn and Winter, the driest and coldest stations of the year. We verified that temperature series affected the number of cases (p = .005) because an increase of 1°C in the temperature series was associated with a 14.24% decrease in the average cases number, with the average number of cases increasing by 10.96% (p < .0001) every quarter, corresponding to an annual increase of 52%. Between 2011 and 2014, the predicted number of sporotrichosis cases averaged 10-12 per year, with 33%-38% occurring in the winter. CONCLUSION We hypothesize that sporotrichosis seasonality is associated with the felines' oestrus cycle, which may provide alternative, cat-directed approaches to the sporotrichosis epidemic control.
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Affiliation(s)
| | | | - Emanoella Nogueira Ribeiro
- Medical Mycology Laboratory (LIM 53/HCFMUSP) and Institute Tropical Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - José Angelo Laulleta Lindoso
- Laboratory of Protozoology (LIM 49/HCFMUSP), Institute of Tropical Medicine, Medical School, University of São Paulo, São Paulo, Brazil
- Emilio Ribas Institute of Infectious Diseases, São Paulo, Brazil
| | | | | | - Gil Benard
- Medical Mycology Laboratory (LIM 53/HCFMUSP) and Institute Tropical Medicine, University of Sao Paulo, Sao Paulo, Brazil
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17
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Gómez-Gaviria M, Martínez-Álvarez JA, Mora-Montes HM. Current Progress in Sporothrix brasiliensis Basic Aspects. J Fungi (Basel) 2023; 9:jof9050533. [PMID: 37233242 DOI: 10.3390/jof9050533] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
Sporotrichosis is known as a subacute or chronic infection, which is caused by thermodimorphic fungi of the genus Sporothrix. It is a cosmopolitan infection, which is more prevalent in tropical and subtropical regions and can affect both humans and other mammals. The main etiological agents causing this disease are Sporothrix schenckii, Sporothrix brasiliensis, and Sporothrix globosa, which have been recognized as members of the Sporothrix pathogenic clade. Within this clade, S. brasiliensis is considered the most virulent species and represents an important pathogen due to its distribution and prevalence in different regions of South America, such as Brazil, Argentina, Chile, and Paraguay, and Central American countries, such as Panama. In Brazil, S. brasiliensis has been of great concern due to the number of zoonotic cases that have been reported over the years. In this paper, a detailed review of the current literature on this pathogen and its different aspects will be carried out, including its genome, pathogen-host interaction, resistance mechanisms to antifungal drugs, and the caused zoonosis. Furthermore, we provide the prediction of some putative virulence factors encoded by the genome of this fungal species.
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Affiliation(s)
- Manuela Gómez-Gaviria
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, Guanajuato 36050, Mexico
| | - José A Martínez-Álvarez
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, Guanajuato 36050, Mexico
| | - Héctor M Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, Guanajuato 36050, Mexico
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García-Carnero LC, Martínez-Duncker I, Gómez-Gaviria M, Mora-Montes HM. Differential Recognition of Clinically Relevant Sporothrix Species by Human Mononuclear Cells. J Fungi (Basel) 2023; 9:jof9040448. [PMID: 37108903 PMCID: PMC10146672 DOI: 10.3390/jof9040448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Sporotrichosis is a human and animal fungal infection distributed worldwide that is caused by the thermodimorphic species of the Sporothrix pathogenic clade, which includes Sporothrix brasiliensis, Sporothrix schenckii, and Sporothrix globosa. The cell wall composition and the immune response against the Sporothrix species have been studied mainly in S. brasiliensis and S. schenckii, whilst little is known about the S. globosa cell wall and the immune response that its components trigger. Therefore, in this study, we aimed to analyze the cell wall composition of S. globosa in three morphologies (germlings, conidia, and yeast-like cells) and the differences in cytokine production when human peripheral blood mononuclear cells (PBMCs) interact with these morphotypes, using S. schenckii and S. brasiliensis as a comparison. We found that S. globosa conidia and yeast-like cells have a higher cell wall chitin content, while all three morphologies have a higher β-1,3-glucan content, which was found most exposed at the cell surface when compared to S. schenckii and S. brasiliensis. In addition, S. globosa has lower levels of mannose- and rhamnose-based glycoconjugates, as well as of N- and O-linked glycans, indicating that this fungal cell wall has species-specific proportions and organization of its components. When interacting with PBMCs, S. brasiliensis and S. globosa showed a similar cytokine stimulation profile, but with a higher stimulation of IL-10 by S. globosa. Additionally, when the inner cell wall components of S. globosa were exposed at the surface or N- and O-glycans were removed, the cytokine production profile of this species in its three morphotypes did not significantly change, contrasting with the S. schenckii and S. brasiliensis species that showed different cytokine profiles depending on the treatment applied to the walls. In addition, it was found that the anti-inflammatory response stimulated by S. globosa was dependent on the activation of dectin-1, mannose receptor, and TLR2, but not TLR4. All of these results indicate that the cell wall composition and structure of the three Sporothrix species in the three morphologies are different, affecting their interaction with human PBMCs and generating species-specific cytokine profiles.
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Affiliation(s)
- Laura C García-Carnero
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Gto., Mexico
| | - Iván Martínez-Duncker
- Laboratorio de Glicobiología Humana y Diagnóstico Molecular, Centro de Investigación en Dinámica Celular, Instituto de Investigación en Ciencias Básicas y Aplicadas, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mor., Mexico
| | - Manuela Gómez-Gaviria
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Gto., Mexico
| | - Héctor M Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Gto., Mexico
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Izoton CFG, de Brito Sousa AX, Valete CM, Schubach ADO, Procópio-Azevedo AC, Zancopé-Oliveira RM, de Macedo PM, Gutierrez-Galhardo MC, Castro-Alves J, Almeida-Paes R, Martins ACDC, Freitas DFS. Sporotrichosis in the nasal mucosa: A single-center retrospective study of 37 cases from 1998 to 2020. PLoS Negl Trop Dis 2023; 17:e0011212. [PMID: 36972287 PMCID: PMC10079221 DOI: 10.1371/journal.pntd.0011212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/06/2023] [Accepted: 03/02/2023] [Indexed: 03/29/2023] Open
Abstract
Background
Sporotrichosis is a subcutaneous or implantation mycosis caused by some species of the genus Sporothrix. Rio de Janeiro state, Brazil, experiences hyperendemic levels of zoonotic sporotrichosis, with increasing cases of disseminated disease, especially in people living with HIV (PLHIV). Involvement of the nasal mucosa is rare and occurs isolated or in disseminated cases, with a delayed resolution.
Methodology/Principal findings
This study aimed to describe the epidemiological, clinical, and therapeutic profiles of 37 cases of sporotrichosis with involvement of the nasal mucosa treated at the ear, nose, and throat (ENT) outpatient clinic of the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, from 1998 to 2020. Data were reviewed from the medical records and stored in a database. The Mann–Whitney test was used to compare the means of quantitative variables, and Pearson chi-square and Fisher’s exact tests were used to verify the association between qualitative variables (p<0.05). Most patients were males, students or retirees, with a median age of 38 years, residents in the municipality of Rio de Janeiro, and infected through zoonotic transmission. Disseminated sporotrichosis forms in patients with comorbidities (mostly PLHIV) were more common than the isolated involvement of the mucosa. The main characteristics of lesions in the nasal mucosa were the presence/elimination of crusts, involvement of various structures, mixed appearance, and severe intensity. Due to therapeutic difficulty, itraconazole was combined with amphotericin B and/or terbinafine in most cases. Of the 37 patients, 24 (64.9%) healed, with a median of 61 weeks of treatment, 9 lost follow-up, 2 were still treating and 2 died.
Conclusions
Immunosuppression was determinant to the outcome, with worse prognosis and lower probability of cure. Notably in this group, the systematization of the ENT examination for early identification of lesions is recommended to optimize the treatment and outcome of the disease.
