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Sporotrichosis is an infection caused by a dimorphic fungus of the Sporothrix schenckii complex. Host immunity is an important factor in the clinical manifestations of the disease. Deeply immunocompromised individuals, especially those infected with the Human Immunodeficiency Virus (HIV) and T CD4 counts < 350 cells/ul lymphocytes, may present with...
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Sporotrichosis is a human and animal disease caused by species of the Sporothrix schenckii complex. It is classically acquired through traumatic inoculation of fungal elements. Most frequently, sporotrichosis presents as a fixed cutaneous or as a lymphocutaneous form. A much smaller number of cases occur as cutaneous disseminated and disseminated f...
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 di...
Background
Pregnant women with sporotrichosis should not receive systemic antifungal therapy except in severe cases when amphotericin B is recommended. Thermotherapy is the most reported treatment described in this group of patients. It entails weeks of daily self-application of heat to the lesions, requires that the patient faithfully apply it, an...
Sporotrichosis is a fungal infection caused by the Sporothrix species, which have distinct virulence profiles and geographic distributions. We performed a phylogenetic study in strains morphologically identified as Sporothrix schenckii from clinical specimens in Japan, which were preserved at the Medical Mycology Research Center, Chiba University....
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 specim...
Citations
... 4 It is an endemic disease in the state of Rio de Janeiro (RJ), Brazil, where the species Sporothrix brasiliensis predominates, and correlated with atypical clinical presentations of the disease. 5 The gold standard for the diagnosis of SP is the isolation and identification of Sporothrix sp. 6 In RJ, the main clinical differential diagnosis of CL is SP, particularly with ulcerated or verrucous fixed skin forms. ...
Introduction:
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.
... Sporotrichosis has a high prevalence of zoonotic transmission, especially via cats [1], a pertinent risk factor in this case. Another case of CNS involvement of sporotrichosis began with a cat scratch which led to an ulcerated lesion on the patient's hand [8]. The fungus was found in the patient's cerebrospinal fluid (CSF) and she developed hydrocephalus resulting in headache, nystagmus, and confusion [8]. ...
... Another case of CNS involvement of sporotrichosis began with a cat scratch which led to an ulcerated lesion on the patient's hand [8]. The fungus was found in the patient's cerebrospinal fluid (CSF) and she developed hydrocephalus resulting in headache, nystagmus, and confusion [8]. In this case (Table 1), the CSF culture grew S. brasiliensis, an especially virulent species of Sporothrix found in Brazil. ...
... While our patient had CSF cytology performed, it did not raise suspicion for infection and CSF bacterial cultures, not fungal cultures, were initially performed on the available CSF specimen. In the case reported by Paixão et al., the patient's CSF was cultured using Sabouraud, Mycosel, and BHI-Agar [8]. If we had cultured our patient's CSF to look for fungal growth, a diagnosis may have been made sooner. ...
Background
Disseminated sporotrichosis is a severe opportunistic infection that often affects immunocompromised patients after a cutaneous inoculation. Here we present a rare case of disseminated sporotrichosis discovered as a solitary intramedullary thoracic spinal cord lesion in an immunocompetent patient.
Case description
A 37-year-old man presented with progressive lower limb weakness and sensory changes over 1 week. A spinal magnetic resonance imaging (MRI) revealed a contrast-enhancing intramedullary lesion centered at T10. The patient was afebrile and reported no history of trauma or cutaneous lesions. The lesion was unresponsive to a trial of corticosteroids. A thoracic laminectomy was performed and a biopsy obtained. A cutaneous lesion on the arm was concurrently discovered, which was also biopsied. Both the skin and spinal cord biopsies showed Sporothrix schenckii by macroscopic and microscopic morphology which were later confirmed by MALDI-TOF mass spectrometry.
Conclusion
This is a rare case of intramedullary disseminated sporotrichosis affecting the central nervous system of an immunocompetent patient. This unusual presentation should be taken into consideration when such intramedullary lesions are encountered.
