Geographic Expansion of Sporotrichosis, Brazil.

Brazil has experienced geographic expansion of zoonotic sporotrichosis. Social problems in the country contribute substantially to the expansion. A comprehensive sporotrichosis control program is beyond the sphere of public health. A One Health approach is needed to control the disease in animals and humans.

Sporotrichosis: When Uncommon Etiology Makes a Treatable Disease Nearly Fatal.

Sporotrichosis is typically seen as a cutaneous infection, resulting from inoculation of the fungus, Sporothrix schenckii. This fungus is typically found on the thorns of rose bushes in lush, humid environments, and the pathogen enters the body via breaches in the skin barrier.

Sporotrichosis on the face of a 7-year-old boy following a bicycle accident.

A 7-year-old boy presented with an annular verrucous plaque on the chin of 5 weeks duration. The lesion occurred after a bicycle accident and was unresponsive to antibiotics. Fungal culture grew Sporothrix schenckii. Sporotrichosis should be considered and fungal culture obtained whenever a nodule or plaque fails to respond to initial treatment.

Sporotrichosis (Sporothrix schenckii infection) in the New South Wales mid-north coast, 2000-2010.

OBJECTIVE: To determine the geographical, epidemiological and clinical features of sporotrichosis (a cutaneous fungal infection caused by Sporothrix schenckii) in the New South Wales mid-north coast. DESIGN AND SETTING: We undertook a retrospective case review of S. schenckii infections that occurred during the period 2000-2010. Microbiology laboratory staff and medical practitioners in the NSW mid-north coast were contacted to identify cases through database searches and clinical data collection. RESULTS: Thirty-one cases of S. schenckii infection were identified. Twenty-one occurred in males, the mean age of patients was 59 years, and all cases with data available involved cutaneous disease affecting the limbs (multiple lesions in 18 of 20 cases). Despite an impression of temporal clustering (eight cases in 1 year), this was not statistically significant (P = 0.3). Most cases occurred in months with higher rainfall (13 of 14 cases with data available). Inoculating events included injuries in gardens, in bushland and on farms, and possible bites. Symptom duration before correct diagnosis ranged from 4 to 30 weeks (median, 8 weeks; data available for 15 cases), unnecessary antibacterial therapy was common (13 of 19 cases with data available), and morbidity occurred in the form of recurrence (three cases) and mild itraconazole-induced hepatotoxicity (two cases). In all cases with recorded treatment details, the patients received itraconazole, and the median duration of itraconazole treatment was 24 weeks. CONCLUSIONS: These data highlight that health providers on the NSW mid-north coast should consider sporotrichosis when patients present with characteristic lesions after an inoculating injury sustained from or contaminated by decaying vegetation. The risk may be higher in older people and in wetter months. Fungal culture to confirm the diagnosis needs to be specifically requested. In contrast to outbreaks reported from other states, the epidemiological pattern in NSW appears most consistent with sporadic occurrence in an endemic setting.

Evolution of virulence-related phenotypes of Sporothrix brasiliensis isolates from patients with chronic sporotrichosis and acquired immunodeficiency syndrome.

Sporotrichosis in immunocompromised patients has a high morbidity and may cause deaths. Particularly, patients with acquired immunodeficiency syndrome (AIDS) with low T CD4 counts develop a chronic disease, with severe and widespread forms. Recently, the ability of Sporothrix brasiliensis, the main agent of zoonotic sporotrichosis, to increase its virulence in a diabetic patient without HIV infection was described. Since it was a unique finding, it is not known how often this occurs in patients with chronic and refractory sporotrichosis. The aim of this study is to compare sequential Sporothrix isolates obtained from patients with sporotrichosis and AIDS in order to detect changes in virulence-related phenotypes and acquisition of antifungal resistance during the evolution of the disease. Fungal growth in different substrates, antifungal susceptibility, thermotolerance, resistance to oxidative stress, and production of hydrolytic enzymes were evaluated. Correlations were assessed between clinical and phenotypic variables. Sixteen isolates, all identified as S. brasiliensis, obtained from five patients were studied. They grew well on glucose and N-acetyl-D-glucosamine, but poorly on lactate. Except from isolates collected from two patients, which were non-wild type for terbinafine, they were considered wild type for the antifungal drugs tested. Thermotolerance of the isolates was moderate to high. Except for phytase and phospholipase, isolates were able to produce virulence-related enzymes on different levels. Changes in all studied phenotypes were observed during the course of the disease in some patients. The results show that the HIV-driven immunosuppression is more relevant than fungal phenotypes on the unfavorable outcomes of disseminated sporotrichosis.

The clinico-epidemiological characteristics and therapeutic experience of 152 patients with cutaneous sporotrichosis: a 10-year retrospective study from India.

