Fig 2 - uploaded by Ar Kar Aung
Content may be subject to copyright.
Case 2: (A) Chest X-ray showing emphysematous changes in right lung with fi brocavitary disease in left upper lobe. (B) High resolution CT confi rmation of chest X-ray fi ndings with large thick-walled left apical cavity. Med Mycol Downloaded from informahealthcare.com by University of Western Australia on 06/26/13
Source publication
Pulmonary infections by Sporothrix spp. manifest radiologically as cavitary or non-cavitary disease depending on whether the infection is primary pulmonary or multifocal sporotrichosis. Despite current guidelines, the optimal management for pulmonary sporotrichosis remains unclear. In order to clarify this, we present two cases of pulmonary sporotr...
Contexts in source publication
Context 1
... 60-year-old man with severe emphysema (FEV1/FVC of 27.4%) presented in respiratory failure with three days of productive cough. He had a 40 pack/year smoking his- tory and recent hospitalization for myocardial infarction. Chest X-ray ( Fig. 2A) on admission showed left apical pleural scarring with a large, thick walled cavity in the upper lobe. High-resolution chest CT (Fig. 2B) confi rmed bullous emphysema and infl ammatory changes in the cav- ity. A course of intravenous antibiotics, bronchodilators and steroids initially improved his clinical situation. Mul- tiple ...
Context 2
... emphysema (FEV1/FVC of 27.4%) presented in respiratory failure with three days of productive cough. He had a 40 pack/year smoking his- tory and recent hospitalization for myocardial infarction. Chest X-ray ( Fig. 2A) on admission showed left apical pleural scarring with a large, thick walled cavity in the upper lobe. High-resolution chest CT (Fig. 2B) confi rmed bullous emphysema and infl ammatory changes in the cav- ity. A course of intravenous antibiotics, bronchodilators and steroids initially improved his clinical situation. Mul- tiple cultures sputum culturers subsequently yielded S. schenckii and the patient was started on long-term itra- conazole, 200 mg twice daily. ...
Similar publications
Sporotrichosis is a polymorphic disease of humans and animals, which is acquired via traumatic inoculation of Sporothrix propagules into cutaneous or subcutaneous tissue. The etiological agents are in a clinical complex, which includes Sporothrix brasiliensis, Sporothrix schenckii, Sporothrix globosa, and Sporothrix luriei, each of which has specif...
Citations
... Remarkably, the isolation of S. schenckii s.l. from pleural fluid, as reported by Ordoñez et al. [30], suggests pulmonary involvement, as reported in other case series [45][46][47], and in agreement with the clinical findings of our report. This mode of dissemination typically occurs through hematogenous or lymphatic routes originating from the primary lesion. ...
... It is often observed in immunocompromised individuals or those with predisposing risk factors. This manifestation affects both lungs, leading to diffuse reticulonodular parenchymal infiltrates or consolidations that may be diffuse or concentrated in the lower lung lobes [46,48]. ...
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.
... highest number of case reports in Brazil, and represents a zoonotic transmission disease [8][9][10][11]. The clinical manifestations of sporotrichosis are characterized by the appearance of lesions in the cutaneous or subcutaneous tissues [4,12] and are classified as cutaneous-localized, cutaneouslymphatic, disseminated, and extracutaneous forms [13][14][15]. The clinical form of sporotrichosis and severity of the symptoms are directly related to the individual's immune status, microbial load, depth of the affected tissue, and virulence factors of the inoculated strain [13][14][15][16][17][18]. ...
... The clinical manifestations of sporotrichosis are characterized by the appearance of lesions in the cutaneous or subcutaneous tissues [4,12] and are classified as cutaneous-localized, cutaneouslymphatic, disseminated, and extracutaneous forms [13][14][15]. The clinical form of sporotrichosis and severity of the symptoms are directly related to the individual's immune status, microbial load, depth of the affected tissue, and virulence factors of the inoculated strain [13][14][15][16][17][18]. This study aimed to collect, identify, and characterize clinical isolates of Sporothrix spp., from humans and cats, from the metropolitan region of Belo Horizonte, Minas Gerais, Brazil. ...
Sporotrichosis’ clinical manifestations, lesions in the cutaneous or subcutaneous tissues, it is caused by dimorphic fungi of the Sporothrix complex, is a cosmopolitan mycosis that affects humans and animals. This study aimed to identify prevalent species in Minas Gerais, Brazil, and characterize virulence profiles and antifungal susceptibility associated with Sporothrix isolates. Isolates were identified using macro and micro-morphological traits as well molecular biology techniques. Antifungal susceptibility was determined using the Minimal Inhibitory Concentration test, while, virulence factors such as growth at different temperatures, biofilm formation, melanin production, and urease activity were assessed. Our findings revealed S. brasiliensis as a predominant species isolated. Urease activity was a crucial factor associated with growth at 50°C in S. brasiliensis isolates, highlighting their high thermotolerance. Furthermore, strains isolated from humans produced a more robust biofilm compare to those from felines. Strains of S. brasiliensis isolated from Felis catus exhibited faster melanin production, decreased susceptible to antifungal agents tested, and superior growth capacity at 50°C to strains isolated from humans. Therefore, our study highlights the prevalence of S. brasiliensis causing sporotrichosis in both human and felines. However, it underscores the circulation of different strains, with varying levels of virulence and susceptibility to antifungal agents.
