Leukocytoclastic Vasculitis Caused by Disseminated Cutaneous Sporotrichosis: A Case Report and Review of the Literature.

ABSTRACT: Cutaneous leukocytoclastic vasculitis (CLV) is a vasculitis that involves mainly small blood vessels in the skin. CLV has different causes (drugs, infections, or neoplastic or systemic inflammatory diseases). Sporotrichosis has rarely been associated with CLV. We report a case of disseminated cutaneous sporotrichosis caused by microorganisms in the Sporothrix clade in a Chinese woman with a tuberculous peritonitis history. Her lesions included many ulcers with crusts on the limbs. A skin biopsy yielded a histologic diagnosis of leukocytoclastic vasculitis. Periodic acid-Schiff and Grocott methenamine silver stains revealed numerous round-to-oval, thick-walled yeast cells in the necrotic tissue of the dermis. Mycological cultures grew pure dark brown wrinkled and villous fungus colonies morphologically and microscopic characteristics suggestive of the pathogenic Sporothrix clade which was followed confirmed as Sporothrix globosa (S. globosa) by the PCR method and sequencing based on calmodulin gene. Although infrequently, Sporothrix clade may cause CLV and should be considered in its differential diagnosis.

Sporotrichosis in Rio de Janeiro, Brazil: Sporothrix brasiliensis is associated with atypical clinical presentations.

BACKGROUND: There have been several recent changes in the taxonomy of Sporothrix schenckii as well as new observations regarding the clinical aspects of sporotrichosis. In this study, we determined the identification of the Sporothrix species associated with both classic and unusual clinical aspects of sporotrichosis observed in the endemic area of sporotrichosis in Rio de Janeiro, Brazil. METHODOLOGY/PRINCIPAL FINDINGS: To verify whether S. brasiliensis is associated with clinical manifestations of sporotrichosis, a cross-sectional study was performed in which Sporothrix isolates from 50 patients with different clinical manifestations were analyzed and their isolates were studied by phenotypic and genotypic methods. Data from these patients revealed a distinct clinical picture and therapeutic response in infections caused by Sporothrix brasiliensis (n = 45) compared to patients with S. schenckii sensu stricto (n = 5). S. brasiliensis was associated with disseminated cutaneous infection without underlying disease, hypersensitivity reactions, and mucosal infection, whereas patients with S. schenckii presented with less severe and more often localized disease, similar to the majority of previously described sporotrichosis cases. Interestingly, S. brasiliensis-infected patients overall required shorter durations of itraconazole (median 16 weeks) compared to the individuals with S. schenckii (median 24 weeks). CONCLUSIONS/SIGNIFICANCE: These findings suggest that Sporothrix species are linked to different clinical manifestations of sporotrichosis and that S. brasiliensis is effectively treated with oral itraconazole.

Alterações hematológicas em felinos com esporotricose cutânea / Hematological alterations of cats with cutaneous sporotrichosis / Alterações hematológicas en felinos con esporotricosis cutânea

A esporotricose é a micose subcutânea de maior ocorrência em pequenos animais, especialmente felinos e caninos. Esta doença causa lesões cutâneas ulceradas de caráter subagudo ou crônico que podem resultar no comprometimento do estado geral do animal. Este estudo avaliou alterações hematológicas em gatos com esporotricose relacionando-as com a forma clínica da doença. As alterações hematológicas foram observadas em 73,3% dos animais, sendo caracterizadas principalmente por leucocitose por neutrofilia e anemia. Os resultados demonstram que animais com a forma cutânea fixa da micose não apresentam alterações no hemograma, enquanto animais com a forma cutânea disseminada desenvolvem importantes alterações que indicam o agravamento do quadro clínico com possibilidade de evolução da micose para uma forma sistêmica.

Sporotrichosis is the most frequent subcutaneous mycosis of small animals, specially cats and dogs. This disease leads toof the mycosis do not present alterations in the blood count. However, animals with the cutaneous disseminated form develop important alterations that can aggravate the disease and evolve the mycosis to a systemic form.