... Likewise, as reported by Moreira et al., the largest number of cases were reported in Brazil, with a predominance of males [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. This could be interpreted in two ways: firstly, that the largest number of HIV cases are from males, as reported by the epidemiological services of Brazil, and other affected countries, such as the US and South Africa [36-38]; and secondly, as mentioned above, that Brazil is a hyperendemic country for sporotrichosis due to the extensive zoonotic transmission in that area (cats) [9,10]. ...
... Nevertheless, this can be understood, as mucous membranes can be affected after hematogenous dissemination, which is very common in patients with immunosuppression caused by HIV [39]. It is important to mention that even when CNS ECDs are recurrent cases in PLHIV, in several of the reported cases, it was impossible to isolate the pathogen, or in its case, to perform molecular identification of the type of sporotrichosis due to the low burden that the patients had [21,35]. ...
Background:
Sporotrichosis is a fungal infection that can affect both humans and animals, caused by a species of thermo-dimorphic fungi of the genus Sporothrix. This pathology can be acquired by subcutaneous traumatic inoculation through contact with contaminated plants, soil or decomposing organic matter, and/or by inhalation of conidia. The infection can progress to chronic skin infection, or it can even spread to blood vessels, lymph, muscles, bones, and other organs, such as the lungs and nervous system. Those disseminated types are usually associated with cellular immunodeficiency and infection by inhalation, which explains why people living with human immunodeficiency virus (PLHIV) get infected in such a manner. This virus changes the natural history of sporotrichosis, producing a greater fungal load.
Methods:
The search was carried out in three databases: Pubmed, Scopus, and Scielo. Eligible articles were considered as those that described sporotrichosis in patients infected with HIV-AIDS, as well as case series.
Results:
A total of 24 articles were selected, with a sum of 37 patients with sporotrichosis and HIV infection. Of these patients, 31 came from Brazil, two from the United States, one from South Africa, one from Bangladesh, and two from an unspecified region. Regarding epidemiology, a predominance of the male sex was found in 28 of the 37 cases (75.6%), while nine were female (24.3%).
Conclusions:
Sporotrichosis infection continues to present in a more severe and disseminated way among HIV-positive subjects with lower CD4+ counts.
... Fluconazole and voriconazole exhibit minimal activity to most strains. Posaconazole has shown good in vitro activity again Sporothrix sp. and success has been reported in refractory cases of disseminated disease [85]. ...
Purpose of Review
This review summarizes our current understanding of the medical and surgical management of fungal osteoarticular infections (FOAI). These infections are uncommon, heterogenous, and often severe; management is often highly dependent on expert opinion with a dearth of high-quality evidence.
Recent Findings
FOAI can be broadly categorized into three groups: native infections with endemic fungi, hematogenous infections among patients with underlying immunodeficiency, and complications of orthopedic surgery. Management of this diverse set of infections relies on careful coordination with orthopedic surgery, and attention to the patient’s overall medical and orthopedic prognosis. Extended courses of antifungal therapy are generally used, although shorter courses may be reasonable when surgical extirpation of infection is complete, and finite antifungal therapy is usually unsuccessful when infected hardware is not resected.
Summary
Future advances in management of FOAI may emerge as more is learned about eradicating biofilm-embedded persister cells, as the roles of depot and topical antifungal agents are further elucidated, and as effective therapeutic drug monitoring is developed for these uncommon, but devastating, conditions.
... While other systemic mycoses usually have a good response to AMB [16,17], severe sporotrichosis has many cases of unsatisfactory response [7], especially when the central nervous system is affected, which is a site of difficult sterilization in patients with sporotrichosis [18]. For this reason, we evaluated possible synergisms of AMB with two antifungal drugs. ...
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.
... One possible explanation is that meningitis increases the permeability of the blood-brain barrier, contributing to the drug's major effect. In the present cohort, in one patient with persistent fungal CSF isolation despite AMB, posaconazole resulted in a better clinical response and clearing of the fungus in the CSF [36]. Since then, it has been used in nearly all severe sporotrichosis cases at INI-FIOCRUZ. ...
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.