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Affiliation(s)
| | - Antonio Xavier de Brito Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Instituto de Educação Médica, Rio de Janeiro, Brazil
| | - Cláudia Maria Valete
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Julio Castro-Alves
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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20
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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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Severe Sporotrichosis Caused by Sporothrix brasiliensis: Antifungal Susceptibility and Clinical Outcomes. J Fungi (Basel) 2022; 9:jof9010049. [PMID: 36675870 PMCID: PMC9864959 DOI: 10.3390/jof9010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
Itraconazole is the first choice for treating sporotrichosis. Amphotericin B is indicated for severe and disseminated forms. The aim of the study was to evaluate the antifungal susceptibility of Sporothrix brasiliensis strains isolated from patients with severe sporotrichosis treated with amphotericin B and correlate with clinical outcomes. Clinical and epidemiological data were obtained from severe sporotrichosis cases caused by S. brasiliensis. Antifungal susceptibility tests against amphotericin B, itraconazole, terbinafine, posaconazole, and 5-flucytosine were performed. Moreover, possible synergisms between amphotericin B and posaconazole or 5-flucytosine were assessed. Relationships between clinical and laboratorial data were then analyzed. Forty-six S. brasiliensis isolates from 37 patients were studied. Clinical forms included disseminated (94.6%) and disseminated cutaneous sporotrichosis (5.4%). The median treatment time was 784 days (range: 7 to 3115 days). Cure occurred in 45.9% of the cases and death due to sporotrichosis in 24.3%. Forty-three (93.5%) S. brasiliensis isolates were classified as wild-type for all the antifungals tested according to their in vitro antifungal susceptibility. There was no synergism for the combinations studied. Finally, we found no association between higher Minimal Inhibitory Concentration (MIC) values of amphotericin B or itraconazole with unfavorable outcomes; however, there were higher MIC values of itraconazole in strains isolated from alcoholic patients. Possibly, clinical factors, such as the extent of dissemination, immunosuppression, and late treatment onset, are the main determinants of patient outcomes, rather than antifungal resistance. The current study suggests that the need to use amphotericin B therapy is not associated with the emergence of S. brasiliensis resistant strains.
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22
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Lima MA, Freitas DFS, Oliveira RVC, Fichman V, Varon AG, Freitas AD, Lamas CC, Andrade HB, Veloso VG, Almeida-Paes R, Almeida-Silva F, Zancopé-Oliveira RM, de Macedo PM, Valle ACF, Silva MTT, Araújo AQC, Gutierrez-Galhardo MC. Meningeal Sporotrichosis Due to Sporothrix brasiliensis: A 21-Year Cohort Study from a Brazilian Reference Center. J Fungi (Basel) 2022; 9:17. [PMID: 36675837 PMCID: PMC9863964 DOI: 10.3390/jof9010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Meningeal sporotrichosis is rare and occurs predominantly in immunosuppressed individuals. This retrospective study explored clinical and laboratory characteristics, treatment, and prognosis of patients with disseminated sporotrichosis who underwent lumbar puncture (LP) at a Brazilian reference center from 1999 to 2020. Kaplan-Meier and Cox regression models were used to estimate overall survival and hazard ratios. Among 57 enrolled patients, 17 had meningitis. Fifteen (88.2%) had HIV infection, and in 6 of them, neurological manifestations occurred because of the immune reconstitution inflammatory syndrome (IRIS). The most frequent symptom was headache (88.2%). Meningeal symptoms at first LP were absent in 7/17 (41.2%) patients. Sporothrix was diagnosed in cerebrospinal fluid either by culture or by polymerase chain reaction in seven and four patients, respectively. All but one patient received prolonged courses of amphotericin B formulations, and seven received posaconazole, but relapses were frequent. Lethality among patients with meningitis was 64.7%, with a higher chance of death compared to those without meningitis (HR = 3.87; IC95% = 1.23;12.17). Meningeal sporotrichosis occurs mostly in people with HIV and can be associated with IRIS. Screening LP is indicated in patients with disseminated disease despite the absence of neurological complaints. Meningitis is associated with poor prognosis, and better treatment strategies are needed.
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Affiliation(s)
- Marco A. Lima
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
- Neurology Section, Hospital Universitário Clementino Fraga Filho, The Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | - Dayvison F. S. Freitas
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Raquel V. C. Oliveira
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Vivian Fichman
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Andréa G. Varon
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Andréa D. Freitas
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Cristiane C. Lamas
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Hugo B. Andrade
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Valdilea G. Veloso
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Rodrigo Almeida-Paes
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Fernando Almeida-Silva
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Rosely Maria Zancopé-Oliveira
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Priscila M. de Macedo
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Antonio C. F. Valle
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Marcus T. T. Silva
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
| | - Abelardo Q. C. Araújo
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
- Deolindo Couto Institute of Neurology (INDC), The Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 22290-140, Brazil
| | - Maria C. Gutierrez-Galhardo
- Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Rio de Janeiro 21040-900, Brazil
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Alvarez CM, Oliveira MME, Pires RH. Sporotrichosis: A Review of a Neglected Disease in the Last 50 Years in Brazil. Microorganisms 2022; 10:2152. [PMID: 36363744 PMCID: PMC9695284 DOI: 10.3390/microorganisms10112152] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 08/15/2023] Open
Abstract
Sporotrichosis is caused by fungi belonging to the genus Sporothrix, which saprophytically are found in plants and organic matter. However, cats are highly susceptible to contamination with fungal spores and, when they become sick, they can transmit it to other animals and to man. The objective of this study is to carry out a systematic review on the emergency, diagnosis, clinical symptoms, therapeutics, and control of zoonotic sporotrichosis. Published data covering the last 50 years using a combination of keywords were selected to answer the question: Why has the zoonotic sporotrichosis been a neglected disease up to now? A total of 135 studies were included in this review. The studies emphasize that in recent decades, Brazil has experienced an unprecedented zoonotic outbreak of sporotrichosis. Advances on the genus Sporothrix allowed one to associate thermotolerance, capacity for melanin synthesis, potential for adhesion to tissue macromolecules, ergosterol peroxide production, and expression of virulence proteins as tools for infection and invasion in S. brasiliensis, the main species involved, although cases with S. schenckii or S. lurei were also reported. Correct diagnosis, early treatment, basic educational measures that emphasize responsible ownership of animals and reproductive control programs for felines can contribute to the control of zoonosis.
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Affiliation(s)
- Carmen Magaly Alvarez
- Laboratory of Mycology and Environmental Diagnosis, Postgraduate Program in Health Promotion, University of Franca, Franca 14404-600, SP, Brazil
- Faculty of Veterinary Medicine, Universidad Agraria del Ecuador, Guayaquil 090104, Ecuador
| | | | - Regina Helena Pires
- Laboratory of Mycology and Environmental Diagnosis, Postgraduate Program in Health Promotion, University of Franca, Franca 14404-600, SP, Brazil
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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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Rodrigues AM, Gonçalves SS, de Carvalho JA, Borba-Santos LP, Rozental S, de Camargo ZP. Current Progress on Epidemiology, Diagnosis, and Treatment of Sporotrichosis and Their Future Trends. J Fungi (Basel) 2022; 8:jof8080776. [PMID: 35893145 PMCID: PMC9331723 DOI: 10.3390/jof8080776] [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: 06/29/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 01/19/2023] Open
Abstract
Sporotrichosis, a human and animal disease caused by Sporothrix species, is the most important implantation mycosis worldwide. Sporothrix taxonomy has improved in recent years, allowing important advances in diagnosis, epidemiology, and treatment. Molecular epidemiology reveals that S. brasiliensis remains highly prevalent during the cat-transmitted sporotrichosis outbreaks in South America and that the spread of S. brasiliensis occurs through founder effects. Sporothrix globosa and S. schenckii are cosmopolitan on the move, causing major sapronoses in Asia and the Americas, respectively. In this emerging scenario, one-health approaches are required to develop a creative, effective, and sustainable response to tackle the spread of sporotrichosis. In the 21st century, it has become vital to speciate Sporothrix, and PCR is the main pillar of molecular diagnosis, aiming at the detection of the pathogen DNA from clinical samples through multiplex assays, whose sensitivity reaches remarkably three copies of the target. The treatment of sporotrichosis can be challenging, especially after the emergence of resistance to azoles and polyenes. Alternative drugs arising from discoveries or repositioning have entered the radar of basic research over the last decade and point to several molecules with antifungal potential, especially the hydrazone derivatives with great in vitro and in vivo activities. There are many promising developments for the near future, and in this review, we discuss how these trends can be applied to the Sporothrix-sporotrichosis system to mitigate the advance of an emerging and re-emerging disease.
