Ocular Manifestations of Sporotrichosis in a Hyperendemic Region in Brazil: Description of a Series of 120 Cases.

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.

Ocular Sporotrichosis: 26 Cases with Bulbar Involvement in a Hyperendemic Area of Zoonotic Transmission.

PURPOSE: To describe 26 cases of bulbar conjunctival sporotrichosis. METHODS: Review of clinical records of patients with bulbar conjunctivitis due to culture-proven Sporothrix spp. infection, in Rio de Janeiro, from 2007 to 2017. RESULTS: Twenty-six patients were identified. Median age was 25 years. Adults were more affected (53.8%), followed by adolescents (26.9%). There was a predominance of women (73.1%). Twenty-four patients (96%) reported contact with cats with sporotrichosis. Twenty-one patients (80.8%) presented a primary ocular sporotrichosis. Five patients presented associated eyelid lesions, and 21 (80.8%) tarsal conjunctivitis. Parinaud oculoglandular syndrome was observed in 17 (81%) patients. Eight patients (36.4%) reported the use of steroid drops before diagnosis was made. All patients but one were treated with oral itraconazole. Twenty-three patients (88.5%) were completely cured and three (11.5%) were lost to follow-up. Eight patients (34.8%) developed ocular sequelae. CONCLUSION: Bulbar conjunctivitis is an important clinical presentation of ocular sporotrichosis. It can lead to ocular sequelae. Sporotrichosis should be considered in the differential diagnosis of ophthalmic external diseases, especially in patients with cat contact history.

Ocular sporotrichosis: A frequently misdiagnosed cause of granulomatous conjunctivitis in epidemic areas.

PURPOSE: Sporotrichosis is a subcutaneous mycosis caused by Sporothrix sp., a dimorphic fungus. Although the cutaneous form is the most frequent form, the ocular presentation has been increasingly diagnosed in epidemic areas. We describe three cases of ocular sporotrichosis with the involvement of the ocular adnexa due to autoinoculation without trauma with successful antifungal treatment. OBSERVATIONS: Patient 1: A 68-year-old woman presented with granulomatous conjunctivitis of the right eye with an ulcerated nodule on the right temporal region for 5 months. Patient 2: A 46-year-old woman with conjunctival hyperemia of the left eye with associated periorbital edema and erythema for the past 4 months was referred to the Dermatology Department due to an ulcerated nodule on the left malar region. Patient 3: A 14-year-old boy presented to the emergency department with inferior palpebral edema with a 5-day evolution. Specimens were obtained from the lesions of the three patients, and the cultures were positive for Sporothrix sp. The three cases were diagnosed as ocular sporotrichosis and were successfully treated with itraconazole (200-400 mg/d). Two of the three patients developed sequelae such as conjunctival fibrosis and symblepharon. CONCLUSIONS AND IMPORTANCE: We emphasize the importance of the ophthalmologist being familiar with the diagnosis and management of this rare and frequently misdiagnosed form of sporotrichosis.

Esporotricose ocular: avaliação dos casos atendidos no Laboratório de Pesquisa Clínica em Oftalmologia Infecciosa, no período de 2007 a 2017

A esporotricose é uma micose subcutânea causada por fungos dimórficos do gênero Sporothrix. A região metropolitana do Rio de Janeiro é hiperendêmica para esporotricose zoonótica transmitida por gatos desde 1998. Esporotricose ocular é raramente descrita em pacientes imunocompetentes ou em indivíduos sem trauma ocular. Este estudo teve como objetivo analisar o perfil epidemiológico, clínico, micológico e terapêutico dos pacientes com esporotricose ocular atendidos no ambulatório do Laboratório de Pesquisa Clínica em Oftalmologia Infecciosa do INIFiocruz, entre 2007 e 2017. Para isso, foram revisados os registros em prontuário dos pacientes com diagnóstico confirmado por isolamento do fungo em cultivo a partir de espécime ocular. Foram encontrados 120 casos, correspondendo a 3,3% (120/3590) dos casos de esporotricose no período estudado. Mulheres foram as mais acometidas (61,7%) e a idade variou de 3 a 86 anos (mediana de 24 anos). As principais faixas etárias acometidas foram adultos (50,8%) e crianças até 11 anos (25,8%). A forma ocular isolada foi mais frequente (75,8%). Esporotricose cutânea fixa foi a mais comumente associada (48,3%), e reação de hipersensibilidade foi observada em 10% dos pacientes. O acometimento ocular foi unilateral em 98,3% dos casos, e a manifestação mais frequente foi a conjuntivite granulomatosa (86,7%), com 84,6% dos casos afetando a conjuntiva tarsal, e 25% a bulbar. Houve maior frequência de comorbidades nos casos de conjuntivite bulbar (45,5%), que é uma forma mais grave da esporotricose ocular. A lesão palpebral foi a segunda mais frequente (25%), principalmente na pálpebra inferior (66,7%). A dacriocistite representou 7,5% dos casos, predominando em crianças (55,6%). Adenomegalia satélite foi encontrada em 73,4% dos pacientes, principalmente associada com conjuntivite granulomatosa (síndrome oculoglandular de Parinaud) (66%). A maioria dos pacientes recebeu tratamento prévio ao atendimento no INI-Fiocruz, mas em somente 27% dos casos o tratamento específico foi instituído, demonstrando a dificuldade da abordagem da esporotricose ocular no Rio de Janeiro. A maioria dos pacientes foi tratada com itraconazol (95,8%), e todos os pacientes tratados curaram. Sequelas foram observadas em 23 pacientes (22,5%), a maioria com indicação de cirurgia. As principais foram dacriocistite crônica (7,8%); alterações corneanas (4,9%); simbléfaro (2,9%); fibrose conjuntival (2,9%) e fístula (2,9%). A conjuntivite bulbar evoluiu com mais sequelas (34,8%) do que a tarsal (16,4%). Dacriocistite evoluiu para dacriocistite crônica e a formação de fístulas em 88,9 e 33,3% dos casos, respectivamente. Desse estudo pode-se concluir que a esporotricose ocular vem se apresentado como forma característica da transmissão zoonótica, com alta morbidade. Deve ser considerada no diagnóstico diferencial em áreas endêmicas. O retardo do início do tratamento específico provavelmente aumenta o risco de evolução para formas mais graves da doença e do desenvolvimento de sequelas oculares.