BACKGROUND: Cutaneous sporotrichosis, a subcutaneous mycosis because of Sporothrix schenckii, is sporadic worldwide with local hyperendemic pockets. OBJECTIVES: To study clinico-epidemiological and therapeutic aspects of sporotrichosis in our clinic. METHODS: We retrospectively analyzed medical records of 152 (M:F 52:100) patients with cutaneous sporotrichosis managed during 2010-2019. RESULTS: All patients were involved in agricultural activities, and 63.2% were aged 21-60 years. Women outnumbered men by nearly two times. Fixed and lymphocutaneous sporotrichosis occurred in 54.6% and 43.4% patients, respectively. Only 2% of patients had multifocal sporotrichosis. Only 48% of patients imputed their disease to prior injuries. Extremities, upper in 53.9% and lower in 21% of patients, were mostly involved. Scrotum involvement in one patient was unusual. A mixed inflammatory infiltrate in 38.7%, chronic granuloma formation in 35%, and presence of spores in 48.9% biopsies was noted. S. schenckii grew on Sabouraud's dextrose agar in 40.2% of cases. Treatment with saturated solution of potassium iodide was curative in 76.8% patients, and lesions healed in 2-9 months (average 5.2 months). Metallic taste was experienced by 42.9% of patients. Itraconazole therapy was safe and effective in seven patients, and the response was better when combined with SSKI compared to either drug used alone. CONCLUSION: Cutaneous sporotrichosis mostly affects persons during active years of life. The injuries predisposing to infection are mostly forgotten. Both fixed and lymphocutaneous sporotrichosis involving extremities remain common forms. SSKI alone or in combination with itraconazole is safe and effective treatment. Itraconazole is preferable in patients having preexisting hypothyroidism or intolerance to SSKI.

[Simultaneous bilateral lymphangitic sporotrichosis]. / Esporotricosis linfangítica bilateral y simultánea.

BACKGROUND: Sporotrichosis is the most frequent subcutaneous mycoses in Jalisco, Mexico. The forms of transmission described in the literature are from bites of different animals and injuries due to utensils. AIMS: To present an unusual case with bilateral and lymphangitic cutaneous lesions in the upper limbs caused by a pocket gopher bite (Geomys bursarius). METHODS: Mycology studies were performed on the arm lesions, including Gram and Ziehl Neelsen stains, direct exam, Sabouraud and mycobiotic cultures at temperatures of 25-28 degrees C. RESULTS: Gram and Ziehl Neelsen stains were negative. Sporothrix schenckii grew in the culture plates. Treatment with saturated potassium iodide solution was prescribed and four months later complete remissions of the lesions were achieved, and the control cultures were negative. CONCLUSIONS: The most common clinical presentations of sporotrichosis are the fixed and lymphangitic forms. Bilateral lymphangitic sporotrichosis is rare.

[Isolation of Sporothrix schenckii from environmental samples in Venezuela]. / Aislamiento de Sporothrix schenckii del medio ambiente en Venezuela.

The dimorphic fungus Sporothrix schenckii is the etiological agent of sporotrichosis, a subcutaneous mycosis frequently found in Latin America. The isolation of this fungus from the environment and other sources has been widely reported. Nevertheless, to our knowledge this fungus has not been isolated from the endemic areas of Venezuela. In studies related to a clinical case of sporotrichosis in "Colonia Tovar", produced by traumatism after manipulating soil samples, the fungus was isolated from the soil of that particular area. This is the first report of the isolation of S. schenckii from environmental sources in an endemic area of Venezuela.

Sporotrichosis in Iran.

This report describes a 23 year-old male florist gardener diagnosed with subcutaneous sporotrichosis caused by the dimorphic pathogenic soil fungus Sporothrix schenckii. The patient had several small skin lesions over the left upper arm with ascendant chains of enlarged lymph nodes.Sporothrix schenckii was detected from clinical samples by direct microscopy and culture and its ability to switch from mould to yeast form at 37 degrees C. The patient was successfully treated with long-term potassium iodide and advised to wear gloves and long sleeves when handling any kind of plant material.

Extracutaneous sporotrichosis in a patient with liver cirrhosis.

We report an unusual case of disseminated cutaneous sporotrichosis with oral mucous and tracheal involvement in a forty-year-old male with a history of heavy drinking and liver cirrhosis. We also review the literature and other similar published cases.

Cutaneous and meningeal sporotrichosis in a HIV patient.