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Affiliation(s)
- Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), Sao Paulo 04023062, Brazil; (J.A.d.C.); (Z.P.d.C.)
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), Sao Paulo 04023062, Brazil
- Correspondence: ; Tel.: +55-1155764551 (ext. 1540)
| | - Sarah Santos Gonçalves
- Infectious Diseases Postgraduate Program, Center for Research in Medical Mycology, Federal University of Espírito Santo (UFES), Vitoria 29043900, Brazil;
| | - Jamile Ambrósio de Carvalho
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), Sao Paulo 04023062, Brazil; (J.A.d.C.); (Z.P.d.C.)
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), Sao Paulo 04023062, Brazil
| | - Luana P. Borba-Santos
- Cell Biology and Parasitology Program, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941902, Brazil; (L.P.B.-S.); (S.R.)
| | - Sonia Rozental
- Cell Biology and Parasitology Program, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941902, Brazil; (L.P.B.-S.); (S.R.)
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), Sao Paulo 04023062, Brazil; (J.A.d.C.); (Z.P.d.C.)
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), Sao Paulo 04023062, Brazil
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Veríssimo I, Cupolillo G, Jorge BMDS, Novaes RLM, Tavares JA, Gabriel MM, Costa-Neto SF, do Couto ALG, Schmidt E, Miranda A, de Andreazzi CS, Moratelli R. Medium- and large-sized mammals from Estação Biológica Fiocruz Mata Atlântica, Rio de Janeiro, south-eastern Brazil. Biodivers Data J 2022; 10:e86756. [PMID: 36761537 PMCID: PMC9848567 DOI: 10.3897/bdj.10.e86756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022] Open
Abstract
The Pedra Branca Forest is in a highly urbanised region of the central portion of Rio de Janeiro City and comprises the largest urban forest in the world (> 12,000 ha). The local flora and fauna are protected by three conservation units and the Estação Biológica Fiocruz Mata Atlântica (EFMA), which comprises 462 hectares on the east side of the remnant. The local biodiversity is still little known compared to other Atlantic Forest remnants from the Rio de Janeiro State. Here, we provide results of a survey of medium- and large-sized terrestrial mammals from the EFMA. In addition, we analysed the distribution of this fauna along three habitat types defined as Peridomicile, Transitional Forest and Forest Core. Sampling was performed from 2017 to 2020 and comprised a camera-trap survey, interviews with residents and local workers and occasional records. Results include occurrence records for 16 autochthonous and one allochthonous (Callithrix sp.) wild mammals, which are distributed into 14 families and seven orders, in addition to the presence of free-ranging domestic dogs and cats. Four species are in some category of threat of extinction at national or global levels. Amongst them, Leontopithecusrosalia (first record for the Rio de Janeiro City in more than a century) and Leopardusguttulus are classified as Vulnerable by IUCN. Most wild native species were registered in the three habitat types, but with differences in the frequency of records. Our results indicate that the presence of domestic dogs and cats influenced the species composition in each area, with Nasuanasua, Dasyproctaleporina and Didelphisaurita less frequent in places where domestic dogs and cats are more frequent. This is the first systematic effort to understand the occurrence and distribution of mid- and large-sized mammals in the Pedra Branca Forest.
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Affiliation(s)
- Iuri Veríssimo
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Gabriel Cupolillo
- Programa de Pós-Graduação em Ecologia, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilPrograma de Pós-Graduação em Ecologia, Instituto de Biologia, Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
| | - Beatriz Maria da Silva Jorge
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
- Programa de Pós-graduação em Biodiversidade e saúde, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilPrograma de Pós-graduação em Biodiversidade e saúde, Instituto Oswaldo Cruz, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Roberto Leonan Morim Novaes
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Jonatas Amorim Tavares
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
- Programa de Pós-graduação em Biodiversidade e saúde, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilPrograma de Pós-graduação em Biodiversidade e saúde, Instituto Oswaldo Cruz, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Monique Medeiros Gabriel
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Sócrates Fraga Costa-Neto
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
- Laboratório de Biologia e Parasitologia de Mamíferos Silvestres Reservatórios, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilLaboratório de Biologia e Parasitologia de Mamíferos Silvestres Reservatórios, Instituto Oswaldo Cruz, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Ademar Luiz Gomes do Couto
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Ellen Schmidt
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Amarildo Miranda
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Cecilia Siliansky de Andreazzi
- Laboratório de Biologia e Parasitologia de Mamíferos Silvestres Reservatórios, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilLaboratório de Biologia e Parasitologia de Mamíferos Silvestres Reservatórios, Instituto Oswaldo Cruz, Fundação Oswaldo CruzRio de JaneiroBrazil
- Centro de Ecología Funcional, Universidade de Coimbra, Coimbra, PortugalCentro de Ecología Funcional, Universidade de CoimbraCoimbraPortugal
| | - Ricardo Moratelli
- Fiocruz Mata Atlântica, Fundação Oswaldo Cruz, Rio de Janeiro, BrazilFiocruz Mata Atlântica, Fundação Oswaldo CruzRio de JaneiroBrazil
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Sporothrix brasiliensis and Feline Sporotrichosis in the Metropolitan Region of Rio de Janeiro, Brazil (1998–2018). J Fungi (Basel) 2022; 8:jof8070749. [PMID: 35887504 PMCID: PMC9325134 DOI: 10.3390/jof8070749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Feline sporotrichosis is enzootic in different regions of Brazil, especially in Rio de Janeiro. This study compared the genotype profiles of Sporothrix sp. isolated from cats in Rio de Janeiro between 1998 and 2018 and evaluated their association with clinical and epidemiological characteristics. One hundred nineteen Sporothrix sp. isolates from a cohort of cats with sporotrichosis seen at INI/Fiocruz were included. Clinical and epidemiological data were obtained from the medical records of the animals. T3B PCR fingerprinting was used for molecular identification of the Sporothrix species. All isolates were characterized as Sporothrix brasiliensis, with the observation of low intraspecific variation in 31 isolates (31.3%). The interval between lesion onset and first medical visit at INI/Fiocruz, as well as treatment duration until clinical cure, was longer in cats from the first decade of the epizootic. In addition, the frequency of the variables “good general status” and “presence of lymphadenomegaly” was higher among cats whose strains did not exhibit intraspecific variation. So far, S. brasiliensis has been the only species identified in feline cases of sporotrichosis since the beginning of the epizootic in Rio de Janeiro at INI/Fiocruz.
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Gremião IDF, Miranda LHMD, Pereira-Oliveira GR, Menezes RC, Machado ACDS, Rodrigues AM, Pereira SA. Advances and challenges in the management of feline sporotrichosis. Rev Iberoam Micol 2022; 39:61-67. [PMID: 35840526 DOI: 10.1016/j.riam.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/12/2022] Open
Abstract
The domestic cat is the most susceptible host to Sporothrix infection, developing severe clinical forms. Few effective antifungal agents are available for treating feline sporotrichosis, and cases of treatment failure are common. Treatment success depends on cat health status, therapy-related factors, as well as social/economic issues, but it is mainly contingent upon the host-fungus interaction. The owner's adherence is critical and should be reinforced throughout the treatment to increase the chances of a successful outcome. The antifungal agents described for feline sporotrichosis are most often used in monotherapy regimens. Due to cases in which the treatment with itraconazole failed, the use of antifungal agents in combination should be considered to achieve synergy. The combination of itraconazole and potassium iodide represents an important option for the treatment of naïve cats presenting multiple cutaneous lesions, nasal mucosal lesions and/or respiratory signs, as well as for refractory cases. However, the therapeutic options for unsuccessfully treated cases are scarce. Therefore new options are needed, even more taking into account that there are many in vitro potential molecules not available for use in cats yet. More studies are necessary to correlate in vitro antifungal susceptibility tests results and the outcome of cats treated due to sporotrichosis. This review will briefly discuss both the antifungal drugs and treatment protocols used in cats with sporotrichosis, as well as the determinants of treatment failure.