... 5 Although less common, inhaling the conidia from the environment may cause primary pulmonary sporotrichosis. [6][7][8] The classical manifestations of sporotrichosis are chronic skin and subcutaneous infection, leading to fixed cutaneous or lymphocutaneous infection. 9 However, some patients can present with disseminated cutaneous and extracutaneous forms. ...
... Fever, weight loss and dyspnea have been reported in patients with SF of sporotrichosis. 6 Although nonspecific, when these TA B L E 2 HIV-patients: clinical features, viral load, CD4 + T cell count and outcome. ...
... Several studies report that alcoholics are more likely to develop severe inflammatory and infectious lung diseases, including bacterial pneumonia and systemic fungal infections. 8,10,35-37 A systematic review of 86 pulmonary cases of sporotrichosis showed that alcohol consumption was present in 39.5% of the patients.6 On the other hand, Fichman et al. found that 78.6% of patients using alcohol in ...
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.
... When primary, it may be limited to the lung, as in chronic obstructive pulmonary disease (COPD), or spread from the lungs, which is common in immunosuppressed patients. 56 In these cases, it is difficult to identify whether the dissemination occurred from that organ or from the skin. The history of trauma preceding the clinical picture can help to define the probable route of spread. ...
... Multifocal pulmonary ---it occurs in an immunosuppressed patient with sporotrichosis in other organs, in which the lesions are not normally cavitated. 56 Immunosuppression due to chronic alcoholism and cavitated pulmonary lesions has been reported in a patient with disseminated sporotrichosis. 57 Cavitated lesions confound the diagnosis of pulmonary tuberculosis, contributing to the underdiagnosis of pulmonary sporotrichosis, particularly in endemic regions. ...
... Most authors recommend a 6---12 month duration. 2,56,112,113 9) Surgical intervention is recommended for patients with localized lung involvement and/or those with radiological features of cavity disease.56,112 Superior results are obtained with early surgery in combination with amphotericin B when compared to using drugs only.56,113,114 ...
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.
... First, the disease is commonly caused by traumatic inoculation into the skin by soil and plant material (e.g., spines or thorns) harboring fungal cells; the second form involves a bite or scratch most commonly from a mammal (e.g., cats or dog) but in some cases by birds (Barros et al., 2011;Orofino-Costa et al., 2017). Other less common forms of transmission include inhalation of conidia and mucosal infection by aerosols containing Sporothrix cells (Arinelli et al., 2019;Aung et al., 2013). All Sporothrix spp. ...
Feline-transmitted sporotrichosis has garnered attention due to the recent high incidence and the lack of efficient control in the epicenter of the epidemic, Rio de Janeiro, Brazil. Sporothrix brasiliensis is the major pathogen involved in feline-to-human sporotrichosis in Brazil and displays more virulent genotypes than the closely related species S. schenckii. Over the last two decades, several reports of antifungal-resistant strains have emerged. Sequencing and comparison analysis of the outbreak strains allowed us to observe that the azole non-wild-type S. brasiliensis strain CFP 1054 had significant chromosomal variations compared to wild-type strains. One of these variants includes a region of 231 Kb containing 75 duplicated genes, which were overrepresented for lipid and isoprenoid metabolism. We also identified an additional strain (CFP 1055) that was resistant to itraconazole and amphotericin B, which had a single nucleotide polymorphism in the tac1 gene. The patients infected with these two strains showed protracted clinical course and sequelae. Even though our sample size is modest, these results suggest the possibility of identifying specific point mutations and large chromosomal duplications potentially associated with antifungal resistance and clinical outcomes of sporotrichosis.
... Subsequent nodular lymphangitic spread is a common development (75-90%) [22]. Pulmonary sporotrichosis presumably results from inhalation of the fungus and has been rarely reported [23,24]. The infection may also be hematogenously disseminated and involves the bones, joints, skin, eyes, central nervous system, and/or genitourinary tract [25,26]. ...
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.
... Pulmonary sporotrichosis is a rare manifestation, presenting with two clinical patterns: primary pulmonary sporotrichosis (PPS), a unifocal disease resulting from direct fungal inhalation, and multifocal sporotrichosis, when the fungus is acquired by direct inhalation of conidia with subsequent dissemination or, more commonly, by hematogenous or lymphatic spread from a distal site due to immunosuppression. While patients with PPS tend to have underlying respiratory conditions (mainly chronic obstructive pulmonary disease (COPD)), those with the multifocal form are mostly immunosuppressed [9]. The respiratory clinical presentation is nonspecific, similar to that of tuberculosis (TB) and endemic systemic mycoses. ...