La esporotricosis es la micosis subcutánea de mayor ocurrencia en pequeños animales, específicamente felinos y caninos. Esta enfermedad produce lesiones cutáneas ulceradas de carácter sub agudo o crónico que pueden resultar en el comprometimiento del estado general del animal. Este estudio evalúo alteraciones hematológicas en gatos con esporotricosis, relacionándolas con la forma clínica de la enfermedad. Se ha observado alteraciones hematológicas en 73,3% de los animales, siendo caracterizadas principalmente por leucocitosis por neutrofilia y anemia. Los resultados demuestran que animales con la forma cutánea fija de la micosis no presentan alteraciones en el hemograma, mientras que los animales con la forma cutánea diseminada desarrollan importantes alteraciones que indican el comprometimiento del cuadro clínico con posibilidad de evolución de la micosis para una forma sistémica.

Taenia taeniaeformis in rat favors protracted skin lesions caused by Sporothrix schenckii infection: Dectin-1 and IL-17 are dispensable for clearance of this fungus.

We occasionally found that cestode Taenia taeniaeformis in rats favored Sporothrix schenckii infection and survival, causing protracted cutaneous lesions. In this study, we compared the pathology and cytokines profile of rats co-infected with the two pathogens and infected with S. schenckii alone to explore underlying mechanisms. In the co-infection group, there was high expression of ß-glucan receptor Dectin-1 in the cutaneous lesions and no multinucleated giant cells, but in the S. schenckii infection group the opposite was observed. Cytokines profiles demonstrated an expected finding that IL-4, commonly expressed in helminth and fungus infection, is undetectable in the two infection groups. In the single fungal infection group, cytokines IFN-γ, IL-10 and IL-17 kept increasing in the first few weeks of infection to a peak which was followed by gradual decrease. This study showed that Dectin-1 and IL-17, which were believed to be the major anti-fungus mechanisms, are Th2 independent and dispensable for clearance of S. schenckii infection, suggesting that S. schenckii has a different molecular recognition pattern and evokes anti-infection mechanisms other than Dectin-1 and IL-17.

Positive Montenegro skin test among patients with sporotrichosis in Rio De Janeiro.

We studied 52 patients with sporotrichosis confirmed by isolation of Sporothrix schenckii and reactivity to the Montenegro skin test (MST) during an ongoing outbreak of this mycosis in Rio de Janeiro. The objective was to emphasize the importance of parasitological confirmation and the possibility of incorrect diagnosis based on the lesion's appearance, epidemiological information, and immunological tests. The antigen used for the MST was conserved in either thimerosal 1:10,000 (group 1) or 0.4% phenol (group 2). Nineteen patients (39%) in group 1 and seven (12%) in group 2 presented an induration>or=10 mm (p<0.001). Sera from three patients (6.7%) reacted to indirect immunofluorescence (IIF) for leishmaniasis, while sera from 10 patients (22.2%) reacted to enzyme-linked immunosorbent assay (ELISA). Fifteen patients (28.8%) presented up to two lesions, with a predominance of ulcers. Forty-four patients (84.6%) were treated with itraconazole. In the differential diagnosis between sporotrichosis and cutaneous leishmaniasis, the possibility of co-infection, allergy to the reagent diluent, and cross-reactions should be further investigated, especially in regions with limited laboratory facilities.

Uveíte anterior granulomatosa causada por Sporothrix schenckii / Granulomatous anterior uveites caused by Sporothrix schenckii

Os autores relatam o caso de uma paciente de 12 anos, com uveíte anterior granulomatosa portadora de esporotricase e ocular concomitantes. O caso é comparado com os achados da literatura e é chamada atençäo para a necessidade de se iniciar o tratamento específico precocemente.

Isolamento de Sporotrhix schenckii no humor aquoso de uma paciente com uveíte anterior granulomatosa - parte II / S. schenckii isolation from the aqueous humor in a case of anterior uveites

Os autores relatam o isolamento de Sporothrix schenckii no humor aquoso de uma paciente de 12 anos, portadora de esporotricase cutânea e extracutânea sistêemico. A dificuldade de tratamento dessa forma de apresentaçäo da micose é discutida e comparada com a literatura, apesar dos dados serem escassos.