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Affiliation(s)
- Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.
| | | | - Gabriela Reis Pereira-Oliveira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Rodrigo Caldas Menezes
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Ana Caroline de Sá Machado
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | | | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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A neglected disease. Human sporotrichosis in a densely populated urban area in São Paulo, Brazil: clinical-epidemiological and therapeutic aspects. Braz J Microbiol 2022; 53:739-748. [PMID: 35301695 PMCID: PMC9151930 DOI: 10.1007/s42770-022-00713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/13/2022] [Indexed: 02/07/2023] Open
Abstract
Human sporotrichosis is caused by different Sporothrix species; however, Sporothrix brasiliensis is the main species, usually related to cat transmission in urban areas. A retrospective descriptive study was conducted at the Institute of Infectology Emílio Ribas from 2010 to 2018. Demography, clinical, diagnostic, and therapeutic data were obtained from medical records. Polymerase chain reaction of the calmodulin gene was performed to identify Sporothrix species. In addition, to evaluate the spread of the disease across São Paulo metropolitan region, TerraView version 4.2.2 software was used for geocoding cases according to residence addresses. Kernell's maps using QGIS software version 2.16.3 were constructed to determine the concentration of cases. Results: 260 cases of sporotrichosis were diagnosed between 2010 and 2018. We observed a 700% increment in the number of human cases in the 2016-2018 triennium compared with the 2013-2015 triennium. Female adults with a median age of 46 years old were the predominant infected group associated with cats' exposition at home care, although the age range of all patients was 01 to 86 years old. The main epidemiological risk of acquiring sporotrichosis was contact with cats, reported by 96.5% of the patients. Molecular identification showed that most of the tested isolates were Sporothrix brasiliensis. Lymphocutaneous form was observed in 59.2% and fixed cutaneous form in 37.5% of the patients. Regarding treatment, itraconazole was the main drug used (94.2%) with a cure rate of 98.8%. We observed an important spread of human sporotrichosis involving cat transmission caused by Sporothrix brasiliensis in a densely populated area of São Paulo state. These results are important to alert clinicians and dermatologists about the occurrence and progression of a neglected tropical disease in an urban area and the urgent necessity to include sporotrichosis as a differential diagnosis in the clinical investigation routine.
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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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Fichman V, Mota-Damasceno CG, Procópio-Azevedo AC, Almeida-Silva F, de Macedo PM, Medeiros DM, Astacio GSM, Zancopé-Oliveira RM, Almeida-Paes R, Freitas DFS, Gutierrez-Galhardo MC. Pulmonary Sporotrichosis Caused by Sporothrix brasiliensis: A 22-Year, Single-Center, Retrospective Cohort Study. J Fungi (Basel) 2022; 8:jof8050536. [PMID: 35628791 PMCID: PMC9142940 DOI: 10.3390/jof8050536] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 02/07/2023] Open
Abstract
Pulmonary sporotrichosis is a rare condition. It can present as a primary pulmonary disease, resulting from direct Sporothrix species (spp). conidia inhalation, or as part of multifocal sporotrichosis with multiple organ involvement, mainly in immunocompromised patients. This study aimed to describe the sociodemographic and epidemiological characteristics and clinical course of patients with positive cultures for Sporothrix spp. from pulmonary specimens (sputum and/or bronchoalveolar lavage) at a reference center in an area hyperendemic for zoonotic sporotrichosis. The clinical records of these patients were reviewed. Fourteen patients were included, and Sporothrix brasiliensis was identified in all cases. Disseminated sporotrichosis was the clinical presentation in 92.9% of cases, and primary pulmonary sporotrichosis accounted for 7.1%. Comorbidities included human immunodeficiency virus infection (78.6%), alcoholism (71.4%), and chronic obstructive pulmonary disease (14.3%). Treatment with amphotericin B followed by itraconazole was the preferred regimen and was prescribed in 92.9% of cases. Sporotrichosis-related death occurred in 42.9% while 35.7% of patients were cured. In five cases there was a probable contamination from upper airway lesions. Despite the significant increase in sporotrichosis cases, pulmonary sporotrichosis remains rare. The treatment of disseminated sporotrichosis is typically difficult. Prompt diagnosis and identification of all affected organs are crucial for better prognosis.
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Affiliation(s)
- Vivian Fichman
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil; (V.F.); (C.G.M.-D.); (P.M.d.M.); (M.C.G.-G.)
| | - Caroline Graça Mota-Damasceno
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil; (V.F.); (C.G.M.-D.); (P.M.d.M.); (M.C.G.-G.)
| | - Anna Carolina Procópio-Azevedo
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz. Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil; (A.C.P.-A.); (F.A.-S.); (R.M.Z.-O.); (R.A.-P.)
| | - Fernando Almeida-Silva
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz. Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil; (A.C.P.-A.); (F.A.-S.); (R.M.Z.-O.); (R.A.-P.)
| | - Priscila Marques de Macedo
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil; (V.F.); (C.G.M.-D.); (P.M.d.M.); (M.C.G.-G.)
| | - Denise Machado Medeiros
- Medical Service, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil;
| | - Guis Saint-Martin Astacio
- Image Service, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil;
| | - Rosely Maria Zancopé-Oliveira
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz. Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil; (A.C.P.-A.); (F.A.-S.); (R.M.Z.-O.); (R.A.-P.)
| | - Rodrigo Almeida-Paes
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz. Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil; (A.C.P.-A.); (F.A.-S.); (R.M.Z.-O.); (R.A.-P.)
| | - Dayvison Francis Saraiva Freitas
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-360, RJ, Brazil; (V.F.); (C.G.M.-D.); (P.M.d.M.); (M.C.G.-G.)
- Correspondence:
| | - 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 21040-360, RJ, Brazil; (V.F.); (C.G.M.-D.); (P.M.d.M.); (M.C.G.-G.)
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Fichman V, Freitas DFS, do Valle ACF, de Souza RV, Curi ALL, Valete-Rosalino CM, de Macedo PM, Varon AG, Figueiredo-Carvalho MHG, Almeida-Silva F, Zancopé-Oliveira RM, Oliveira RDVC, Almeida-Paes R, Gutierrez-Galhardo MC. Severe Sporotrichosis Treated with Amphotericin B: A 20-Year Cohort Study in an Endemic Area of Zoonotic Transmission. J Fungi (Basel) 2022; 8:jof8050469. [PMID: 35628725 PMCID: PMC9144044 DOI: 10.3390/jof8050469] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022] Open
Abstract
Although rare, disseminated sporotrichosis is increasing in several countries. Despite its limiting toxic potential, amphotericin B is the only intravenous antifungal available to treat severe sporotrichosis. We aimed to describe the effectiveness and safety of amphotericin B treatment for severe sporotrichosis. Clinical records of patients with disseminated sporotrichosis at a reference center were reviewed. This study included 73 patients. Most (53.4%) were men and non-white. HIV coinfection was the main comorbidity (52.1%). Most reported contact with cats (76.7%). Sporothrix brasiliensis was the causative species. Affected sites were skin (98.6%), osteoarticular system (64.4%), upper airway (42.5%), central nervous system (20.5%), eyes (12.3%), and lungs (8.2%). Median doses of amphotericin B used were 750 mg and 4500 mg for deoxycholate and lipid complex formulations, respectively. Amphotericin B discontinuation occurred in 20.5% due to adverse events, mainly azotemia. The outcomes included cure (52.1%), death due to sporotrichosis (21.9%), death due to other causes (9.6%), and loss to follow-up (8.2%). Survival analysis showed an association between cure and the absence of bone, upper airway, and central nervous system involvement. Amphotericin B is the first-choice treatment for disseminated sporotrichosis; however, the severity of systemic dissemination might predict its response. Favorable clinical results depend on prompt diagnosis, investigation of fungal dissemination, and early therapy initiation.