... In two cases (Cases 1 and 2), the most likely transmission route was conidial inhalation. Both patients were male, smokers, and had COPD, fitting the risk profile previously reported, in which PPS most often presents in males with structurally abnormal lungs [9]. The radiological pattern that presents with cavitary disease is also described as typical of PPS [9,34]. ...
... Both patients were male, smokers, and had COPD, fitting the risk profile previously reported, in which PPS most often presents in males with structurally abnormal lungs [9]. The radiological pattern that presents with cavitary disease is also described as typical of PPS [9,34]. Case 2 also had osteoarticular involvement, and the fungus may have spread from the lungs to the bones by hematogenous dissemination because the patient experienced no previous cutaneous trauma history or skin lesions. ...
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.
... Cytological analysis and culture of the induced sputum reveal the pathogen in most cases. 38 Sporotrichosis with CNS involvement is extremely rare, associated in most cases with immunosuppression. Cerebrospinal fluid (CSF) examination shows pleocytosis, hyperproteinorrhachia, and hypoglycorrhachia. ...
... Lobectomy can be considered in pulmonary sporotrichosis, segmental cases, or in those unresponsive to treatment. 38 The combination of surgical resection and amphotericin B in these cases is considered the best therapeutic approach and is superior to the use of these measures alone. 64 Cryosurgery with liquid nitrogen can be used as a therapeutic complement in refractory cases of the fixed form of sporotrichosis or the cutaneous lymphatic form. ...
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.
... 18 Pulmonary involvement seems to be more common, there are several related cases, and it was suggested that the infection occurred through inhalation of the fungal conidia as well, usually in immunocompromised patients. 21,22 What would make the fungus establishes a sinus or pulmonary infection is not known. ...
Sporotrichosis is usually a subcutaneous infection caused by thermodimorphic fungi of the genus Sporothrix . The disease occurs worldwide, but endemic areas are located in tropical and subtropical regions. The epidemiology of sporotrichosis in Brazil is peculiar because of the cat’s entry in the chain of transmission of this mycosis, associated with Sporothrix brasiliensis , the most virulent species in the genus. Sporothrix species sinusitis is unusual and may be underdiagnosed or confused with other fungal etiologies, like mucormycosis. We report a case of sinusitis due to a Sporothrix species in a 6-year renal transplant recipient. Direct examination of smears of exudate of the sinus specimen (aspirate, biopsy) revealed budding yeasts and cigar-shaped cells. Sporothrix was subsequently recovered from the patient’s exudate culture and identified as S. brasiliensis using species-specific polymerase chain reaction, and she was successfully treated with antifungal therapy. Her parents also developed the disease a week later, both only cutaneous involvement. Sporotrichosis sinusitis is a rare disease, even in immunocompromised patients. Diagnosis is crucial, and benefits from good epidemiological history.
... This form may be accompanied by general malaise, weight loss, a cough with abundant expectoration, hemoptysis, dyspnea, and fatigue. Radiologic findings may include adenopathy and mediastinal widening (Aung et al., 2013;Comstock and Wolson, 1975). ...
... Endemic pulmonary mycosis, chronic aspergillosis tuberculosis and other mycobacteriosis, bacterial and viral pneumonia (Aung et al., 2013). ...
Sporotrichosis is a neglected fungal infection and the most prevalent of the implantation or subcutaneous mycoses. This disease is globally distributed, with higher incidence in tropical and subtropical regions. It is a subacute to chronic suppurative and granulomatous disease caused by thermally dimorphic fungi of the genus Sporothrix, particularly Sporothrix schenckii, S. globosa and S. brasiliensis. Sporotrichosis is typically associated with agricultural activities, but zoonotic transmission is become increasingly common due to an extended outbreak of cat-transmitted infections caused by S. brasiliensis in Brazil. These infections are spreading to other South American countries and can infect humans, cats, and dogs. Most of the human patients present cutaneous or lymphocutaneous clinical forms, but severe clinical pictures with extracutaneous involvement have also been reported, especially in immunocompromised hosts. Like other pathogenic fungi, the primary virulence factors of Sporothrix spp. include thermotolerance, cell wall components, proteins, ergosterol production, melanin synthesis, and biofilm formation. Unlike other endemic mycoses, fungal culture is the most sensitive diagnostic method, since direct mycologic and histopathologic exams have low sensitivity in most populations, except for immunocompromised patients and sick cats. Although some immunodiagnostic tests have been validated, they are not commercially available. Slight differences among the in vitro sensitivity of some Sporothrix species have been demonstrated, but this does not impact in vivo therapy. Itraconazole is currently the therapy of choice for human and feline sporotrichosis, but terbinafine is an alternative therapeutic option. For the most severe clinical forms, amphotericin B should be used. To prevent sporotrichosis, the use of personal protective equipment to avoid traumatic implantation is recommended, since there is no vaccine to prevent this mycosis.