A male patient with HIV and past history of tuberculosis and suspected neurotoxoplasmosis was admitted to the hospital with vomiting and small nodules through all his body. Few of the nodules were found forming chains of enlarged lymphatic vessels, especially on lesions located on the limbs. Some of the nodules were ulcerated with a serosanguineous discharge. Collected samples from ulcerated and the nodular lesions showed the presence of Sporothrix schenckii in culture. Although all hemocultures were negative, a spinal fluid collected from this patient and cultures from the cutaneous lesions were both positive for S. schenckii. The patient showed improvement after treatment with Amphotericin B. Sadly, he later died of complications not related to the S. schenckii infection. This case of disseminated sporotrichosis is a remainder that in patients with immunological disorders exotic forms of this fungal clinical entity could be expected.

MULTIFOCAL CHOROIDITIS IN DISSEMINATED SPOROTRICHOSIS IN PATIENTS WITH HIV/AIDS.

PURPOSE: In this article, the authors describe multifocal choroiditis related to disseminated sporotrichosis in patients with HIV/AIDS. METHODS: We conducted a retrospective observational study of three patients infected with HIV who presented with disseminated sporotrichosis characterized by cutaneous lesions, multifocal choroiditis, and other manifestations, including osteomyelitis and involvement of the bone marrow, larynx, pharynx, and nasal and oral mucosa. RESULTS: Five eyes of three patients with HIV/AIDS showed multifocal choroiditis related to disseminated sporotrichosis. The CD4 counts ranged from 25 to 53 mm. All patients were asymptomatic visually. The ocular disease was bilateral in two patients. The lesion size ranged from 1/3 to 2 disc diameters. None of the patients had vitritis. Of the 12 lesions, 9 were localized in the posterior pole (Zone 1) and 3 were localized in the mild periphery (Zone 2). CONCLUSION: Multifocal choroiditis due to disseminated sporotrichosis can occur in profoundly immunosuppressed patients with HIV/AIDS.

Sporotrichosis: an update on epidemiology, etiopathogenesis, laboratory and clinical therapeutics.

In the late 90's there was a change in both the route of transmission and the people at risk for sporotrichosis. This zoonotic cat-man alternative transmission route elicited changes in strategies to control the epidemic. There was a progressive increase in the number of cases involving especially children and the elderly. In addition to becoming hyperendemic, uncommon clinical pictures like immunoreactive clinical presentations or severe systemic cases have emerged. New species were identified and classified through molecular tools using more virulent clinical isolates, like S. brasiliensis, compared to the environmental isolates. Likewise, different species of Sporothrix have been associated with different geographic regions. The serological and molecular techniques are used as an auxiliary tool for the diagnosis and/or for species identification, although the isolation and the identification of Sporothrix spp. in clinical specimen is still the gold standard. Currently sporotrichosis epidemics requires the knowledge of the epidemiological-molecular profile to control the disease and the specific treatment. Itraconazole, potassium iodide, terfinafine, and amphotericin B are the available drugs in Brazil to treat sporotrichosis. The drug of choice, its posology, and treatment duration vary according to the clinical presentation, the Sporothrix species, and host immune status. New treatment choices, including a vaccine, are being developed; nevertheless, more clinical trials are required to confirm its efficacy.

Fatal sporotrichosis.

Disseminated sporotrichosis is a serious fungal infection caused by the soil inhabitant Sporothrix schenckii. It is seen in immunocompromised patients, with a substantial number of recent cases involving patients with acquired immunodeficiency syndrome (AIDS). However, individuals with other conditions that affect the immune system also are at increased risk. We report a case of fatal disseminated sporotrichosis in a patient with liver disease and a diagnosis of a granulomatous condition presumed to be sarcoidosis; the patient was receiving systemic corticosteroid therapy. The various presentations of S schenckii infection, the risk of disseminated disease in immunocompromised hosts, and the importance of making accurate histologic diagnoses are reviewed.

[Dermatological zoonosis by fungi in Japan].

Dermatophytosis, cryptococcosis and sporotrichosis are dermatological zoonosis caused by fungi. Control of dermatophytosis is still difficult, although it is well known as a transmittable disease from animal to human. Exotic animals such as hamster, guinea pig and rabbit, some imported from foreign countries, have become a frequent source of human dermatophytosis, and the emergence of fungal pathogens followed. The nasal cavity of dogs and cats is an important reservoir of pathogens of cryptococcosis, in addition to bird droppings. Though there have been many reports of human sporotrichosis caused by patients' pet, especially cats in Europe and U.S., since there has been no report of zoonotic transmission of sporotrichosis, zoonosis is not believed do be present in Japan. The interrelation and cooperation of medical and veterinary doctors and all other scientists involved is therefore required to prevent fungal zoonosis, because the condition may be partly due to changes in the environments of human and animal life and the more intimate relationships between humans and animals.