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Affiliation(s)
- Vivian Fichman
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Fiocruz. Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil; (V.F.); (D.F.S.F.); (A.C.F.d.V.); (P.M.d.M.)
| | - Dayvison Francis Saraiva Freitas
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Fiocruz. Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil; (V.F.); (D.F.S.F.); (A.C.F.d.V.); (P.M.d.M.)
| | - Antonio Carlos Francesconi do Valle
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Fiocruz. Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil; (V.F.); (D.F.S.F.); (A.C.F.d.V.); (P.M.d.M.)
| | - Rogerio Valls de Souza
- Medical Service, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (R.V.d.S.); (A.G.V.)
| | - André Luiz Land Curi
- Laboratory of Clinical Research in Infectious Ophthalmology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil;
| | - Cláudia Maria Valete-Rosalino
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil;
| | - Priscila Marques de Macedo
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Fiocruz. Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil; (V.F.); (D.F.S.F.); (A.C.F.d.V.); (P.M.d.M.)
| | - Andréa Gina Varon
- Medical Service, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (R.V.d.S.); (A.G.V.)
| | - Maria Helena Galdino Figueiredo-Carvalho
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (M.H.G.F.-C.); (F.A.-S.); (R.M.Z.-O.); (R.A.-P.)
| | - Fernando Almeida-Silva
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (M.H.G.F.-C.); (F.A.-S.); (R.M.Z.-O.); (R.A.-P.)
| | - Rosely Maria Zancopé-Oliveira
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (M.H.G.F.-C.); (F.A.-S.); (R.M.Z.-O.); (R.A.-P.)
| | | | - Rodrigo Almeida-Paes
- Laboratory of Mycology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (M.H.G.F.-C.); (F.A.-S.); (R.M.Z.-O.); (R.A.-P.)
| | - Maria Clara Gutierrez-Galhardo
- Laboratory of Clinical Research in Infectious Dermatology, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Fiocruz. Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil; (V.F.); (D.F.S.F.); (A.C.F.d.V.); (P.M.d.M.)
- Correspondence: ; Tel.: +55-21-3865-9578
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Falcão EMM, Romão AR, Magalhães MDAFM, de Lima Filho JB, do Valle ACF, Bastos FI, Gutierrez-Galhardo MC, Freitas DFS. A Spatial Analysis of the Spread of Hyperendemic Sporotrichosis in the State of Rio de Janeiro, Brazil. J Fungi (Basel) 2022; 8:jof8050434. [PMID: 35628690 PMCID: PMC9145434 DOI: 10.3390/jof8050434] [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: 03/30/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 02/01/2023] Open
Abstract
Sporotrichosis is a subacute/chronic subcutaneous mycosis. Since the late 1990s, there has been a hyperendemic zoonotic transmission in the state of Rio de Janeiro, involving Sporothrix brasiliensis, the most virulent causative species, and a “belt” was described along the limits between the capital and its outskirts (“Baixada Fluminense”). This study analyzes the distribution of sporotrichosis using secondary data from the Notifiable Diseases Information System (Sinan) of the Rio de Janeiro State Health Department (SES/RJ) from 2011 to 2015 and from the INI Electronic Patient Record System (Sipec) from 2008 to 2015. Cases diagnosed since the onset of the hyperendemic exceed all previously reported case series of the disease and there is a progressive expansion in the state of Rio de Janeiro. The study suggests the spread of the mycosis to all regions of the state and the expansion of the previously described “belt”, despite public health measures and changes in its profile over the years, with great social impact.
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Affiliation(s)
- Eduardo Mastrangelo Marinho Falcão
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-90, RJ, Brazil;
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-90, RJ, Brazil; (J.B.d.L.F.); (A.C.F.d.V.); (M.C.G.-G.)
- Correspondence:
| | - Anselmo Rocha Romão
- Instituto de Comunicação e Informação Científica e Tecnologia em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro 21040-90, RJ, Brazil; (A.R.R.); (M.d.A.F.M.M.); (F.I.B.)
| | | | - José Berilo de Lima Filho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-90, RJ, Brazil; (J.B.d.L.F.); (A.C.F.d.V.); (M.C.G.-G.)
| | - Antonio Carlos Francesconi do Valle
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-90, RJ, Brazil; (J.B.d.L.F.); (A.C.F.d.V.); (M.C.G.-G.)
| | - Francisco Inácio Bastos
- Instituto de Comunicação e Informação Científica e Tecnologia em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro 21040-90, RJ, Brazil; (A.R.R.); (M.d.A.F.M.M.); (F.I.B.)
| | - Maria Clara Gutierrez-Galhardo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-90, RJ, Brazil; (J.B.d.L.F.); (A.C.F.d.V.); (M.C.G.-G.)
| | - Dayvison Francis Saraiva Freitas
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-90, RJ, Brazil;
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-90, RJ, Brazil; (J.B.d.L.F.); (A.C.F.d.V.); (M.C.G.-G.)
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Maubon D, Garnaud C, Ramarozatovo LS, Fahafahantsoa RR, Cornet M, Rasamoelina T. Molecular Diagnosis of Two Major Implantation Mycoses: Chromoblastomycosis and Sporotrichosis. J Fungi (Basel) 2022; 8:jof8040382. [PMID: 35448613 PMCID: PMC9027143 DOI: 10.3390/jof8040382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Chromoblastomycosis and sporotrichosis are the two main implantation mycoses that are now recognized as fungal neglected tropical diseases (NTDs). Their laboratory diagnosis mainly relies on direct microscopy, histopathology, and identification of the fungus by culture. However, to be appropriately used, these techniques require mycological expertise that is not widely available and may be absent in peripheral health care facilities in endemic areas. In addition, they lack sensitivity and specificity, and the culture for isolation and identification can have a long time-to-results period. Molecular methods, including matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), have been developed in well-equipped reference laboratories. They greatly improve the rapidity and accuracy of diagnosis; in particular, for species identification. Recently, PCR and sequencing have paved the way for more user-friendly point-of-care tests, such as those based on LAMP or RCA technologies, which can be used in basic healthcare settings and even in field consultations.
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Affiliation(s)
- Danièle Maubon
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
| | - Cécile Garnaud
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
| | | | | | - Muriel Cornet
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
- Correspondence:
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Legabão BC, Fernandes JA, de Oliveira Barbosa GF, Bonfim-Mendonça PS, Svidzinski TI. The zoonosis sporotrichosis can be successfully treated by photodynamic therapy: A scoping review. Acta Trop 2022; 228:106341. [PMID: 35131203 DOI: 10.1016/j.actatropica.2022.106341] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/20/2022]
Abstract
Sporotrichosis is a worldwide zoonosis, prevalent in tropical and subtropical regions. In recent years, there has been a substantial increase in human and feline cases reported in Brazil. Despite this, the antifungal treatment for sporotrichosis is still limited, and thus, research into new therapeutic modalities must be encouraged. Recently, photodynamic therapy has been introduced as a treatment for sporotrichosis. This work presents an overview of both in vitro and in vivo studies that have used photodynamic therapy in the context of photoinactivation of Sporothrix species. Until now, as far as the authors are aware, this is the first scope review specifically on photodynamic therapy for the treatment of sporotrichosis. A systematic electronic search was conducted in two databases: Web of Science and PubMed. Seven original articles published from 2010 to July 2021 were selected, six of which met the proposed inclusion and exclusion criteria and were considered in this scoping review. Concerning the photoinactivation of Sporothrix spp. the results have been promising as studies, in both animals and humans, have reported significant clinical and mycological effects. The most used photosensitizers were methylene blue and its derivatives, and aminolevulinic acid and its methyl derivative, methyl aminolevulinic acid. In conclusion, photodynamic therapy has great potential in treatment of sporotrichosis, as its fungicidal effect both in vitro and in vivo has clearly been demonstrated. Photodynamic therapy could be used in conjunction with classic antifungal agents to optimize treatment outcomes.