... 50 Disseminated skin lesions may represent the only manifestation of hematogenous spread or be associated with the involvement of other organs, when they may be related to more severe conditions of immunosuppression, particularly HIV-induced cases. 51,52 They present with varied morphology, usually ulcerated, suppurative lesions, without odor or significant inflammatory reaction, which differentiates them from a secondary bacterial condition. Because they are suppurative, they +Model Anais Brasileiros de Dermatologia xxxx;xxx(xx):xxx---xxx are often covered by crusts, consisting of solidified pus and blood on the surface. ...
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.
... Os principais fatores de risco para esporotricose em imunodeprimidos incluem a infecção pelo HIV, alcoolismo, diabetes, uso de corticosteroides e de imunobiológicos, entre outros. Pessoas vivendo com HIV, com baixos níveis de CD4+ e alta carga viral, apresentam com maior frequência lesões cutâneas disseminadas, meningoencefalite, pneumonia, endoftalmite e fungemia, além de 30% de taxa de mortalidade (FREITAS et al., 2014(FREITAS et al., , 2015PAIXÃO et al., 2015). ...
Estratégias de vigilância, prevenção e controle dos acidentes ofídicos, escorpiônicos, araneídicos e por lagartas
... Sporothrix species undergo a thermodimorphic transition, facilitating the establishment of infection. The pathogen can be found in the environment at room temperature (25)(26)(27)(28) • C) in the filamentous form and as a yeast when infecting the warm-blooded host (36-37 • C) [17][18][19]. The infection can occur through two main routes: the classical or sapronotic and the alternative or animal route. ...
... The infection may also be hematogenously disseminated and involves the bones, joints, skin, eyes, central nervous system, and/or genitourinary tract [25,26]. However, pulmonary sporotrichosis and hematogenous dissemination are rarely seen in the immunocompetent host but are usually linked to immunosuppression [26][27][28][29]. Animal sporotrichosis has been reported in diverse warm-blooded hosts such as armadillos, camels, cats, cows, dogs, dolphins, mice, etc. [20,[30][31][32][33]. ...
Sporotrichosis is the most important subcutaneous mycosis that affects humans and animals worldwide. The mycosis is caused after a traumatic inoculation of fungal propagules into the host and may follow an animal or environmental transmission route. The main culprits of sporotrichosis are thermodimorphic Sporothrix species embedded in a clinical clade, including S. brasiliensis, S. schenckii, S. globosa, and S. luriei. Although sporotrichosis occurs worldwide, the etiological agents are not evenly distributed, as exemplified by ongoing outbreaks in Brazil and China, caused by S. brasiliensis and S. globosa, respectively. The gold standard for diagnosing sporotrichosis has been the isolation of the fungus in vitro. However, with the advance in molecular techniques, molecular assays have complemented and gradually replaced the classical mycological tests to quickly and accurately detect and/or differentiate molecular siblings in Sporothrix. Nearly all techniques available for molecular diagnosis of sporotrichosis involve PCR amplification, which is currently moving towards detecting Sporothrix DNA directly from clinical samples in multiplex qPCR assays. From an epidemiological perspective, genotyping is key to tracing back sources of Sporothrix infections, detecting diversity in outbreak areas, and thus uncovering finer-scale epidemiological patterns. Over the past decades, molecular epidemiological studies have provided essential information to policymakers regarding outbreak management. From high-to-low throughput genotyping methods, MLSA, AFLP, SSR, RAPD, PCR-RFLP, and WGS are available to assess the transmission dynamics and sporotrichosis expansion. This review discusses the trends in the molecular diagnosis of sporotrichosis, genotyping techniques applied in molecular epidemiological studies, and perspectives for the near future.
... Os principais fatores de risco para esporotricose em imunodeprimidos incluem a infecção pelo HIV, alcoolismo, diabetes, uso de corticosteroides e de imunobiológicos, entre outros. Pessoas vivendo com HIV, com baixos níveis de CD4+ e alta carga viral, apresentam com maior frequência lesões cutâneas disseminadas, meningoencefalite, pneumonia, endoftalmite e fungemia, além de 30% de taxa de mortalidade (FREITAS et al., 2014(FREITAS et al., , 2015PAIXÃO et al., 2015). ...