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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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Schechtman RC, Falcão EMM, Carard M, García MSC, Mercado DS, Hay RJ. Sporotrichosis: hyperendemic by zoonotic transmission, with atypical presentations, hypersensitivity reactions and greater severity. An Bras Dermatol 2022; 97:1-13. [PMID: 34893422 PMCID: PMC8799859 DOI: 10.1016/j.abd.2021.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/23/2021] [Accepted: 07/13/2021] [Indexed: 11/01/2022] Open
Abstract
In recent decades, an alarming increase in the number of sporotrichosis cases has been reported in southern and southeastern Brazil, especially in the state of Rio de Janeiro, has been considered a long-term hyperendemic condition associated with feline transmission. According to phenotypic classifications, the Sporothrix species recovered from cats were classified as S. brasiliensis in 96.5% of the studied cases. This finding has also been demonstrated in humans, which confirms the zoonotic transmission associated with this predominant species in Brazil. The zoonotic transmission of the fungus and its important virulence in the context of the hyperendemic situation in Rio de Janeiro have changed the approach to the disease, which in its classic form was restricted to certain professional groups and very specific regions in the Brazilian territory, into a public health challenge of scientific interest. Its atypical manifestations and hypersensitivity reactions are increasingly frequent, constituting a new sporotrichosis aspect, which deserves attention from the medical community, as well as from other health professionals.
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Affiliation(s)
- Regina Casz Schechtman
- Instituto de Dermatologia Professor Rubem David Azulay, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | - Marciela Carard
- Instituto de Dermatologia Professor Rubem David Azulay, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Maria Salomé Cajas García
- Instituto de Dermatologia Professor Rubem David Azulay, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diana Stohmann Mercado
- Instituto de Dermatologia Professor Rubem David Azulay, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Roderick James Hay
- International Foundation of Dermatology, University of London, London, UK
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Silva FS, Cunha SC, Moraes VA, Leite JS, Ferreira AM. Refractory feline sporotrichosis: a comparative analysis on the clinical, histopathological, and cytopathological aspects. PESQUISA VETERINÁRIA BRASILEIRA 2022. [DOI: 10.1590/1678-5150-pvb-6923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT: Sporotrichosis is a chronic fungal infection caused by Sporothrix species. The occurrence of cases that are resistant to long-term treatment, especially in the nasal planum of cats, emphasizes the importance of studying its pathogenesis. The purpose of this study was to analyze and compare the inflammatory process of cutaneous lesions of feline refractory sporotrichosis to clinical aspects through cytopathological and histopathological examination. Moreover, the study included 13 cats with cutaneous lesions that had been resistant to itraconazole treatment for more than a year. Cutaneous lesions samples were collected for cytopathological, histopathological, and fungal culture analyses. Tissue fragments were processed and stained with hematoxylin-eosin (HE) and Grocott methenamine silver (GMS). Further, two clinical presentations had the highest occurrence: the localized cutaneous form in animals with good general condition and stable disease (n=9, 69.2%) and the disseminated cutaneous form in cats with poor general condition (n=4, 30.8%). In cats with refractory sporotrichosis, the nasal planum (84.6%) was the most common location of lesions. In the cytopathological study, cats with fewer than two lesions and in good general condition (n=9, 69.2%) showed absence or mild yeast intensity (up to 5 yeasts per field), lower intensity of macrophages and neutrophils, and higher intensity of epithelioid cells, lymphocytes, plasma cells, and eosinophils. On the other hand, (n=4, 30.8%) of the cats with disseminated sporotrichosis and a poor general condition had a marked intensity of yeasts, which were mostly phagocytosed by an increased number of macrophages and neutrophils. Of those animals with good general condition, the majority (n=6, 66.7%) had higher eosinophil intensity. In histopathology, malformed suppurative granuloma was the predominant type (n=9, 69.2%) in feline sporotrichosis lesions, followed by well-formed granulomas (n=4, 30.8%). Malformed granulomas showed mild to moderate fungal intensity (55.6%) in animals with good general condition and localized lesions while marked fungal intensity (44.4%) in cats with the disseminated form of the disease and poor general condition. Well-formed granulomas (n=4, 30.7%) had mild to moderate intensity of fungal load, and 75% of the animals with this type of granuloma had only one lesion and were in good general condition. Long-term itraconazole treatment in these cats with refractory sporotrichosis can keep the infection under control and localized lesions stable; however, fungus reactivation can occur, resulting in an exuberant and inefficient immune response.
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Brandolt TM, Klafke GB, Ramos DF, Halicki PCB, Vicenti JRDM, Pereira WA, Poester VR, Sanchotene KO, Xavier MO. In vitro susceptibility of Sporothrix spp. to complexes coordinated with Co(II) and cobalt chloride hexahydrate. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Della Terra PP, Gonsales FF, de Carvalho JA, Hagen F, Kano R, Bonifaz A, Camargo ZPD, Rodrigues AM. Development and evaluation of a multiplex qPCR assay for rapid diagnostics of emerging sporotrichosis. Transbound Emerg Dis 2021; 69:e704-e716. [PMID: 34687495 DOI: 10.1111/tbed.14350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/03/2021] [Accepted: 10/04/2021] [Indexed: 01/19/2023]
Abstract
Sporothrix schenckii and related species are the agents of human and animal sporotrichosis. Routine diagnoses using classical mycological approaches are unspecific due to overlapping phenotypes. As the frequency and prevalence of sporotrichosis increases worldwide, developing specific, sensitive and cost-effective diagnostic tools is essential to understand the distribution patterns, map-affected areas and promote specific public health strategies to mitigate future outbreaks. Polymorphisms among the β-tubulin gene were exploited to speciate S. brasiliensis, S. schenckii and S. globosa in a one-tube multiplex probe-based qPCR assay. A panel of 84 Sporothrix revealed 100% specificity (AUC = 1.000, 95% CI = 0.971-1.000, p < .0001) without cross-reacting with other medically relevant fungi, human, feline or murine DNA. Speciation via multiplex qPCR matched phylogenetic identification (Kappa = 1.0; 95% CI = 1.0-1.0; very good agreement), supporting its use as a reliable alternative to DNA sequencing. Remarkably, the lower limit of detection was 3 copies of the target for all species. As a proof of concept, we used swabs of wound exudate of 70 cats suspected of sporotrichosis to reveal an overwhelming occurrence of S. brasiliensis in 69 specimens (sensitivity = 98.57%; 95%CI: 92.3-100.0 and specificity = 100%; 95% CI = 78.2-100). In comparison to culture, qPCR showed a larger area under the curve (AUC = 0.993±0.007; 95% CI = 0.944-1.000; p < .0001; Youden's index = 0.9857), supporting that qPCR is an essential tool for accurately detect Sporothrix DNA directly from clinical samples, thus accelerating the diagnosis of sporotrichosis. Moreover, our multiplex qPCR system has the potential to increase diagnostic capacity in Sporothrix-affected areas, helping the local animal health agent or veterinarian to quickly identify and isolate new cases, which will likely benefit thousands of patients infected every year worldwide.
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Affiliation(s)
- Paula Portella Della Terra
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Jamile Ambrósio de Carvalho
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, Shandong, People's Republic of China
| | - Rui Kano
- Department of Veterinary Dermatology, Nihon University College of Bioresource Sciences, Fujisawa, Kanagawa, Japan
| | - Alexandro Bonifaz
- Dermatology Service, Mycology Department, Hospital General de México, Mexico City, Mexico
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Martínez-Herrera E, Arenas R, Hernández-Castro R, Frías-De-León MG, Rodríguez-Cerdeira C. Uncommon Clinical Presentations of Sporotrichosis: A Two-Case Report. Pathogens 2021; 10:pathogens10101249. [PMID: 34684198 PMCID: PMC8541424 DOI: 10.3390/pathogens10101249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 01/19/2023] Open
Abstract
Sporotrichosis is a subcutaneous endemic mycosis caused by species of the Sporothrix schenckii complex. The most common clinical form of the disease is lymphocutaneous, while the fixed cutaneous and disseminated cutaneous forms are rare. Moreover, it is more prevalent in immunocompetent individuals. In this study, we present two cases of sporotrichosis with uncommon clinical forms: fixed cutaneous (Case 1) and disseminated cutaneous (Case 2). Both cases were diagnosed in immunocompetent males from endemic regions in Mexico, who had at least 1 year of evolution without improvement in response to prior nonspecific treatments. The diagnosis of sporotrichosis caused by S. schenckii sensu stricto was established through the isolation of the pathogen and its identification through the amplification of a 331 bp fragment of the gene encoding calmodulin. In both cases, improvement was observed after treatment with potassium iodide. Cases 1 and 2 illustrate the rarity of these clinical forms in individuals residing in endemic areas; hence, it is important to ensure a high index of clinical suspicion for the diagnosis of mycosis, as the differential diagnoses vary widely.
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Affiliation(s)
- Erick Martínez-Herrera
- Research Unit, Regional Hospital of High Specialty of Ixtapaluca, Ixtapaluca 56530, Mexico; (E.M.-H.); (M.G.F.-D.-L.)
- Postgraduate Studies and Research Section, Higher School of Medicine, National Polytechnic Institute, Mexico City 11340, Mexico
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain;
| | - Roberto Arenas
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain;
- Department of Mycology, General Hospital “Dr. Manuel Gea González”, Mexico City 14080, Mexico
| | - Rigoberto Hernández-Castro
- Department of Ecology of Pathogens, General Hospital “Dr. Manuel Gea González”, Mexico City 14080, Mexico;
| | - María Guadalupe Frías-De-León
- Research Unit, Regional Hospital of High Specialty of Ixtapaluca, Ixtapaluca 56530, Mexico; (E.M.-H.); (M.G.F.-D.-L.)
| | - Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain;
- Department of Dermatology, Hospital Vithas Ntra. Sra. de Fátima and University of Vigo, 36206 Vigo, Spain
- Campus of Vigo, University of Vigo, 36310 Vigo, Spain
- Correspondence: ; Tel.: +34-600-536-114
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de Carvalho J, Beale M, Hagen F, Fisher M, Kano R, Bonifaz A, Toriello C, Negroni R, Rego RDM, Gremião I, Pereira S, de Camargo Z, Rodrigues A. Trends in the molecular epidemiology and population genetics of emerging Sporothrix species. Stud Mycol 2021; 100:100129. [PMID: 35027980 PMCID: PMC8693333 DOI: 10.1016/j.simyco.2021.100129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Sporothrix (Ophiostomatales) comprises species that are pathogenic to humans and other mammals as well as environmental fungi. Developments in molecular phylogeny have changed our perceptions about the epidemiology, host-association, and virulence of Sporothrix. The classical agent of sporotrichosis, Sporothrix schenckii, now comprises several species nested in a clinical clade with S. brasiliensis, S. globosa, and S. luriei. To gain a more precise view of outbreaks dynamics, structure, and origin of genetic variation within and among populations of Sporothrix, we applied three sets of discriminatory AFLP markers (#3 EcoRI-GA/MseI-TT, #5 EcoRI-GA/MseI-AG, and #6 EcoRI-TA/MseI-AA) and mating-type analysis to a large collection of human, animal and environmental isolates spanning the major endemic areas. A total of 451 polymorphic loci were amplified in vitro from 188 samples, and revealed high polymorphism information content (PIC = 0.1765-0.2253), marker index (MI = 0.0001-0.0002), effective multiplex ratio (E = 15.1720-23.5591), resolving power (Rp = 26.1075-40.2795), discriminating power (D = 0.9766-0.9879), expected heterozygosity (H = 0.1957-0.2588), and mean heterozygosity (Havp = 0.000007-0.000009), demonstrating the effectiveness of AFLP markers to speciate Sporothrix. Analysis using the program structure indicated three genetic clusters matching S. brasiliensis (population 1), S. schenckii (population 2), and S. globosa (population 3), with the presence of patterns of admixture amongst all populations. AMOVA revealed highly structured clusters (PhiPT = 0.458-0.484, P < 0.0001), with roughly equivalent genetic variability within (46-48 %) and between (52-54 %) populations. Heterothallism was the exclusive mating strategy, and the distributions of MAT1-1 or MAT1-2 idiomorphs were not significantly skewed (1:1 ratio) for S. schenckii (χ2 = 2.522; P = 0.1122), supporting random mating. In contrast, skewed distributions were found for S. globosa (χ2 = 9.529; P = 0.0020) with a predominance of MAT1-1 isolates, and regional differences were highlighted for S. brasiliensis with the overwhelming occurrence of MAT1-2 in Rio de Janeiro (χ2 = 14.222; P = 0.0002) and Pernambuco (χ2 = 7.364; P = 0.0067), in comparison to a higher prevalence of MAT1-1 in the Rio Grande do Sul (χ2 = 7.364; P = 0.0067). Epidemiological trends reveal the geographic expansion of cat-transmitted sporotrichosis due to S. brasiliensis via founder effect. These data support Rio de Janeiro as the centre of origin that has led to the spread of this disease to other regions in Brazil. Our ability to reconstruct the source, spread, and evolution of the ongoing outbreaks from molecular data provides high-quality information for decision-making aimed at mitigating the progression of the disease. Other uses include surveillance, rapid diagnosis, case connectivity, and guiding access to appropriate antifungal treatment.
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Affiliation(s)
- J.A. de Carvalho
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
| | - M.A. Beale
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK
| | - F. Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584CT, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
- Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, Shandong, People's Republic of China
| | - M.C. Fisher
- MRC Center for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - R. Kano
- Department of Veterinary Dermatology, Nihon University College of Bioresource Sciences, Fujisawa, Kanagawa, Japan
| | - A. Bonifaz
- Dermatology Service, Mycology Department, Hospital General de México, "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - C. Toriello
- Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico City, Mexico
| | - R. Negroni
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires City, Buenos Aires, Argentina
| | - R.S. de M. Rego
- Mycology Division, Associate Pathologists of Pernambuco, Recife, Brazil
| | - I.D.F. Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - S.A. Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Z.P. de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
| | - A.M. Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, 04023062, Brazil
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The spread of cat-transmitted sporotrichosis due to Sporothrix brasiliensis in Brazil towards the Northeast region. PLoS Negl Trop Dis 2021; 15:e0009693. [PMID: 34460830 PMCID: PMC8432896 DOI: 10.1371/journal.pntd.0009693] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/10/2021] [Accepted: 07/30/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sporotrichosis is a worldwide subcutaneous mycosis caused by Sporothrix spp. In the past, this infection was associated with armadillo hunting, horticulturists, miners, and gardeners, being considered an implantation mycosis acquired by plant debris injury. Nevertheless, since the late nineties, it has been considered a zoonotic disease in Brazil. Here we report a case series of 121 patients with cat-transmitted sporotrichosis seen in Northeast Brazil. METHODOLOGY/PRINCIPAL FINDINGS Patient's demographic, clinical data, and length of treatment were recorded. In addition, a mycological examination and further PCR confirmation of species identification were performed. One hundred and twenty two patients were diagnosed with subcutaneous sporotrichosis from October 2016 to December 2019, while PCR revealed that 71 of them were due to S. brasiliensis. The majority of the individuals were female (n = 86; 70.5%). Patient's age ranged from 5 to 87 years old. The clinical forms found were lymphocutaneous (58.2%) and fixed cutaneous (39.4%). Interestingly, 115 patients reported previous contact with cats diagnosed with sporotrichosis. Patients were successfully treated with itraconazole and potassium iodide. CONCLUSIONS/SIGNIFICANCE Our study adds important contributions for the investigation of the spread of cat-transmitted subcutaneous sporotrichosis in Brazil, specifically towards the Northeast region of a continental-size country. It will also help clinicians to be aware of the existence and importance to accurately diagnose sporotrichosis and treat patients with this infectious disease in the lowest income region of Brazil.
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Procópio-Azevedo AC, Rabello VBS, Muniz MM, Figueiredo-Carvalho MHG, Almeida-Paes R, Zancopé-Oliveira RM, Silva JCAL, de Macedo PM, Valle ACF, Gutierrez-Galhardo MC, Freitas DFS. Hypersensitivity reactions in sporotrichosis: A retrospective cohort of 325 patients from a reference hospital in Rio de Janeiro, Brazil (2005-2018). Br J Dermatol 2021; 185:1272-1274. [PMID: 34258756 DOI: 10.1111/bjd.20646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022]
Abstract
Sporotrichosis is a worldwide subcutaneous mycosis caused by thermally dimorphic fungi of the genus Sporothrix. Since 1998, it emerged in Rio de Janeiro (RJ), Brazil with a zoonotic profile, extending to neighboring states and countries. Nowadays, it is considered a Neglected Tropical Disease by the World Health Organization. The Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ) is the main reference for its diagnosis and treatment.
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Affiliation(s)
- A C Procópio-Azevedo
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - V B S Rabello
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - M M Muniz
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - M H G Figueiredo-Carvalho
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - R Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - R M Zancopé-Oliveira
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - J C A L Silva
- Coordenação de Pesquisa, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - P M de Macedo
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - A C F Valle
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - M C Gutierrez-Galhardo
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
| | - D F S Freitas
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz) - Avenida Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP- 21045-900, Brasil
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Abstract
Various uncommon fungal pathogens have been increasingly identified as causes of disseminated and invasive fungal disease (IFD) worldwide. Growing recognition and clinical knowledge of these emerging fungal pathogens has occurred through improved molecular diagnostics, nucleic sequence databases, and taxonomic reclassification of medically significant fungi. However, emerging fungal diseases carry significant morbidity and mortality and, due to a paucity of published literature, the collective clinical experience with these fungi is often limited. In this review, we focus on unusual emerging fungal pathogens not extensively covered elsewhere in this issue of Infectious Diseases Clinics of North America.
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Ramírez-Oliveros JF, Casz Schechtman R, de Vries HJ, Lora L, Cardoso Arinelli A, da Costa Nery JA, Saraiva Freitas DF. Ocular adnexal sporotrichosis: A case series. JAAD Case Rep 2021; 13:52-56. [PMID: 34150968 PMCID: PMC8190125 DOI: 10.1016/j.jdcr.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Joaquín Felipe Ramírez-Oliveros
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay (IDPRDA), Santa Casa da Misericórdia do Rio de Janeiro-Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Regina Casz Schechtman
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay (IDPRDA), Santa Casa da Misericórdia do Rio de Janeiro-Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Henry John de Vries
- Department of Dermatology, Amsterdam UMC & Amsterdam Infection and Immunity Institute (AI&II), Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Leonardo Lora
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay (IDPRDA), Santa Casa da Misericórdia do Rio de Janeiro-Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Cardoso Arinelli
- Laboratory of Clinical Research in Infectious Ophthalmology, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - José Augusto da Costa Nery
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay (IDPRDA), Santa Casa da Misericórdia do Rio de Janeiro-Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Dayvison Francis Saraiva Freitas
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Laboratory of Clinical Research in Infectious Dermatology, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Antifungal activity of Acylhydrazone derivatives against Sporothrix spp. Antimicrob Agents Chemother 2021; 65:AAC.02593-20. [PMID: 33593845 PMCID: PMC8092869 DOI: 10.1128/aac.02593-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Sporotrichosis is an emerging mycosis caused by members of the genus Sporothrix The disease affects humans and animals, particularly cats, which plays an important role in the zoonotic transmission. Feline sporotrichosis treatment options include itraconazole (ITC), potassium iodide and amphotericin B, drugs usually associated with deleterious adverse reactions and refractoriness in cats, especially when using ITC. Thus, affordable, non-toxic and clinically effective anti-Sporothrix agents are needed. Recently, acylhydrazones (AH), molecules targeting vesicular transport and cell cycle progression, exhibited a potent antifungal activity against several fungal species and displayed low toxicity when compared to the current drugs. In this work, the AH derivatives D13 and SB-AF-1002 were tested against Sporothrix schenckii and Sporothrix brasiliensis Minimal inhibitory concentrations of 0.12 - 1 μg/mL were observed for both species in vitro D13 and SB-AF-1002 showed an additive effect with itraconazole. Treatment with D13 promoted yeast disruption with release of intracellular components, as confirmed by transmission electron microscopy of S. brasiliensis exposed to the AH derivatives. AH-treated cells displayed thickening of the cell wall, discontinuity of the cell membrane and an intense cytoplasmic degeneration. In a murine model of sporotrichosis, treatment with AH derivatives was more efficient than ITC, the drug of choice for sporotrichosis. The results of the preliminary clinical study in cats indicate that D13 is safe and has potential to become a therapeutic option for sporotrichosis when associated to ITC. Our results expand the antifungal broadness of AH derivatives and suggest that these drugs could be exploited to combat sporotrichosis.
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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: 14] [Impact Index Per Article: 4.7] [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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Toriello C, Brunner-Mendoza C, Ruiz-Baca E, Duarte-Escalante E, Pérez-Mejía A, Del Rocío Reyes-Montes M. Sporotrichosis in Mexico. Braz J Microbiol 2021; 52:49-62. [PMID: 33125684 PMCID: PMC7966611 DOI: 10.1007/s42770-020-00387-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 10/16/2020] [Indexed: 01/19/2023] Open
Abstract
Sporotrichosis is an endemic mycosis caused by the species of the Sporothrix genus, and it is considered one of the most frequent subcutaneous mycoses in Mexico. This mycosis has become a relevant fungal infection in the last two decades. Today, much is known of its epidemiology and distribution, and its taxonomy has undergone revisions. New clinical species have been identified and classified through molecular tools, and they now include Sporothrix schenckii sensu stricto, Sporothrix brasiliensis, Sporothrix globosa, and Sporothrix luriei. In this article, we present a systematic review of sporotrichosis in Mexico that analyzes its epidemiology, geographic distribution, and diagnosis. The results show that the most common clinical presentation of sporotrichosis in Mexico is the lymphocutaneous form, with a higher incidence in the 0-15 age range, mainly in males, and for which trauma with plants is the most frequent source of infection. In Mexico, the laboratory diagnosis of sporotrichosis is mainly carried out using conventional methods, but in recent years, several researchers have used molecular methods to identify the Sporothrix species. The treatment of choice depends mainly on the clinical form of the disease, the host's immunological status, and the species of Sporothrix involved. Despite the significance of this mycosis in Mexico, public information about sporotrichosis is scarce, and it is not considered reportable according to Mexico's epidemiological national system, the "Sistema Nacional de Vigilancia Epidemiológica." Due to the lack of data in Mexico regarding the epidemiology of this disease, we present a systematic review of sporotrichosis in Mexico, between 1914 and 2019, that analyzes its epidemiology, geographic distribution, and diagnosis.
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Affiliation(s)
- Conchita Toriello
- Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico City, Mexico.
| | - Carolina Brunner-Mendoza
- Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico City, Mexico
| | - Estela Ruiz-Baca
- Facultad de Ciencias Químicas, Universidad Juárez del Estado de Durango, Av. Veterinaria S/N, 34120, Durango, Mexico
| | - Esperanza Duarte-Escalante
- Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico City, Mexico
| | - Amelia Pérez-Mejía
- Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico City, Mexico
| | - María Del Rocío Reyes-Montes
- Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), 04510, Mexico City, Mexico
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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: 54] [Impact Index Per Article: 18.0] [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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